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Managing uncertainty in couples living with atrial fibrillation
Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
Vise andre og tillknytning
2014 (engelsk)Inngår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, nr 3, s. E1-E10Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

Objective: The aim of this study was to explore couples’ main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

Methods: Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

Results: Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples’ shifting between implicit and explicit sharing.

Conclusions: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples’ daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

sted, utgiver, år, opplag, sider
2014. Vol. 29, nr 3, s. E1-E10
Emneord [en]
atrial fibrillation, couples, grounded theory, qualitative research, uncertainty
HSV kategori
Identifikatorer
URN: urn:nbn:se:hj:diva-23464DOI: 10.1097/JCN.0b013e3182a180daISI: 000337681400001PubMedID: 24108265Scopus ID: 2-s2.0-84899480539OAI: oai:DiVA.org:hj-23464DiVA, id: diva2:695982
Tilgjengelig fra: 2014-02-12 Laget: 2014-02-12 Sist oppdatert: 2017-12-06bibliografisk kontrollert
Inngår i avhandling
1. Partner relationship in couples living with atrial fibrillation
Åpne denne publikasjonen i ny fane eller vindu >>Partner relationship in couples living with atrial fibrillation
2016 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The aim of this thesis was to describe and explore how the partner relationship of patient–partner dyads isaffected following cardiac disease and, in particular, atrial fibrillation (AF) in one of the spouses.

The thesis is based on four individual studies with different designs: descriptive (I), explorative (II, IV), and cross-sectional (III). Applied methods comprised a systematic review (I) and qualitative (II, IV) and quantitative methods (III). Participants in the studies were couples in which one of the spouses was afflicted with AF. Coherent with a systemic perspective, the research focused on the dyad as the unit of analysis. To identify and describe the current research position and knowledge base, the data for the systematic review were analyzed using an integrative approach. To explore couples’ main concern, interview data (n=12 couples) in study II were analyzed using classical grounded theory. Associations between patients and partners (n=91 couples) where analyzed through the Actor–Partner Interdependence Model using structural equation modelling (III). To explore couples’ illness beliefs, interview data (n=9 couples) in study IV were analyzed using Gadamerian hermeneutics.

Study I revealed five themes of how the partner relationship is affected following cardiac disease: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Study II showed that couples living with AF experienced uncertainty as the common main concern, rooted in causation of AF and apprehension about AF episodes. The theory of Managing Uncertainty revealed the strategies of explicit sharing (mutual collaboration and finding resemblance) and implicit sharing (keeping distance and tacit understanding). Patients and spouses showed significant differences in terms of self-reported physical and mental health where patients rated themselves lower than spouses did (III). Several actor effects were identified, suggesting that emotional distress affects and is associated with perceived health. Patient partner effects and spouse partner effects were observed for vitality, indicating that higher levels of symptoms of depression in patients and spouses were associated with lower vitality in their partners. In study IV, couples’ core and secondary illness beliefs were revealed. From the core illness belief that “the heart is a representation of life,” two secondary illness beliefs were derived: AF is a threat to life, and AF can and must be explained. From the core illness belief that “change is an integral part of life,” two secondary illness beliefs were derived: AF is a disruption in our lives, and AF will not interfere with our lives. Finally, from the core illness belief that “adaptation is fundamental in life,” two secondary illness beliefs were derived: AF entails adjustment in daily life, and AF entails confidence in and adherence to professional care.

In conclusion, the thesis result suggests that illness, in terms of cardiac disease and AF, affected and influenced the couple on aspects such as making sense of AF, responding to AF, and mutually incorporating and dealing with AF in their daily lives. In the light of this, the thesis results suggest that clinicians working with persons with AF and their partners should employ a systemic view with consideration of couple’s reciprocity and interdependence, but also have knowledge regarding AF, in terms of pathophysiology, the nature of AF (i.e., cause, consequences, and trajectory), and treatments. A possible approach to achieve this is a clinical utilization of an FSN based framework, such as the FamHC. Even if a formalized FSN framework is not utilized, partners should not be neglected but, rather, be considered a resource and be a part of clinical caring activities. This could be met by inviting partners to take part in rounds, treatment decisions, discharge calls or follow-up visits or other clinical caring activities. Likewise, interventional studies should include the couple as a unit of analysis as well as the target of interventions.

sted, utgiver, år, opplag, sider
Jönköping: Jönköping University, School of Health and Welfare, 2016. s. 96
Serie
Dissertation Series. School of Health and Welfare, ISSN 1654-3602 ; 75
Emneord
Atrial fibrillation, cardiac disease, couples, partner-relationship
HSV kategori
Identifikatorer
urn:nbn:se:hj:diva-32272 (URN)978-91-85835-74-4 (ISBN)
Disputas
2016-12-16, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2016-11-25 Laget: 2016-11-14 Sist oppdatert: 2016-12-05bibliografisk kontrollert

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