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  • 301.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Sjöström, Björn
    Department of Health Care Pedagogics, Göteborg University and Department of Health Sciences, University of Skövde, Skövde, Sweden.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Quality indicators in postoperative pain management: a validation study2001In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 15, no 4, p. 331-338Article in journal (Refereed)
    Abstract [en]

    In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care.

  • 302.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hamrin, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Development of an instrument to measure strategic and clinical quality indicators in postoperative pain management2002In: Journal of Advanced Nursing, ISSN 0309-2402, Vol. 37, no 6, p. 532-540Article in journal (Refereed)
    Abstract [en]

    AIM OF THE STUDY: To develop and evaluate psychometric properties, that is reliability and validity, of an instrument to measure strategic and clinical quality indicators in postoperative pain management.

    BACKGROUND: Strategic and clinical quality indicators in postoperative pain management were previously developed from a tentative model of important aspects of surgical nursing care and assessed to have content validity, that is to be essential for the quality of care, realistic to carry out and possible for nurses to use to influence management.

    METHODS: The quality indicators were converted to items suitable for a patient questionnaire and were scored on a 5-point scale, with higher scores indicating higher quality of care. Inpatients from five surgical wards took part in this study on their second postoperative day. The response rate was 96% and the average ages of the female (n=120) and the male (n=78) respondents were 62 and 63 years, respectively.

    RESULTS: Items in the total scale had an average inter-item correlation >0.20 and an item-total correlation >0.30. Cronbach's coefficient alpha was 0.84 for the total scale. Four factors entitled 'communication', 'action', 'trust' and 'environment' emerged from an orthogonal factor analysis, with a cumulative variance of 61.4%. Patients who received epidural analgesia had higher scores on the total scale compared with those who did not receive epidural analgesia. Patients who reported more pain than expected had lower scores on the total scale compared with those who did not report more pain than expected. Correlation between the total scale and an overall pain relief satisfaction question was 0.53.

    CONCLUSION: The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated.

  • 303.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Rooke, L.
    Important aspects of nursing care in surgical wards as expressed by nurses1998In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 7, no 6, p. 512-520Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to find out clinical nurses' perceptions of important aspects of nursing care that might have an impact on quality of care in surgical wards. A qualitative approach using focus group interviews was used. The data analysis revealed 15 categories of important aspects of care which could be condensed into two dimensions, here called 'prerequisites' (i.e., staffing, routines and attitudes) and 'elements of performance' (i.e., detecting and acting on signs and symptoms and acting on behalf of the patients). These aspects could be a starting point for developing quality indicators. Carper's four fundamental patterns of knowing were used to make a theoretical interpretation, and three of them were identified.

  • 304. Jaarsma, T
    et al.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Heart failure management programmes in Europe: a first overview.2006Conference paper (Other academic)
  • 305. Jaarsma, T
    et al.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Similarities and differences between Dutch and Swedish heart failure patients in regard to sexual problems.2006Conference paper (Other academic)
  • 306. Jaarsma, T
    et al.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    The European Heart Failure Self-Care Behaviour Scale: data from clinical and research populations.2006Conference paper (Other academic)
  • 307. Jaarsma, T
    et al.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, K
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    the 9-item European Heart Failure Self-Care Behavior Scale tested with data from 6 countries2008Conference paper (Other academic)
  • 308. Jaarsma, T
    et al.
    Strömberg, A
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Mårtensson, J
    The European Heart Failure Self-Care Behaviour Scale: development and revision.2000Conference paper (Other academic)
  • 309.
    Jaarsma, Tiny
    et al.
    University of Groningen.
    Franzen Arestedt, Kristofer
    University of Kalmar.
    Martensson, Jan
    Jonköping University.
    Dracup, Kathleen
    University of California.
    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.
    The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument2009In: EUROPEAN JOURNAL OF HEART FAILURE, ISSN 1388-9842, Vol. 11, no 1, p. 99-105Article in journal (Refereed)
    Abstract [en]

    Aims Improved self-care is the goat of many heart failure (HF) management programmes. The 12-item European Heart Failure Self-Care Behaviour Scale (EHFScB scale) was developed and tested to measure patient self-care behaviours. It is now available in 14 languages. The aim of this study was to further determine reliability and validity of the EHFScB scale.

    Methods and results Data from 2592 HF patients (mean age 73 years, 63% mate) from six countries were analysed. Internal consistency was determined by Cronbachs alpha. Validity was established by (1) interviews with HF experts and with HF patients; (2) item analysis; (3) confirmatory factor analysis; and (4) analysing the relationship between the EHFScB scale and scales measuring quality of life and adherence. Internal consistency of the 12-item scale was 0.77 (0.71-0.85). After factor analyses and critical evaluation of both psychometric properties and content of separate items, a nine-item version was further evaluated. The reliability estimates for the total nine-item scale (EHFScB-9) was satisfactory (0.80) and Cronbachs alpha varied between 0.68 and 0.87 in the different countries. One reliable subscale was defined (consulting behaviour) with a Cronbachs alpha of 0.85. The EHFScB-9 measures a different construct than quality of life (r = 0.18) and adherence (r = 0.37).

    Conclusion The 12-item EHFScB scale was revised into the nine-item EHFScB-9, which can be used as an internally consistent and valid instrument to measure HF-related self-care behaviour.

  • 310.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    n/a.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Thompson, David R.
    n/a.
    The European Journal of Cardiovascular Nursing endorses the CONSORT statement and extension.2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, p. 235-236Article in journal (Other academic)
  • 311.
    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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  • 312.
    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)
  • 313.
    Jaarsma, Tiny
    et al.
    University Hospital Groningen, The Netherlands.
    Stewart, Simon
    De Geest, Sabina
    University of Basel, Switzerland).
    Fridlund, Bengt
    Högskolan i Halmstad.
    Heikkilä, Johanna
    Mårtensson, Jan
    Moons, Philip
    Scholte op Reimer, Wilma
    Smith, Karen
    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.
    Thompson, David R
    A survey of coronary risk factors and B-type natriuretic peptide concentrations in cardiac nurses from Europe: do nurses still practice what they preach?2004In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 3, no 1, p. 3-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: From a previous survey of cardiac nurses attending a scientific conference, we learned that these nurses adopted a healthier lifestyle than the general population. AIMS: The aim of this study was to determine the overall profile of cardiac risk factors in a similar cohort and determine whether cardiac nurses continue to 'practice what they preach' in this regard. Secondly, we examined the practical value of screening a large cohort of individuals within a short time frame (total of 8 hours screening time) and determined the range of BNP concentrations within a 'healthy' cohort. METHODS: Data on CHD risk factors were collected with a short self-report questionnaire. The sample consisted of 122 cardiac nurses from 19 countries attending a European cardiac nursing conference held in Stockholm. A venous blood sample was collected into a tube containing potassium ETDA. B-type natriuretic peptide was measured on-site with the use of a portable fluorescence immunoassay kit. RESULTS: Most participants were female (89%). Participants ranged in age from 23 to 60 years with a mean age of 41 (S.D. 9.4). Eleven percent - all female - reported they were current smokers, 27% (34) had a BMI >25 and 27% of the sample stated they did not exercise regularly. Almost half (48%) of the sample reported a family history of CHD. As expected, all BNP-values were within the normal range. There were significant differences in BNP on the basis of sex (P<0.05) and age (P<0.05) and a trend towards increasing BNP concentrations with progressively higher BMI scores (P=0.06). CONCLUSION: This study reconfirms the likelihood that many cardiac nurses heed their own advice on lifestyle modification to reduce cardiovascular risk and therefore provide a good role model for the promotion of primary and secondary prevention initiatives.

  • 314.
    Jaarsma, Tiny
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cardiovascular Nursing: More than being nice2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 5, p. 315-315Article in journal (Other academic)
  • 315.
    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)
  • 316.
    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.

  • 317.
    Jaarsma, Tiny
    et al.
    University Hospital Groningen.
    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.
    Mårtensson, J
    Ryhov County Hospital Jönköping.
    Dracup, K
    UCSF School of Nursing San Francisco.
    Development and testing of the European Heart Failure Self-Care Behaviour Scale2003In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 5, no 3, p. 363-370Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Improvement of self-care behaviour is an aim of several non-pharmacological nurse-led management programmes for patients with heart failure. These programmes are often evaluated based on their effects on readmission, costs and quality of life. It is, however, also important to know how patients changed their self-care behaviour as a result of such a programme. Therefore a comprehensive, reliable and valid measure of the self-care behaviour of HF patients is needed. OBJECTIVES: To develop a scale measuring the behaviour that heart failure patients perform to maintain life, healthy functioning, and well-being. METHOD: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed in three phases: (1) concept analysis and first construction; (2) revision of items and response and scoring format; and (3) testing of the new scale for validity and reliability. RESULTS: The European Heart Failure Self-Care Behaviour Scale is a 12-item, self-administered questionnaire that covers items concerning self-care behaviour of patients with heart failure. Face-validity and concurrent validity was established and the internal consistency of the scale was tested using pooled data of 442 patients from two centres in Sweden, three in the Netherlands and one in Italy. Cronbachs's alpha was 0.81. CONCLUSION: The instrument is a valid, reliable and practical scale to measure the self-reported self-care behaviour of heart failure patients. It is ready to use by investigators evaluating the outcome of heart failure management programmes that target changes in patients' self-care practices.

  • 318.
    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)
  • 319.
    Jarkman Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Family therapy sessions with regugee families: a qualitative study2013In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 7, article id 7Article in journal (Refereed)
    Abstract [en]

    Background

    Due to the armed conflicts in the Balkans in the 1990s many families escaped to other countries. The main goal of this study was to explore in more detail the complexity of various family members’ experiences and perceptions from their life before the war, during the war and the escape, and during their new life in Sweden. There is insufficient knowledge of refugee families’ perceptions, experiences and needs, and especially of the complexity of family perspectives and family systems. This study focused on three families from Bosnia and Herzegovina who came to Sweden and were granted permanent residence permits. The families had at least one child between 5 and 12 years old.

    Method

    Family therapy sessions were videotaped and verbatim transcriptions were made. Nine family therapy sessions were analysed using a qualitative method with directed content analysis.

    Results

    Three main categories and ten subcategories were found - 1. Everyday life at home, with two subcategories: The family, Work and School/preschool; 2. The influence of war on everyday life, with three subcategories: The war, The escape, Reflections; 3. The new life, with five subcategories: Employment, Health, Relatives and friends, Limited future, Transition to the new life.

    Conclusions

    Health care and social welfare professionals need to find out what kind of lives refugee families have lived before coming to a new country, in order to determine individual needs of support. In this study the families had lived ordinary lives in their country of origin, and after experiencing a war situation they escaped to a new country and started a new life. They had thoughts of a limited future but also hopes of getting jobs and taking care of themselves and their families. When analysing each person’s point of view one must seek an all-embracing picture of a family and its complexity to tie together the family narrative. To offer refugee families meetings with family-oriented professionals to provide the opportunity to create a family narrative is recommended for the health and social welfare sector. Using this knowledge by emphasizing the salutogenic perspectives facilitates support to refugee families and individuals. This kind of support can help refugee families to adapt to a new system of society and recapture a sense of coherence, including all three components that lead to coherence: comprehensibility, manageability and meaningfulness. More studies are needed to further investigate the thoughts, experiences and needs of various refugee families and how refugee receiving societies can give the most effective support.

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  • 320.
    Joakimson, Daga
    et al.
    Högskolan i Jönköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nursing Science Focusing on Dying and Death: A Compulsory Course.2000In: Palliative care 2000, Jerusalem, 2000Conference paper (Refereed)
  • 321.
    Johansson, A
    et al.
    Central Hospital Skovde.
    Swahn, Eva
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Ejdeback, J
    Central Hospital Skovde.
    Edell-Gustafsson, Ulla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sleep quality, hyperarousal, and sleeplessness behaviour in patients with a previous history of myocardial infarction2008In: JOURNAL OF SLEEP RESEARCH,ISSN 0962-1105: Volume 17, 2008, Vol. 17, p. 176-176Conference paper (Refereed)
  • 322. Order onlineBuy this publication >>
    Johansson, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep.  Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.

    The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.

    Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.

    The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.

    Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.

    This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.

    List of papers
    1. Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: A phenomenographical study
    Open this publication in new window or tab >>Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: A phenomenographical study
    Show others...
    2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 467-475Article in journal (Refereed) Published
    Abstract [en]

    A framework is needed for identifying internal and external factors essential for the nursing management of psychological supportive health care and education for patients' self-care in sleep. In order to generate more knowledge from the patient's perspective, the aim of this study was to describe how patients with coronary artery disease (CAD) perceive that their sleep is influenced by rest, activity and health in outpatient care. Qualitative interviews were performed with 33 outpatients. The data were analysed using a phenomenographic method. Three descriptive categories of the phenomenon were described: my lifestyle is reflected in my sleep behaviour, handling the practices around tiredness and sleep, and feelings of negative and positive efficacy. Feelings of tiredness, fatigue and sleepiness were different pre-sleep stages, but were also related to the patient's adaptation and recovery. Creating one's own personal time and feelings of efficacy gave an inner sense of strength which is indicated as being particularly important in managing stress and the demands of everyday life in a satisfactory manner. From a contextual, holistic perspective on health, it is important to identify the patient's needs, symptoms and intentional or unintentional self-care management strategies regarding sleep and lifestyle. To promote a positive health outcome it is essential to identify sleeplessness behaviour and perceived self-efficacy for self-care in sleep. © 2007 Nordic College of Caring Science.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-40566 (URN)10.1111/j.1471-6712.2007.00496.x (DOI)53493 (Local ID)53493 (Archive number)53493 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
    2. Sleep, arousal and health-related quality of life in men and women with coronary artery disease.
    Open this publication in new window or tab >>Sleep, arousal and health-related quality of life in men and women with coronary artery disease.
    Show others...
    2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2787-2801Article in journal (Refereed) Published
    Abstract [en]

    Aim. To evaluate whether there are gender differences in insomnia, sleep quality, sleep efficiency (%), general arousal, disease-specific and health-related quality of life in patients with coronary artery disease, compared with an age- and gender-matched randomly selected group from the general population.

    Background.  There are gender difference effects of sleep disturbances in the general population, but this perspective among patients with coronary artery disease has been poorly analysed.

    Design.  In this prospective study, comparative, descriptive and model testing designs were used.

    Method.  The patients with coronary artery disease, 556 men and 324 women aged 25–86, were compared with a matched population-based group. Data were collected by validated and reliability-tested questionnaires.

    Results.  The prevalence of severe insomnia varied between 17–44% in all four groups. The severe insomniac coronary artery disease patients displayed a two- or threefold higher presleep arousal, had two hours shorter nocturnal sleep duration/night and were more limited in their physical exercise level than the population-based group. Gender differences in sleep quality, sleep efficiency (%) and general arousal disappeared with increased insomnia severity.

    Conclusions.  Independent of gender, age and comorbidity, physical exercise, general arousal behaviour and delayed poststress recovery after mental stress were found to have a negative impact on the coronary artery disease patients’ sleep quality and sleep efficiency (%), interfering with their health-related quality of life. The variables significantly explained 41% of the sleep quality outcome and 29% of the sleep efficiency (%).

    Relevance to clinical practice.  Insomnia because of hyperarousal behaviour can be an important factor in the development of an individual self-care management programme supported by a healthcare team.

    Place, publisher, year, edition, pages
    Blackwell, 2011
    Keywords
    arousal, coronary artery disease, gender, health-related quality of life, insomnia, nurses, nursing, sleep quality
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-70130 (URN)10.1111/j.1365-2702.2011.03787.x (DOI)000295096700011 ()
    Note
    Funding Agencies|Swedish Research Council (Vr)| 2001-504-338-37 |Ostergotland County Council| F2002-218 |Research and Development unit at Skaraborg Hospital, Sweden| VGSKAS-9122 |Available from: 2011-08-19 Created: 2011-08-19 Last updated: 2017-12-08
    3. Sleep-wake-activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample –an actigraphy and questionnaire study
    Open this publication in new window or tab >>Sleep-wake-activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample –an actigraphy and questionnaire study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to explore whether there are gender differences in sleep and health related quality of life in patients with coronary artery disease CAD and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, whether factors that predict patients´ sleep quality could be identified. Fifty-seven patients with stable CAD and forty-seven participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for 7 days. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and BMI explained 60% of the sleep quality outcome (USI) (P<0.0001). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary, P<0.0001). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses.

     

    Keywords
    Actigraphy, coronary artery disease, health related quality of life, sleep quality, sleep-activity rhythm.
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76678 (URN)
    Available from: 2012-04-16 Created: 2012-04-16 Last updated: 2012-04-17Bibliographically approved
    4. Evaluation of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomized intervention pilot study
    Open this publication in new window or tab >>Evaluation of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomized intervention pilot study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim. This randomized intervention pilot study aimed to evaluate the effectiveness of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease (CAD) following treatment.

    Background. Recent scientific findings have shown that physical exercise and stress interfere with CAD patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity.

    Methods. A pretest- posttest control design. Fifty-three CAD patients were randomized to either an intervention group (I-group) or to a control group (C-group) 3 to 7 weeks after treatment. They filled in questionnaires, kept a sleep diary and performed actigraphy for 10 days, with a follow-up after 3-4 months. The I-group underwent an individualized non-pharmacological education programme to promote self-care of sleep-activity led by a nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme were provided by a physiotherapist. Both groups received a brochure about sleep and stress.

    Results: At a 3-4 month follow-up results indicated that the interventions improved patients’ sleep quality, sleep duration and sleep efficiency. In the I-group the main improvements were seen in sleep quality, sleep duration and SE% in the sleep diary for 10 days and SE% in actigraphy. Statistical improvements in HRQoL were revealed. This was not so obvious in the control group.

    Conclusions: These preliminary findings suggest that an individualized non-pharmacological programme to promote self-care of sleep-activity including relaxation in patients with CAD supported by a nurse can improve sleep quality. However,

    Keywords
    actigraphy, coronary artery disease, health, nursing, pretest-posttest control group design, self-care, sleep-activity
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76680 (URN)
    Available from: 2012-04-16 Created: 2012-04-16 Last updated: 2012-04-17Bibliographically approved
    Download full text (pdf)
    Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
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  • 323.
    Johansson, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Adamson, Anita
    Department of Physical therapy, Kärnsjukhuset, Skövde, Sweden.
    Ejdebäck, Jan
    Department of Cardiology, Kärnsjukhuset, Skövde, Sweden.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evaluation of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomized intervention pilot studyManuscript (preprint) (Other academic)
    Abstract [en]

    Aim. This randomized intervention pilot study aimed to evaluate the effectiveness of an individualized non-pharmacological programme to promote self-care in sleep-activity in patients with coronary artery disease (CAD) following treatment.

    Background. Recent scientific findings have shown that physical exercise and stress interfere with CAD patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity.

    Methods. A pretest- posttest control design. Fifty-three CAD patients were randomized to either an intervention group (I-group) or to a control group (C-group) 3 to 7 weeks after treatment. They filled in questionnaires, kept a sleep diary and performed actigraphy for 10 days, with a follow-up after 3-4 months. The I-group underwent an individualized non-pharmacological education programme to promote self-care of sleep-activity led by a nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme were provided by a physiotherapist. Both groups received a brochure about sleep and stress.

    Results: At a 3-4 month follow-up results indicated that the interventions improved patients’ sleep quality, sleep duration and sleep efficiency. In the I-group the main improvements were seen in sleep quality, sleep duration and SE% in the sleep diary for 10 days and SE% in actigraphy. Statistical improvements in HRQoL were revealed. This was not so obvious in the control group.

    Conclusions: These preliminary findings suggest that an individualized non-pharmacological programme to promote self-care of sleep-activity including relaxation in patients with CAD supported by a nurse can improve sleep quality. However,

  • 324.
    Johansson, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Karlsson, Johan
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Brödje, Karin
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Edell-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Self-care strategies to facilitate sleep in patients with heart disease: A qualitative study2012In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 18, no 1, p. 44-51Article in journal (Refereed)
    Abstract [en]

    Johansson A, Karlsson J, Brödje K, Edell-Gustafsson U. International Journal of Nursing Practice 2012; 18: 44-51 Self-care strategies to facilitate sleep in patients with heart disease-A qualitative study This study aimed at exploring and describing the self-care management strategies used by patients with coronary artery disease to facilitate sleep. Qualitative interviews in a dialogue manner, in a phenomenographic reference frame analyzed according to manifest and latent principles of qualitative content analysis, were performed. A purposeful sampling technique was used including 11 patients with coronary heart disease in a Heart Medical Unit in a general hospital setting. Two main themes were identified: sleep-rhythm and sleep-hygiene including four descriptive categories. The categories reveal five basic responses including emotions, cognition, physical symptoms (reactions), behaviours and/or the sleep environment, which were related to perceived or actual presence of sleep-wake problems and health that were the underlying reason for the self-care management strategies. Basically, intervention studies that address these five responses for choice of non-pharmacological methods based on cognitive behavioural therapy provided by nurses are needed.

  • 325.
    Johansson, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sleep-wake-activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample –an actigraphy and questionnaire studyManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to explore whether there are gender differences in sleep and health related quality of life in patients with coronary artery disease CAD and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, whether factors that predict patients´ sleep quality could be identified. Fifty-seven patients with stable CAD and forty-seven participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for 7 days. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and BMI explained 60% of the sleep quality outcome (USI) (P<0.0001). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary, P<0.0001). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses.

     

  • 326.
    Johansson, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Ejdebäck, Jan
    Hjärtkliniken, Kärnsjukhuset i Skövde.
    Tygesen, Hans
    Hjärt-och lungkliniken, Södra Älvsborgs Sjukhus, Borås.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sleep, arousal and health-related quality of life in men and women with coronary artery disease.2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2787-2801Article in journal (Refereed)
    Abstract [en]

    Aim. To evaluate whether there are gender differences in insomnia, sleep quality, sleep efficiency (%), general arousal, disease-specific and health-related quality of life in patients with coronary artery disease, compared with an age- and gender-matched randomly selected group from the general population.

    Background.  There are gender difference effects of sleep disturbances in the general population, but this perspective among patients with coronary artery disease has been poorly analysed.

    Design.  In this prospective study, comparative, descriptive and model testing designs were used.

    Method.  The patients with coronary artery disease, 556 men and 324 women aged 25–86, were compared with a matched population-based group. Data were collected by validated and reliability-tested questionnaires.

    Results.  The prevalence of severe insomnia varied between 17–44% in all four groups. The severe insomniac coronary artery disease patients displayed a two- or threefold higher presleep arousal, had two hours shorter nocturnal sleep duration/night and were more limited in their physical exercise level than the population-based group. Gender differences in sleep quality, sleep efficiency (%) and general arousal disappeared with increased insomnia severity.

    Conclusions.  Independent of gender, age and comorbidity, physical exercise, general arousal behaviour and delayed poststress recovery after mental stress were found to have a negative impact on the coronary artery disease patients’ sleep quality and sleep efficiency (%), interfering with their health-related quality of life. The variables significantly explained 41% of the sleep quality outcome and 29% of the sleep efficiency (%).

    Relevance to clinical practice.  Insomnia because of hyperarousal behaviour can be an important factor in the development of an individual self-care management programme supported by a healthcare team.

  • 327.
    Johansson, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Windahl, Maria
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Fredrichsen, Maria
    Department of Social and Welfare Studies, Palliative Research Unit, Vrinnevi Hospital, Norrköping, Sweden.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Yngman Uhlin, Pia
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Edell-Gustafsson, Ulla
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: A phenomenographical study2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 467-475Article in journal (Refereed)
    Abstract [en]

    A framework is needed for identifying internal and external factors essential for the nursing management of psychological supportive health care and education for patients' self-care in sleep. In order to generate more knowledge from the patient's perspective, the aim of this study was to describe how patients with coronary artery disease (CAD) perceive that their sleep is influenced by rest, activity and health in outpatient care. Qualitative interviews were performed with 33 outpatients. The data were analysed using a phenomenographic method. Three descriptive categories of the phenomenon were described: my lifestyle is reflected in my sleep behaviour, handling the practices around tiredness and sleep, and feelings of negative and positive efficacy. Feelings of tiredness, fatigue and sleepiness were different pre-sleep stages, but were also related to the patient's adaptation and recovery. Creating one's own personal time and feelings of efficacy gave an inner sense of strength which is indicated as being particularly important in managing stress and the demands of everyday life in a satisfactory manner. From a contextual, holistic perspective on health, it is important to identify the patient's needs, symptoms and intentional or unintentional self-care management strategies regarding sleep and lifestyle. To promote a positive health outcome it is essential to identify sleeplessness behaviour and perceived self-efficacy for self-care in sleep. © 2007 Nordic College of Caring Science.

  • 328.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Betydelsen av att skydda barn mot passiv rökning.2004In: Forskning och UtvecklingArticle in journal (Other (popular science, discussion, etc.))
  • 329.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Passiv rökning hos barn: Betydelsen av föräldrars rökning och rökbeteende2004In: Medikament, ISSN 1402-3881, Vol. 4, p. 33-37Article in journal (Other (popular science, discussion, etc.))
  • 330. Order onlineBuy this publication >>
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Passive Smoking in Children: The Importance of Parents’ Smoking and Use of Protective Measures2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Passive smoking has been recognised as a health hazard, and chidren are especially vulnerable. The general aim of this thesis was to describe and analyse the importance of parents’ smoking and smoking behaviour for children’s tobacco smoke exposure. The studies were conducted in the South-East part of Sweden and pre-school children and their parents constituted the study samples. Five studies are described in six papers. Smoking prevalence among parents (14%) and commonly used measures of protection were surveyed. An instrument designed to measure children’s tobacco smoke exposure in the home was developed and validated. It was used on 687 families with a smoking parent and a child 2½-3 years old, included in a prospective cohort study on environmental variables of importance for immun-mediated diseases ABIS (All Babies in South-East Sweden). Almost 60% of the parents stated that they always smoked outdoors with the door closed, 14% mixed this with smoking near the kitchen fan, 12% near an open door, 7% mixed all these behaviours and 8 % smoked indoors without precautions. The smoking behaviours were related to the children’s creatinine adjusted urine cotinine. All groups had significantly higher values than had children from non-smoking homes, controls. Outdoor smoking with the door closed seemed to be the best, though not a total, measure for tobacco smoke protection in the home.

    Most parents were aware of the importance of protecting children from tobacco smoke exposure but all were not convinced of the increased risk for disease for exposed children. The majority of parents were not satisfied with the smoking prevention in health-care and 50% did not think that their smoking was of any concern to the child health care nurse.

    Further research is warranted to describe if the difference in exposure score related to smoking behaviours is related to different prevalence of disease. Efforts are needed to convince those who still smoke indoors that tobacco smoke exposure influence children’s health and that consequent outdoor smoking with the door closed seemed to give the best protection.

    List of papers
    1. Indoor and outdoor smoking: Impact on children’s health
    Open this publication in new window or tab >>Indoor and outdoor smoking: Impact on children’s health
    2003 (English)In: European Journal of Public Health, ISSN 1101-1262, Vol. 13, no 1, p. 61-66Article in journal (Refereed) Published
    Abstract [en]

    Background: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children.

    Methods: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12–24 months old.

    Results: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers.

    Conclusion: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.

    Keywords
    children, environmental tobacco smoke, health effects, smoking behaviour
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13622 (URN)10.1093/eurpub/13.1.61 (DOI)
    Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
    2. Does having children affect adult smoking and behaviours at home?
    Open this publication in new window or tab >>Does having children affect adult smoking and behaviours at home?
    2003 (English)In: Tobacco Induced Diseases, ISSN 1617-9625, Vol. 1, no 3, p. 175-183Article in journal (Refereed) Published
    Abstract [en]

    Background

    Smoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.

    Methods

    Questionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.

    Results

    Parenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.

    Conclusion

    As smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

    Keywords
    smoking prevalence, children, protection, parents, SF-36
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13623 (URN)10.1186/1617-9625-1-3-175 (DOI)
    Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
    3. Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
    Open this publication in new window or tab >>Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
    2005 (English)In: Annals of Epidemiology, ISSN 1047-2797, Vol. 15, no 6, p. 453-459Article in journal (Refereed) Published
    Abstract [en]

    Purpose

    To construct and validate a questionnaire aiming to measure children's exposure to environmental tobacco smoke (ETS) in the home.

    Methods

    The development of the instrument included epidemiological studies, qualitative interviews, pilot studies, and validation with biomarkers and is described in seven consecutive steps. Parents of preschool children, from different population-based samples in south-east Sweden, have participated in the studies.

    Results

    Content and face validity was tested by an expert panel and core elements for the purpose of the instrument identified. Reliability was shown with test-retest of the first version. The validation with biomarkers indicated that the sensitivity of the instrument was high enough to discriminate between children's ETS exposure levels. Cotinine/creatinine levels were related to parents' described smoking behaviors. Differences were shown between children from non-smoking homes, and all groups with smoking parents, independent of their smoking behavior (p < 0.01), as well as between parents smoking strictly outdoors and parents reporting indoor smoking (p < 0.001).

    Conclusion

    The results indicate that the presented instrument can be used to discriminate between different levels of ETS exposure and when children's level of tobacco smoke exposure is to be assessed.

    Keywords
    Cotinine; ETS; Parents; Outdoor Smoking
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13624 (URN)10.1016/j.annepidem.2004.09.012 (DOI)
    Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
    4. When does exposure of children to tobacco smoke become child abuse?
    Open this publication in new window or tab >>When does exposure of children to tobacco smoke become child abuse?
    2003 (English)In: The Lancet, ISSN 0140-6736, Vol. 361, no 9371, p. 1828-1828Article in journal (Refereed) Published
    Abstract [en]

    We report an instance of a child aged 2.5 years, who is exposed to tobacco smoke in the home. The child is a participant in a prospective cohort study (ABIS; all babies in southeast Sweden) we are undertaking, on environmental factors affecting development of immune-mediated diseases in children.1

    Exposure to environmental tobacco smoke, known to affect present and future health of children,2 is one of the environmental factors being studied. Parents are asked, in questionnaires, if and how much they smoke. A subsample of smoking parents of 2–3 year-old children has been asked about their smoking behaviour at home—ie, what precautions they use to protect their child from tobacco smoke. To validate this questionnaire, we have analysed urine cotinine concentrations (the major urinary metabolite of nicotine) in specimens provided by children of this age. We recorded that the smoking behaviour of parents at home was significantly associated with cotinine concentrations of their child. Cotinine concentrations were adjusted for creatinine.3

    The child we report here had a cotinine/creatinine ratio of 800 μg cotinine/1 g creatinine, corresponding to active smoking of 3–5 cigarettes a day.4 The parents reported a joint consumption of 41–60 cigarettes a day. They said they smoke in the kitchen and living room, whereas bedrooms were reported to be smoke-free. The parents reported smoking at the dinner table once a day and in front of the television set several times a day. They also said they smoke near the kitchen fan several times a day and near an open door at least once a week. These comments from the parents indicate that, in their opinion, their child was well protected from exposure to environmental tobacco smoke, since they did not smoke in bedrooms and the windows were almost always open.

    Though nicotine and cotinine metabolism is independent probably due to genetic differences,5 the cotinine concentration of this child is remarkably high. If active smoking in adults causes lung cancer and other serious diseases, passive smoking from the age of 2.5 years (and probably younger) must be even more deleterious. Since a child at this age cannot, by his or her own will, avoid a smoky environment, we ask ourselves when exposure to tobacco smoke should be regarded as child abuse?

    We want to stress the fact that, although most parents are aware of the importance of protecting their children from tobacco smoke, and try in different ways, children can still be massively exposed to this toxic drug. Since to just forbid smoking might be ineffective, nurses and doctors should pay attention to smoking behaviour of smoking parents they meet. Until we know more about effective measures of protection, the recommendation should be never to smoke indoors in homes with children.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13625 (URN)10.1016/S0140-6736(03)13431-9 (DOI)
    Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
    5. How should parents protect their children from environmental tobacco-smoke exposure in the home?
    Open this publication in new window or tab >>How should parents protect their children from environmental tobacco-smoke exposure in the home?
    2004 (English)In: Pediatrics, ISSN 1098-4275, Vol. 113, no 4, p. 291-295Article in journal (Refereed) Published
    Abstract [en]

    Background. Children’s exposure to tobacco smoke is known to have adverse health effects, and most parents try to protect their children.

    Objective. To examine the effectiveness of parents’ precautions for limiting their children’s tobacco-smoke exposure and to identify variables associated to parents’ smoking behavior.

    Design and participants. Children, 2.5 to 3 years old, participating in All Babies in Southeast Sweden, a prospective study on environmental factors affecting development of immune-mediated diseases. Smoking parents of 366 children answered a questionnaire on their smoking behavior. Cotinine analyses were made on urine specimen from these children and 433 age-matched controls from nonsmoking homes.

    Results. Smoking behavior had a significant impact on cotinine levels. Exclusively outdoor smoking with the door closed gave lower urine cotinine levels of children than when mixing smoking near the kitchen fan and near an open door or indoors but higher levels than controls.

    Variables of importance for smoking behavior were not living in a nuclear family (odds ratio: 2.1; 95% confidence interval: 1.1–4.1) and high cigarette consumption (odds ratio: 1.6; 95% confidence interval: 1.2-2.1).

    An exposure score with controls as the reference group (1.0) gave an exposure score for outdoor smoking with the door closed of 2.0, for standing near an open door + outdoors of 2.4, for standing near the kitchen fan + outdoors of 3.2, for mixing near an open door, kitchen fan, and outdoors of 10.3, and for indoor smoking of 15.2.

    Conclusion. Smoking outdoors with the door closed was not a total but the most effective way to protect children from environmental tobacco-smoke exposure. Other modes of action had a minor effect.

    Keywords
    ETS, cotinine, children, smoking behavior, measures of precaution
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13626 (URN)
    Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
    6. Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
    Open this publication in new window or tab >>Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
    2004 (English)In: Journal of Pediatric Health Care, ISSN 0891-5245, Vol. 18, no 5, p. 228-235Article in journal (Refereed) Published
    Abstract [en]

    Introduction

    The objective of the study was to understand the opinions and attitudes among parents of preschool children towards children's passive smoking, to show how attitudes influenced smoking and smoking behavior, and how the parents had experienced the handling of the tobacco issue in antenatal and child health care.

    Method

    A subsample of smoking and nonsmoking parents (n = 300) with 4- to 6-year-old children participating in All Babies in Southeast Sweden (ABIS), a prospective study on environmental factors affecting development of immune-mediated diseases, answered a questionnaire on their opinions and attitudes to children's passive smoking.

    Results

    Indoor smokers were more positive regarding smoking, less aware of the adverse health effects from passive smoking, and more negative regarding the handling of tobacco prevention in health care than both outdoor smokers and nonsmokers. Indoor smokers' idea of how children should be protected from tobacco smoke exposure was significantly different from the idea of nonsmokers and outdoor smokers.

    Discussion

    Results indicate that further intense efforts are needed to convince the remaining indoor smokers about the adverse health effects related to tobacco smoke exposure. Pediatric nurses meet these parents in their daily work and should be aware of the need to focus this group and their use of protective measures.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13627 (URN)10.1016/j.pedhc.2004.03.006 (DOI)
    Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
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  • 331.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Halling, Arne
    Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    The Linquest Study Group,
    Does having children affect adult smoking and behaviours at home?2003In: Tobacco Induced Diseases, ISSN 1617-9625, Vol. 1, no 3, p. 175-183Article in journal (Refereed)
    Abstract [en]

    Background

    Smoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.

    Methods

    Questionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.

    Results

    Parenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.

    Conclusion

    As smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

  • 332.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Halling, Arne
    Department of Health sciences, Kristianstad University, Sweden .
    Indoor and outdoor smoking: Impact on children’s health2003In: European Journal of Public Health, ISSN 1101-1262, Vol. 13, no 1, p. 61-66Article in journal (Refereed)
    Abstract [en]

    Background: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children.

    Methods: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12–24 months old.

    Results: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers.

    Conclusion: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.

  • 333.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Ludvigsson, Johnny
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    How should parents protect their children from environmental tobacco-smoke exposure in the home?2004In: Pediatrics, ISSN 1098-4275, Vol. 113, no 4, p. 291-295Article in journal (Refereed)
    Abstract [en]

    Background. Children’s exposure to tobacco smoke is known to have adverse health effects, and most parents try to protect their children.

    Objective. To examine the effectiveness of parents’ precautions for limiting their children’s tobacco-smoke exposure and to identify variables associated to parents’ smoking behavior.

    Design and participants. Children, 2.5 to 3 years old, participating in All Babies in Southeast Sweden, a prospective study on environmental factors affecting development of immune-mediated diseases. Smoking parents of 366 children answered a questionnaire on their smoking behavior. Cotinine analyses were made on urine specimen from these children and 433 age-matched controls from nonsmoking homes.

    Results. Smoking behavior had a significant impact on cotinine levels. Exclusively outdoor smoking with the door closed gave lower urine cotinine levels of children than when mixing smoking near the kitchen fan and near an open door or indoors but higher levels than controls.

    Variables of importance for smoking behavior were not living in a nuclear family (odds ratio: 2.1; 95% confidence interval: 1.1–4.1) and high cigarette consumption (odds ratio: 1.6; 95% confidence interval: 1.2-2.1).

    An exposure score with controls as the reference group (1.0) gave an exposure score for outdoor smoking with the door closed of 2.0, for standing near an open door + outdoors of 2.4, for standing near the kitchen fan + outdoors of 3.2, for mixing near an open door, kitchen fan, and outdoors of 10.3, and for indoor smoking of 15.2.

    Conclusion. Smoking outdoors with the door closed was not a total but the most effective way to protect children from environmental tobacco-smoke exposure. Other modes of action had a minor effect.

  • 334.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care2004In: Journal of Pediatric Health Care, ISSN 0891-5245, Vol. 18, no 5, p. 228-235Article in journal (Refereed)
    Abstract [en]

    Introduction

    The objective of the study was to understand the opinions and attitudes among parents of preschool children towards children's passive smoking, to show how attitudes influenced smoking and smoking behavior, and how the parents had experienced the handling of the tobacco issue in antenatal and child health care.

    Method

    A subsample of smoking and nonsmoking parents (n = 300) with 4- to 6-year-old children participating in All Babies in Southeast Sweden (ABIS), a prospective study on environmental factors affecting development of immune-mediated diseases, answered a questionnaire on their opinions and attitudes to children's passive smoking.

    Results

    Indoor smokers were more positive regarding smoking, less aware of the adverse health effects from passive smoking, and more negative regarding the handling of tobacco prevention in health care than both outdoor smokers and nonsmokers. Indoor smokers' idea of how children should be protected from tobacco smoke exposure was significantly different from the idea of nonsmokers and outdoor smokers.

    Discussion

    Results indicate that further intense efforts are needed to convince the remaining indoor smokers about the adverse health effects related to tobacco smoke exposure. Pediatric nurses meet these parents in their daily work and should be aware of the need to focus this group and their use of protective measures.

  • 335.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Tobacco Exposure and Diabetes-Related Autoantibodies in Children Results from the ABIS Study2008In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1150, p. 197-199Article in journal (Refereed)
    Abstract [en]

    Passive smoking has decreased in recent years ("increased hygiene"). Less environmental tobacco smoke (ETS) gives increased hygiene that, if the hygiene hypothesis is true, in turn might give more autoimmune diseases. The presence of auto antibodies is considered to be an early indicator of type 1 diabetes (T1D). Because tobacco exposure may influence the immune system, we analyzed the relation between passive smoking and development of autoantibodies. A subsample (n = 8794) of the children in the ABIS study was used for this analysis. The parents answered questionnaires on smoking from pregnancy and onwards, and blood samples from the children aged 2.5-3 years were analyzed for GADA and IA-2A. Results showed that there was no significant difference in the prevalence of GADA or IA-2A (> 95 percentile) between tobacco-exposed and nonexposed children. It was concluded that passive smoking does not seem to influence development of diabetes-related autoantibodies early in life.

  • 336.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    When does exposure of children to tobacco smoke become child abuse?2003In: The Lancet, ISSN 0140-6736, Vol. 361, no 9371, p. 1828-1828Article in journal (Refereed)
    Abstract [en]

    We report an instance of a child aged 2.5 years, who is exposed to tobacco smoke in the home. The child is a participant in a prospective cohort study (ABIS; all babies in southeast Sweden) we are undertaking, on environmental factors affecting development of immune-mediated diseases in children.1

    Exposure to environmental tobacco smoke, known to affect present and future health of children,2 is one of the environmental factors being studied. Parents are asked, in questionnaires, if and how much they smoke. A subsample of smoking parents of 2–3 year-old children has been asked about their smoking behaviour at home—ie, what precautions they use to protect their child from tobacco smoke. To validate this questionnaire, we have analysed urine cotinine concentrations (the major urinary metabolite of nicotine) in specimens provided by children of this age. We recorded that the smoking behaviour of parents at home was significantly associated with cotinine concentrations of their child. Cotinine concentrations were adjusted for creatinine.3

    The child we report here had a cotinine/creatinine ratio of 800 μg cotinine/1 g creatinine, corresponding to active smoking of 3–5 cigarettes a day.4 The parents reported a joint consumption of 41–60 cigarettes a day. They said they smoke in the kitchen and living room, whereas bedrooms were reported to be smoke-free. The parents reported smoking at the dinner table once a day and in front of the television set several times a day. They also said they smoke near the kitchen fan several times a day and near an open door at least once a week. These comments from the parents indicate that, in their opinion, their child was well protected from exposure to environmental tobacco smoke, since they did not smoke in bedrooms and the windows were almost always open.

    Though nicotine and cotinine metabolism is independent probably due to genetic differences,5 the cotinine concentration of this child is remarkably high. If active smoking in adults causes lung cancer and other serious diseases, passive smoking from the age of 2.5 years (and probably younger) must be even more deleterious. Since a child at this age cannot, by his or her own will, avoid a smoky environment, we ask ourselves when exposure to tobacco smoke should be regarded as child abuse?

    We want to stress the fact that, although most parents are aware of the importance of protecting their children from tobacco smoke, and try in different ways, children can still be massively exposed to this toxic drug. Since to just forbid smoking might be ineffective, nurses and doctors should pay attention to smoking behaviour of smoking parents they meet. Until we know more about effective measures of protection, the recommendation should be never to smoke indoors in homes with children.

  • 337.
    Johansson, Birgitta
    et al.
    Uppsala Universitetssjukhus.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Nordin, Karin
    Uppsala Universitet.
    Langius-Eklöf, Ann
    Örebro Universitet.
    Editorial comment on "Disregarding clinical trial-based patient-reported outcomes is unwarranted: Five advances to substantiate the scientific stringency of quality-of-life measurement".: in Acta Oncologica(ISSN 0284-186X) vol 49, issue 2, pp 163-1652010In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 49, no 2, p. 163-165Article in journal (Other academic)
    Abstract [en]

    Abstract Not available

  • 338.
    Johansson, I.
    et al.
    Gjøvik University College.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Struksnes, S.
    Gjøvik University College.
    Hedelin , B.
    Gjøvik University College.
    Balancing integrity vs. risk of falling - Nurses experiences of caring for elderly people with dementia in nursing homes2009In: Journal of Research in Nursing, ISSN 1744-9871, Vol. 14, no 1, p. 61-73Article in journal (Refereed)
    Abstract [en]

    Dementia is recognized as being a major risk for falls that cause suffering and increase dependency for the individual. The purpose of this study was to explore registered nurses and nurse assistants experiences of caring for elderly people with dementia who are at risk of falling, and factors that contribute or reduce falls in this group. A phenomenographic design was chosen. Ten nurses and 18 nurse assistants with experience of fall events were strategically selected for a recorded interview. The informants were chosen from 10 nursing homes in Sweden and Norway. They were asked to describe a fall situation they had been involved in when caring for elderly people with dementia. The findings shed light on an ethical dilemma in the main category Balancing integrity and autonomy versus risk of falling � which was comprehensively related to two descriptive categories. The first one was Adjusting to the older person�s condition� with the concepts of forgetfulness, anxiety and confusion, ability to express oneself and understand, bodily build and function. The second category was Adjusting the care environment�, comprising these conceptions: the physical environment, the psychosocial environment, organization and human resources. Based on the staff�s perceived difficulties in preventing falls in elderly people with dementia, there is a need for additional support or professional supervision in their work to enhance possibilities for successful fall prevention.

  • 339.
    Johansson, Ingela
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Blixt, F
    Andersson, F
    Strömberg, Anna
    Driving restrictions and implantable cardioverter defibrillator - the patient perspective2009Conference paper (Refereed)
  • 340.
    Johansson, Ingela
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Fluur, Christina
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bolse, Kärstin
    Högskolan i Halmstad.
    Patients' experiences of the ICD from a life perspective, with focus on end-of-life issues2012Conference paper (Other academic)
  • 341.
    Johansson, Ingela
    et al.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. 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. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Experiences of Driving and Driving Restrictions in Recipients with an Implantable Cardioverter Defibrillator - The Patient Perspective2010In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 5, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: The implantable cardioverter defibrillator (ICD) is a lifesaving device for treating patients who have experienced (secondary prevention), or are likely to experience (primary prevention), sudden cardiac death due to ventricular arrhythmias. Individuals with an ICD are prohibited from driving for a restricted period after the implantation and after recurrence of a ventricular arrhythmia, which may affect the ICD recipient in daily life. The aim of this study was therefore to describe how ICD recipients perceive driving and the driving restriction.

     

    Methods: Fourteen men and 6 women, aged 43 to 82 years, with driving restrictions due to both secondary and primary ICD indications, were interviewed. Data were analyzed using phenomenography.

     

    Results: The analysis resulted in the main category, the individual's unique relationship to driving, based on the categories: (1) achieving adherence on driving restrictions, (2) emotional influence of driving restriction, and (3) altered views on driving. The information was sometimes conceived as insufficient and unclear, and the willingness to accept the restriction differed. The ICD recipients perceived a loss of independence and changed self-image. Some patients had changed their driving behavior because of uncertainty of their driving abilities or fear of having arrhythmias/shocks while driving. They had different views on their future driving.

     

    Conclusions: Handling driving restrictions after ICD implantation and shocks is a complex and delicate issue in clinical practice and should be addressed in a dialogue with the ICD recipient. More individualized and structured information and support should be given according to the ICD recipients' experiences and needs.

  • 342.
    Johansson, Ingela
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    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.
    Swahn, Eva
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ambulance use in patients with acute myocardial infarction2004In: Journal of Cardiovascular Nursing, ISSN 0889-4655, Vol. 19, no 1, p. 5-12Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the choice of transportation mode to hospital in patients experiencing acute myocardial infarction.

    Method: A descriptive survey study at the Coronary Care Unit of one Swedish University Hospital. The study was carried out between July 2000 and March 2001.

    Results: The study population consisted of 114 consecutive patients with acute myocardial infarction. Thirty-two percent stated that they did not know the importance of a short delay when experiencing an acute myocardial infarction. Only 60% called the emergency service number, 112. Patients calling for an ambulance differed from those who did not in several aspects. Medical characteristics associated with ambulance use in a univariate analysis were ST-elevation myocardial infarction and prior history of myocardial infarction. There were no differences regarding gender or age. When looking at the patients' symptom-experience, patients with vertigo or nausea and severe pain chose an ambulance for transport to the hospital. The only significant reasons for not choosing an ambulance were cramping pain and the patient perceiving the symptoms not to be serious. In a multivariate analysis, ST-elevation (OR = 0.30, P = .04), unbearable symptoms (OR = 0.20, P = .03), and nausea (OR = .33, P = .04) appeared as independent predictors of ambulance use and cramping pain (OR = 5.17, P = .01) for not using an ambulance.

    Conclusions: Patients with acute myocardial infarction view the ambulance as an option for transportation to hospital only if they feel really sick. For that reason, it needs to be made well known to the public that ambulances are not only a mode of transport, but also provide diagnostics and treatment.

  • 343.
    Johansson, Ingela
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    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.
    Swahn, Eva
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Factors related to delay times in patients with suspected acute myocardial infarction2004In: Heart & Lung: The Journal of Acute and Critical Care, ISSN 0147-9563, Vol. 33, no 5, p. 291-300Article in journal (Refereed)
    Abstract [en]

    Objective

    The study’s objective was to describe symptoms, symptom management, and patient delay times in patients seeking treatment for suspected acute myocardial infarction (AMI), and to find explanatory factors influencing the decision time.

    Method

    This is a descriptive survey study including 403 Swedish patients with a median age of 64 years with suspected AMI.

    Results

    Altogether, 84% of the patients suspected that the symptoms emanated from the heart. Despite this fact, 59% delayed going to the hospital more than 1 hour after the onset of symptoms. In the multiple regression analysis, a “dull pain,” the patients’ belief that it was nothing serious, and contact with the general practitioner were associated with prolonged delay. The decision to contact the emergency service shortened the delay time.

    Conclusions

    The patient’s subjective feeling of the severity of symptoms is an important predictor for delay times. There is still a need for public awareness of the appropriate responses to AMI symptoms, that is, to call for an ambulance instead of contacting the general practitioner.

  • 344.
    Johansson, Ingela
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    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.
    Spouses conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction - A qualitative analysis2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 3, p. 182-188Article in journal (Refereed)
    Abstract [en]

    Background: Delay from onset of acute myocardial infarction symptoms to the delivery of medical care is a major determinant of prognosis. Although studies have explored patient reasons for delay, there are only limited data concerning experiences of the spouse.

    Aim: Was to describe spouses conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction.

    Method: A phenomenographic approach was applied. Fifteen spouses were interviewed <48 h after the partners hospital admittance.

    Findings: Two categories with underlying sub-categories conceptualised the spouses experiences. The category being resourceful contained: sharing the experience, having knowledge, understanding the severity, being rational, and consulting others. The category respecting independence contained: accepting the need for control, marital roles and experiences, restraining emotions, and seeking agreement.

    Conclusion: Our findings suggest that spouses have a strong influence on the course of events. When accepting the partners need for control through following earlier marital roles and experiences, restraining own emotions and seeking agreement, this seemed to contribute to delay. However, when the spouse was resourceful by sharing the experience, having knowledge, understanding the severity, being rational and consulting others when needed, this seemed to have a positive influence on the pre-hospital time.

  • 345. Order onlineBuy this publication >>
    Johansson, Ingrid
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Theoretical understanding of the coping approaches and social support experiences of relatives of critically ill patients during the intensive care unit stay and the recovery period at home2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Relatives may experience a difficult and demanding situation when the patient is critically ill. During the period in the intensive care unit (ICU), the relatives may be subject to strong emotions of an existential nature, and the situation may involve several stressors as a result of changed roles, responsibilities and routines. These emotional stress experiences may result in weakened mental and physical functioning on the part of the relatives. During the patient’s rehabilitation at home the relatives are expected to provide care-giving assistance, which may lead to a further deterioration in their already weakened mental and physical functioning.

    The general aim of the thesis was to develop a theoretical understanding of coping approaches and social support experiences of relatives of critically ill patients, both in the ICU and at home. In order to gain an understanding of these areas it was deemed important to search for knowledge by means of qualitative methods, using grounded theory methodology, simultaneous concept analysis and qualitative content analysis. A total of 32 relatives of critical care patients participated in the studies.

    The findings of study I revealed that relatives of critically ill patients coped with their situation by alleviating, recycling, mastering or excluding their feelings during the ICU stay. The critical factors behind their choice of coping approach were their social circumstances, previous experiences of care and/or caring and how they apprehended the situation. In study II, during the patients’ recovery period at home, the relatives coped with their situation by accepting, volunteering, sacrificing or modulating. The critical factors in this period were the physical and psychological state of the relatives, previous experiences of care and/or caring and the psychological condition of the patient. A coping model was developed in study III, based on the coping concepts generated in studies I and II. In this model, the characteristics of each coping approach were systematised into different determinants in order to highlight the inherent process. The analysis of the relationship between the various coping approaches revealed differences in adaptation to the stressful situation. In terms of coping effectiveness, adaptation was associated with social support and health outcome. In the extended version of the coping model, with its dual perspective of the maladaptive-adaptive coping continuum and the weak-strong social support continuum, the degree of effectiveness of each coping approach was illustrated in relation to the others as well as to social support. In study IV and its Addition, a theoretical understanding of the phenomenon of what relatives experienced as supportive was developed. Support was perceived as empowerment by means of internal and external resources in the form of trusting oneself, encountering charity and encountering professionalism. The sense of empowerment permitted the relatives to experience their situation as safer and easier to control. The three support dimensions with their components and characteristics were illustrated in the empowerment model.

    These four studies have developed knowledge that may provide healthcare professionals with an understanding of the coping approaches and social support experiences of relatives during the critically ill patient’s ICU stay and recovery period at home. The association revealed between coping effectiveness, social support and health outcomes may draw attention to the relatives’ situation as well as to the possibility of enabling relatives to endure the patient’s entire illness and recovery period by enhancing the factors that promote effective coping. The three models may together form the basis for the development of a support programme for relatives of critically ill patients that encompasses the whole course of illness and recovery, which means that both institutional and community-based care would be involved.

    List of papers
    1. Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis
    Open this publication in new window or tab >>Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis
    2002 (English)In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 18, no 2, p. 96-108Article in journal (Refereed) Published
    Abstract [en]

    The aim of the study was to generate a theoretical model of how relatives/close friends cope when faced with having an adult next-of-kin/close friend admitted to critical care. Using interviews, data were collected from 18 relatives/close friends of adult patients in thoracic surgical, neurosurgical, coronary, and general ICUs in south-west Sweden. The design incorporated grounded theory methodology. The results indicate the relatives/close friends tried to make the experience of their situation easier, but that the approaches used differed in accordance with the individual’s internal and external resources. Four coping strategies exhibiting different characteristics were identified: the relatives/close friends alleviated, recycled, mastered, or excluded their feelings. Factors determining the choice of coping strategy were social background, previous experience of ICU-care and how the situation was apprehended. The theoretical model described in this article can contribute to expanding nurses’ understanding of the coping strategies of relatives/close friends in critical care.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13957 (URN)10.1016/S0964-3397(02)00019-8 (DOI)
    Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2009-05-20
    2. Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness
    Open this publication in new window or tab >>Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness
    2004 (English)In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 20, no 5, p. 281-291Article in journal (Refereed) Published
    Abstract [en]

    The trend within the Swedish healthcare system is to reduce the duration of hospital care. This means that a patient who is discharged to their home after critical illness is highly likely to be functionally impaired, and therefore, requires care-giving assistance from a family member. The aim of this study was to generate a theoretical model with regard to relatives’ coping when faced with the situation of having an adult next-of-kin recovering at home after critical illness. The design incorporated grounded theory methodology. Four coping strategies exhibiting different characteristics were identified: volunteering, accepting, modulating and sacrificing. Factors determining the choice of coping strategy were the physical and psychological status of the relative, previous experience of ICU-care and the psychological status of the patient. The theoretical model described in this article can contribute to expanding healthcare professionals’ understanding of the coping strategies of relatives during recovery, but also provide inspiration for social action to be taken.

    Keywords
    Strategies of relatives, Psychological status, Critical illness
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13958 (URN)10.1016/j.iccn.2004.06.007 (DOI)
    Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2009-05-20
    3. Theoretical model of coping among relatives of patients in intensive care units: A simultaneous concept analysis
    Open this publication in new window or tab >>Theoretical model of coping among relatives of patients in intensive care units: A simultaneous concept analysis
    Show others...
    2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 56, no 5, p. 463-471Article in journal (Refereed) Published
    Abstract [en]

    Aim. This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area. Background. When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery. Method. Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home. Findings. The theoretical model was developed in 2004-2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated. Conclusion. This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used. © 2006 The Authors.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-36817 (URN)10.1111/j.1365-2648.2006.04040.x (DOI)32682 (Local ID)32682 (Archive number)32682 (OAI)
    Note
    The original titel on the day of the defence date was "A model of coping approaches among relatives of critically ill patients: a simultaneous concept analysis".Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
    4. What is supportive when an adult next-of-kin is in critical care?
    Open this publication in new window or tab >>What is supportive when an adult next-of-kin is in critical care?
    2005 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 10, no 6, p. 289-298Article in journal (Refereed) Published
    Abstract [en]

    There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented.

    Keywords
    Critical care, Empowerment, Family, Grounded theory, Resources, Support
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13960 (URN)10.1111/j.1362-1017.2005.00136.x (DOI)
    Available from: 2006-09-07 Created: 2006-09-07 Last updated: 2017-12-13
    Download full text (pdf)
    FULLTEXT01
  • 346.
    Johansson, Ingrid
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    Växjö University.
    Hildingh, Cathrine
    Halmstad University.
    What is supportive when an adult next-of-kin is in critical care?2005In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 10, no 6, p. 289-298Article in journal (Refereed)
    Abstract [en]

    There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented.

  • 347.
    Johansson, Ingrid
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Why do women refrain from Mammography screenings?1999In: 10th International Interdisciplinary congress on Women's Health Issues, Indianapolis., 1999Conference paper (Refereed)
  • 348.
    Johansson, Ingrid
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fridlund, Bengt
    School of Social and Health Sciences, Halmstad University, Halmstad and Department of Nursing, Lund University, Lund, Sweden.
    Hildingh, Cathrine
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness2004In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 20, no 5, p. 281-291Article in journal (Refereed)
    Abstract [en]

    The trend within the Swedish healthcare system is to reduce the duration of hospital care. This means that a patient who is discharged to their home after critical illness is highly likely to be functionally impaired, and therefore, requires care-giving assistance from a family member. The aim of this study was to generate a theoretical model with regard to relatives’ coping when faced with the situation of having an adult next-of-kin recovering at home after critical illness. The design incorporated grounded theory methodology. Four coping strategies exhibiting different characteristics were identified: volunteering, accepting, modulating and sacrificing. Factors determining the choice of coping strategy were the physical and psychological status of the relative, previous experience of ICU-care and the psychological status of the patient. The theoretical model described in this article can contribute to expanding healthcare professionals’ understanding of the coping strategies of relatives during recovery, but also provide inspiration for social action to be taken.

  • 349.
    Johansson, Ingrid
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hildingh, Cathrine
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Fridlund, Bengt
    School of Social and Health Sciences, Halmstad University, Halmstad and Department of Nursing, Lund University, Lund, Sweden.
    Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis2002In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 18, no 2, p. 96-108Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to generate a theoretical model of how relatives/close friends cope when faced with having an adult next-of-kin/close friend admitted to critical care. Using interviews, data were collected from 18 relatives/close friends of adult patients in thoracic surgical, neurosurgical, coronary, and general ICUs in south-west Sweden. The design incorporated grounded theory methodology. The results indicate the relatives/close friends tried to make the experience of their situation easier, but that the approaches used differed in accordance with the individual’s internal and external resources. Four coping strategies exhibiting different characteristics were identified: the relatives/close friends alleviated, recycled, mastered, or excluded their feelings. Factors determining the choice of coping strategy were social background, previous experience of ICU-care and how the situation was apprehended. The theoretical model described in this article can contribute to expanding nurses’ understanding of the coping strategies of relatives/close friends in critical care.

  • 350.
    Johansson, Magdalena
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nyirenda, John L Z
    Embangweni Mission Hospital, Mzimba, Malawi.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lorefält, Birgitta
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Perceptions of Malawian Nurses about Nursing Interventions for Malnourished Children and Their Parents2011In: Journal of Health, Population and Nutrition, ISSN 1606-0997, E-ISSN 2072-1315, Vol. 29, no 6, p. 612-618Article in journal (Refereed)
    Abstract [en]

    in developing countries, malnutrition among children is a major public-health issue. The aim of the study was to describe perceptions of Malawian nurses about nursing interventions for malnourished children and their parents. A qualitative method was used. Data were collected and analyzed according to the phenomenographic research approach. Twelve interviews were performed with 12 nurses at a rural hospital in northern Malawi, Southeast Africa. Through the analysis, two major concepts, comprising four categories of description, emerged: managing malnutrition today and promotion of a favourable nutritional status. The categories of description involved identification and treatment of malnutrition, education during treatment, education during prevention, and assurance of food security. The participating nurses perceived education to be the most important intervention, incorporated in all areas of prevention and treatment of malnutrition. Identification and treatment of malnutrition, education during treatment, education to prevent malnutrition, and assurance of food security were regarded as the most important areas of intervention.

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