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  • 1.
    Ernsth-Bravell, Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Finkel, D.
    Indiana University Southeast, New Albany, IN, USA.
    Using National Quality Registries In Gerontological Research: Pros and Cons2018In: Innovation in Aging, ISSN 1556-343X, Vol. 2, no suppl_1, p. 149-149Article in journal (Refereed)
    Abstract [en]

    Health care in Sweden usually focuses on single diseases and is less prepared to treat people with multimorbidity. Combining different national quality registries (NQR) can provide a broader picture of health care, preventive care, and health-promoting care of older people with multimorbidity. The aim of this study was to explore how NQRs can be used in gerontological health care research. A descriptive mixed-method study, including a case report and statistical analysis, was performed. Nine National Quality Registries, three health registries and a social care registry maintained by the Swedish government were individually matched to an older population (birth year 1896 to 1958) in the Swedish Twin Registry (n≈44000). Factor analysis demonstrated the people tended to fall into one of 4 clusters of registries: stroke/dementia/hip, heart/diabetes, arthritis-related, and other. Men were more highly represented in the heart/diabetes cluster. People in the arthritis cluster had the lowest mean age; people in the stroke/dementia/hip cluster had the highest mean age. 161 people were identified as “most ill elderly” (according to the definition by the Swedish government). Two of them were randomly selected for case reports. Each case appeared in 6–7 of the health quality registries, providing sufficient information to track their progression through the health care system until the point of death. The results highlight both pros and cons of using the quality registries as the basis for analysis and “registry-enriched” research designs, but more research needs to be performed to understand how NQRs can be used in gerontological research.

  • 2.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Effects of using a preventive care model among persons with dementia in ordinary home and nursing home with poor nutritional status2018Conference paper (Refereed)
  • 3.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Foodwork and meals in everyday life among persons with dementia and their partners2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to explore and describe foodwork and meals for older persons with dementia and their partners in ordinary homes.

    Descriptive and explorative designs were used in the four papers this thesis is based on. Longitudinal data, including older home-living unlike-sex twins, were analysed using descriptive and analytical statistics. An ethnographic approach was used to describe everyday life for persons with dementia. Interviews with partners and staff were analysed using thematic analysis and qualitative content analysis, respectively.

    The results revealed that, among home-living older persons, there is an association between a person’s cognitive ability and nutritional status; i.e. low cognitive ability leads to increased risk of malnutrition. For home-living persons with dementia and their partners, foodwork and meals sometimes changed, meaning that shopping, preparing food and eating as well as social interaction become complicated, which seemed to lead to transitions in roles, routines and relations. There was foodwork that the persons with dementia could perform, and participants expressed a desire that abilities and independence be preserved. However, support was sometimes needed, and it was emphasized that this was based on the person’s needs, wishes and problems.

    In conclusion, there is an association between decreased cognitive ability and increased risk of malnutrition. Furthermore, foodwork and meals affected both persons with dementia and their partners. Therefore, early intervention whereby both partners in a couple get individually adjusted support is of importance. Consequently, a person-centred care approach can be useful in arranging the support.

  • 4.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Sidenvall, Birgitta
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Spouses' experiences of mealtimes with a partner suffering from dementia2014In: The journal of aging research & clinical practice, ISSN 2273-421X, Vol. 3, no 4, p. 237-244Article in journal (Refereed)
    Abstract [en]

    Background: As difficulties in performing daily activities occur among persons with dementia, their spouses are also affected. This is also true for mealtimes, yet there is a lack of knowledge and research into how couples manage this situation at home. Objective: The aim of the study was to explore and describe spouses’ experiences of mealtimes in couples in which one partner has dementia. Design, Setting and Participants: Ten spouses were interviewed in their home in respect to their experiences regarding mealtimes when living with a partner diagnosed with dementia. To identify themes across the data set, thematic analysis was conducted. Results: One major theme, Recognizing and managing the range of mealtime change, was identified and showed that depending on where the families were in the dementia process their experienced varied. As progression occurred in the partners disease, routines, responsibilities and relationships were affected within the couple. Strategies the participants used tomanage mealtimes at home regarding these problems were highlighted such as getting support from social services, but also strategies they had learnt by themselves. Conclusion: These results generate an insight into what couples face, and their needs for support. Spouses experiences varied which indicates that it is important that support is based on individual needs. Hence, nursing staff should continuously pay attention to couples mealtime situation. Further it increases staff´s knowledge regarding possible solutions on how to involve persons with dementia in mealtime activities and maintain their nutritional intake.

  • 5.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sidenvall, Birgitta
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Staff views on how to improve mealtimes for elderly people with dementia living at home2017In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 16, no 7, p. 835-852Article in journal (Refereed)
    Abstract [en]

    Dementia commonly leads to difficulties in performing daily activities, which can also often affect the ability to prepare and eat meals. As a result, formal support to maintain good nutritional intake might be needed, but there is a lack of knowledge concerning how to support older persons with dementia living at home. The aim of this study was to explore and describe staff views on how to improve mealtimes for persons with dementia who are still living at home. A qualitative descriptive study was performed and data were collected during 2011–2012 through four focus group interviews with staff working in the homes of persons with dementia. Data were analyzed using inductive content analysis. The participants described several ways to improve mealtimes for persons with dementia and advocated adjustments facilitating the preservation of the persons’ independence. Finding suitable actions calls for knowledge about the person and his/her individual situation. Proposed actions were enabling meals at home, taking over, and moving meals outside of the home. In addition, it was found that, the types of meals served to these persons should be as familiar to the individual as possible. The results of this study indicate the importance of using a person-centered approach and meeting the individual needs when supporting people with dementia in regards to their meals when living at home. Individualized care in the home may be expensive, however, it is fair to say that people who become malnourished and admitted to hospitals is even more costly. Furthermore, sharing and reflecting experiences and knowledge can assist staff to identify ways to manage complex situations. Therefore, the use of refection should be a part of staff members’ everyday work.

  • 6.
    Johansson, Linda
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Christensson, Lennart
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Sidenvall, Birgitta
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Managing mealtimes tasks: told by persons with dementia2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17, p. 2552-2562Article in journal (Refereed)
    Abstract [en]

    AIM: To capture the self-description of managing mealtime tasks by persons with dementia.

    BACKGROUND: There are several factors that negatively affect food intake in persons with dementia that may increase the risk of developing malnutrition. Difficulties in managing daily activities increase gradually and mealtime tasks like food shopping, cooking and eating often become troublesome. Still, little is known about how persons with dementia themselves experience this issue.

    DESIGN: A qualitative study with an ethnographic approach.

    METHOD: Ten women and five men aged 69-86 with dementia were interviewed. Interviews were carried out in the informants' own homes and a thematic analysis was performed.

    RESULTS: The informants described that they wanted to be independent and that the memory loss was not affecting them to a great extent. Old habits and routines, as well as newly developed strategies, helped them manage mealtime tasks despite the disease. Informants were satisfied with their current situation, even though it sometimes meant that they had changed their way of managing mealtime tasks, for instance receiving meals-on-wheels.

    CONCLUSIONS: Persons with dementia seem to be able to manage mealtime tasks and these activities were based on old habits and routines. Independence was highly valued and managing mealtime tasks seems to be one way to appear independent.

    RELEVANCE TO CLINICAL PRACTICE:

    It is important for caregivers to understand that persons with dementia might not express difficulties in managing mealtime tasks for fear of losing their independence. It is, therefore, important to create a trustful relationship even before problems arise to be able to support the persons when necessary.

  • 7.
    Johansson, Linda
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Sidenvall, Birgitta
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Malmberg, Bo
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Christensson, Lennart
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Who will become malnourished?: A prospective study of factors associated with malnutrition in older persons living at home2009In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 13, no 10, p. 855-861Article in journal (Refereed)
  • 8.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Silén, Marit
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Gävle, Sweden.
    Research methods in nursing students’ Bachelor's theses in Sweden: A descriptive study2018In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 66, p. 187-193Article in journal (Refereed)
    Abstract [en]

    Background: During the nursing programme in Sweden, students complete an independent project that allows them to receive both a professional qualification as a nurse and a Bachelor's degree. This project gives students the opportunity to develop and apply skills such as critical thinking, problem-solving and decision-making, thus preparing them for their future work. However, only a few, small-scale studies have analysed the independent project to gain more insight into how nursing students carry out this task.

    Objectives: The aim of the present study was to describe the methods, including ethical considerations and assessment of data quality, applied in nursing students’ independent Bachelor's degree projects in a Swedish context.

    Design: A descriptive study with a quantitative approach.

    Methods: A total of 490 independent projects were analysed using descriptive statistics.

    Results: Literature reviews were the predominant project form. References were often used to support the analysis method. They were not, however, always relevant to the method. This was also true of ethical considerations. When a qualitative approach was used, and data collected through interviews, the participants were typically professionals. In qualitative projects involving analysis of biographies/autobiographies or blogs participants were either persons with a disease or next of kin of a person with a disease.

    Conclusions: Although most of the projects were literature reviews, it seemed unclear to the nursing students how the data should be analysed as well as what ethical issues should be raised in relation to the method. Consequently, further research and guidance are needed. In Sweden, independent projects are not considered research and are therefore not required to undergo ethics vetting. However, it is important that they be designed so as to avoid possible research ethics problems. Asking persons about their health, which occurred in some of the empirical projects, may therefore be considered questionable. 

  • 9.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Wijk, Helle
    Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Improving Nutritional Status of Older Persons with Dementia Using a National Preventive Care Program2017In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 3, p. 292-298Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to investigate the outcome of change in body weight associated with use of a structured preventive care process among persons with dementia assessed as at risk of malnutrition or malnourished. The preventive care process is a pedagogical model used in the Senior Alert (SA) quality register, where nutrition is one of the prioritized areas and includes four steps: assessment, analysis of underlying causes, actions performed and outcome.

    DESIGN: An analysis of data from SA with a pre-post design was performed.

    SETTING: The participants were living in ordinary housing or special housing in Sweden.

    PARTICIPANTS: 1912 persons, 65 years and older, registered in both SA and the dementia quality register Svedem were included.

    INTERVENTION: A national preventive care program including individualized actions.

    MEASUREMENTS: The Mini Nutritional Assessment-Short Form was used to assess nutritional status at baseline. Body weight was measured during baseline and follow-up (7-106 days after baseline).

    RESULTS: 74.3% persons were malnourished or at risk of malnutrition. Those at risk of malnutrition or malnourished who were registered in all four steps of the preventive care process, increased in body weight from baseline (Md 60.0 kg) to follow-up (Md 62.0 kg) (p=0.013). In those with incomplete registration no increase in body weight was found.

    CONCLUSION: Using all steps in the structured preventive care process seems to improve nutritional status of persons with dementia assessed as at risk of malnutrition or malnourished. This study contributes to the development of evidence-based practice regarding malnutrition and persons with dementia.

  • 10.
    Lannering, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Effects of a preventive care process for prevention of malnutrition, falls and pressure ulcers among older people living in Swedish nursing homesManuscript (preprint) (Other academic)
  • 11.
    Lannering, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Region Jönköping County, Futurum, Länssjukhuset Ryhov.
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Prevention of falls, malnutrition and pressure ulcers among older persons: nursing staff’s experiences of a structured preventive care process2017In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 25, no 3, p. 1011-1020Article in journal (Refereed)
    Abstract [en]

    A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, teambased interventions and evaluation of results. Since development, this structured work process has become web-based and has been implemented in a national quality registry called ‘Senior Alert’ and used countrywide. The aim of this study was to describe nursing staff’s experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and homebased nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team-based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work.

  • 12.
    Lannering, Christina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Region Jönköping County, Futurum, Länssjukhuset Ryhov, Sweden.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    The effect of a structured nutritional care programme in Swedish nursing homes2017In: The Journal of Nursing Home Research Sciences, ISSN 2496-0799, no 3, p. 64-70Article in journal (Refereed)
    Abstract [en]

    Objective: Malnutrition with consequent weight loss is a well-known problem among older frail persons living in nursing homes. The objective of this study was to examine the effect of a structured preventive care programme including an individualized nutrition plan. Design: A retrospective study, based on already collected data from two different nursing home populations. One population constituted a group of nursing home residents receiving the nutritional care programme (ncp-group), including individually performed nutritions actions. The ncp-group (N=135) was registered in the national quality registry Senior Alert (SA), a platform for following of this preventive care process. The other population constituted a group of nursing home residents receiving “care as usual” (n=186), ie not using the nutritional care programme, collected from the study SHADES. The two populations was compared by a quasi-experimental pre-posttest design with a follow-up time of 5–7 months.

    Settings: Nursing homes in Sweden.

    Participants: Two populations of nursing home residents assessed to be at risk for malnutrition, or to be already malnourished, according to the short form of the Mini Nutritional Assessment (MNA-SF).

    Intervention: The ncp-group received a structured, individually targeted care programme including risk assessments, team-based decisions on actions, and evaluation of results.

    Measurements: Body weight and weight changes were monitored over time. Additionally, nutritional status was described using the MNA-SF scores and body mass index (BMI).

    Results: No statistically significant differences in body weight, MNA-SF or BMI between the groups were found at follow-up. However, within-group analyses in the group followed in SA showed improved outcomes.

    Conclusion: This suggest small differences in nutritional care provided at nursing homes working with SA and “care as usual” in nursing homes, not working with SA.

  • 13.
    Lindmark, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jansson, Henrik
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Periodontology, Centre of Oral Health Sciences, Malmö University, Malmö, Sweden.
    Lannering, Christina
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Oral health matters for the nutritional status of older persons: A population-based study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1143-1152Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the association between oral health and nutritional status in the context of daily care for older people.

    BACKGROUND: Oral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people.

    DESIGN: A retrospective cross-sectional study.

    METHODS: Data from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide-Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8 ± 7.9) had both oral and nutritional assessments registered by the nursing staff in daily care.

    RESULTS: Approximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one-third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished.

    CONCLUSION: There is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems.

    RELEVANCE TO CLINICAL PRACTICE: Nursing staff involved in care for older people should be aware of the importance of including regular oral health check-ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge.

  • 14.
    Lu, Qi
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Tianjin Medical University, China.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Zhao, Y.
    Tianjin Medical University, China.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Living on the edge: Family caregivers’ experiences of caring for post-stroke family members in China: A qualitative study2019In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 94, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Globally, one-third of the 15 million people with stroke suffer permanent physical, cognitive, and emotional impairment. Because of traditional Chinese culture and the limited development of the primary healthcare system, most stroke survivors are cared for and live with their family after hospital discharge. However, previous literature shows a lack of qualitative studies on family caregivers’ experience of caring for their relatives in China. Objectives: The aim of this study was to explore the experience of family caregivers taking care of stroke survivors in China. Methods: An explorative design was used wherein qualitative semi-structured interviews were conducted with family caregivers in China. Family caregivers were selected from one city and three communities using a purposive sampling method until no new data were generated (n = 26). A thematic analysis was used for the data analysis in this study. Findings: Family caregivers’ experience was described as living on the edge, which pulled their lives in multiple directions, created an unstable situation, and reduced their well-being and health. The participants believed they had total responsibility and felt that this was expected from both themselves and society. Little external understanding and insufficient support was emphasised, resulting in the caregivers feeling all alone, drained by caring, and like prisoners in their own lives. The family caregivers had to face all of the family events and make all of the decisions by themselves. They expressed love for their family members with stroke, but this was often overshadowed by feelings of sadness, depression, sensitivity, and anger. This resulted in an inability to see how things could improve and in the family caregivers being uncertain about the future. Conclusion: All of these findings increased understanding and added knowledge of this topic that has been seldom studied in China. Healthcare authorities and professionals should recognise and understand the lives and situations of family caregivers since their relatives had a stroke to further identify their difficulties and needs. Appropriate and effective support, both from government and society, should be planned and implemented for family caregivers to relieve them from caring for their relatives with stroke and maintaining the quality of their own lives.

  • 15.
    Siebmanns, Sandra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, M.
    Linkoping University Hospital, Department of clinical neurophysiology, Linkoping, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Johansson, P.
    Linkoping University Hospital, Department of Cardiology and Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Insomnia in patients with cardiovascular disease - a review of causes, consequences and nursing interventions2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S31-S31Article in journal (Refereed)
    Abstract [en]

    Introduction: Insomnia is defined as a subjective complaint of difficulty to initiate sleep, difficulty to maintain sleep, and early morning awakenings that occur at a minimum of 3 nights per week for 3 months. The prevalence of insomnia in the general adult population is estimated to 12–20%. The prevalence is even higher among those with cardiovascular disease (CVD). Insomnia has a significant impact on the individual’s health and quality of life.

    Aim: To examine causes, consequences and nursing interventions for insomnia in patients with CVD.

    Design: Literature review.

    Method: Electronic search through PubMed and Cinahl for studies published 2001-2016. Insomnia, CVD, causes, consequences, interventions and nurse-led intervention were used as keywords. Detected duplicates, irrelevant studies and others (i.e., editorials, letters) were removed. “Insomnia and CVD” resulted in 214 hits, “insomnia and CVD and causes” in 394 hits, “insomnia and CVD and consequences” in 35 hits, and “insomnia and CVD and interventions” resulted in 51 hits.

    Results: Insomnia causes impaired daytime functioning, poorer cognitive function and a feeling of isolation. The pathophysiological consequences of insomnia are associated with increased risk for arteriosclerosis and CVD (i.e., caused by an increased inflammatory processes). Pharmacological treatment for insomnia have been used for some time (i.e., sedative, hypnotics and antidepressant), but there are concerns about tolerance and dependence, as well as other side effects (i.e., falls, cognitive changes and unusual sleep behaviours) which requires a thorough risk and benefit analysis before prescription. Non-pharmacological treatments such as Cognitive behavioural therapy (CBT) and internet-based CBT (I-CBT) for insomnia, led by therapists, is a less expensive intervention used in previous studies for othe rpatient groups. Despite positive results for both CBT andI-CBT (i.e., improved performance, increased quality of life and reduced symptom burden) in these studies no nurse-led interventions (i.e., of any type) intended for patients with CVD and insomnia were found.

    Conclusion: I-CBT for insomnia seems to be an accessible and effective treatment for other patient groups. The lack of nurse-led interventions, highlights the need for future studies in patients with CVD and insomnia.

  • 16.
    Siebmanns, Sandra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, M.
    Linkoping Univ Hosp, Dept Clin Neurophysiol, Linkoping, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Johansson, P.
    Linkoping Univ, Dept Cardiol, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Internet-based CBT for insomnia in the general population - a description of design, measurements and interventions in recent RCT studies2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 1, SI, p. 290-291, article id P436Article in journal (Refereed)
    Abstract [en]

    Objectives/Introduction: Internet-based cognitive behavioural therapy for insomnia (ICBTi) has been proposed as an effective, accessible, non-pharmacologic treatment for insomnia disorder. The objective was to perform a literature review of published randomized controlled trials (RCT).

    Methods: Literature review. PubMed was used to identify RCTs ofICBTi published since 2013. Keywords were insomnia, ICBT and RCT. The search resulted in 40 hits. Papers with study designs and methods not relevant to the objective were removed (n = 29). Reasons for exclusion were: only study protocol, not internet-based, and results based on old data.

    Results: Design: Recruitment were done via e-mail, from websites, online ads, and advertisements in local newspapers.

    Inclusion criteria: Six studies based their inclusion only on ISI score (from >7to>=15). 3 studies used a combination of ISI and DSM-IV. Two studies used DSM-IV only.

    Sample sizes: 4 studies had less than 100 participants, and 2 studies over 200, the mean number was 139 participants (48-303). The mean age varied from 15 to 52 years. Significantly more female participants in all studies.

    Data collection: ISI combined with sleep diary was the most commonly used primary or secondary outcome measurements (n =7), 2 used ISI only, and 2 used sleep diary only. Other common instruments were, PSQI, HADS, DBAS-16 and CES-D. All studies had pre- and post-treatment measurements, but none during the intervention. The follow-up-period varied between 8 weeks and 3 years. The most common follow-up time was 6 months (n = 4), with a range from 4 weeks3years.Intervention: Most of the studies (n = 10) used traditional ICBTi-treatments (i.e., stimulus control, sleep restriction, relaxation, sleep hygiene). One study did not include stimulus control. The treatment duration were six weeks (n = 8), eight weeks (n = 2) and nine weeks (n = 1). All except one used therapist guided support.

    Results: All studies showed significant post treatment improvements on sleep outcomes.

    Conclusions: All studies showed significant improvement with regard to sleep. The total number of participants in the studies was relatively low. Most studies are not based on clinical samples, which may affect the generalizability of the findings.

    Disclosure: Nothing to disclose

  • 17.
    Siebmanns, Sandra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, M.
    Linkoping University Hospital, Department of clinical neurophysiology, Linkoping, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Johansson, P.
    Linkoping University Hospital, Department of Cardiology and Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Internet-based Intervention to treat insomnia in patients with cardiovascular disease2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S75-S75Article in journal (Refereed)
    Abstract [en]

    Introduction: Insomnia (i.e., trouble initiating sleep,maintaining sleep or difficulties getting enough sleep) is a prevalent problem among patients with cardiovascular disease (CVD). It is associated with physical and mental symptoms such as impaired daytime functioning, worries and depressive symptoms. Recent studies in other patient groups have described Internet-based Cognitive behavioral treatment (I-CBT) as a promising accessible and cost effective intervention. Few if any studies are conductedin CVD patients with insomnia despite the possibility of reduced symptom burden, reduced cardiovascular morbidity and improved quality of life (QoL).

    Aim: To describe the design, content and measures in theHit-IT study, an intervention developed to treat insomnia in patients with CVD.

    Design: An explorative design with 1 year followup including 200 primary care patients with CVD and insomnia from 4 centers. Patients will be randomized to 9 weeks of I-CBT, or to a control group receiving internetbased sleep hygiene without support.

    CONTENT: The I-CBT intervention starts with a 1 week introduction, 2 weeks of psychoeducation (i.e., CVD and insomnia), followed by a 6 weeks treatment part (i.e., sleep hygiene, stimulus control and sleep restriction). Participants can communicate with a nurse and receive feedback during treatment. A psychologist will act as back-up.

    MEASURES: Questionnaires will be administered at baseline, during and post intervention at 6 and 12 months’. The questionnaires will focus on e.g., educational effects, as well as on effects regarding symptoms; sleep/insomnia (PSQI, ISI, ESS, sleep diary), depressive symptoms (PHQ-9), as well as QoL (SF12). The participants’ experience of the program will be explored by repeated interviews (at baseline, after 3 weeks, 6 weeks and after the intervention).

    Conclusion: Depending on its effectiveness a nurseled I-CBT program can be a possible tool for insomnia treatment in cardiovascular care.

  • 18.
    Siebmanns, Sandra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, M.
    Linkoping Univ Hosp, Dept Clin Neurophysiol, Linkoping, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Johansson, P.
    Linkoping Univ, Dept Cardiol, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    "You can’t always get what you want” - methodological challenges with an internet-based CBT intervention for insomnia among patients with cardiovascular disease2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, no 1, SI, p. 291-291, article id P437Article in journal (Refereed)
    Abstract [en]

    Objectives/Introduction: Internet‐based cognitive behavioural therapy for insomnia (ICBTi) is a frequently used intervention. Published studies are promising, but methodological limitations (e.g., heterogeneity, low number of participants, unclear adherence to the intervention) have been reported. The aim was to describe methodological challenges perceived in the Hit‐IT study, an ongoing ICBTi study for patients with insomnia and cardiovascular disease (CVD).

    The Hit‐IT study: Design: RCT with 1‐year follow‐up. All patients with CVD (i.e., myocardial infarction, heart failure, atrial fibrillation and angina) from 6 primary care centers are screened for insomnia and during a clinical examination diagnosed according to DSM‐V criteria.Intervention: 9 weeks I‐CBTi (1‐week introduction, 2 weeks psychoeducation on CVD/insomnia, 6 weeks of sleep hygiene, stimulus control and sleep restriction) vs 3 weeks internet‐based sleep hygiene education.Questionnnaires: Sleep (Pittsburg Sleep Quality Index, Insomnia Severity Index, sleep diary), depressive‐ and cardiac symptoms (Patient Health Qurestionnaire‐9, Cardiac Anxiety Questionnaire) and Quality of Life (SF‐12) at baseline, during and after intervention (after 6 and 12 months).

    Methods: Interim analysis with descriptive statistics.

    Results: Out of 2170 approached patients with diagnosed CVD1508 (70%) responded (No=1330/Yes=178). Of the 178 approvals (124 men/54 women), 54 did not complete internet‐based screening (no e‐mail, declined participation and for unknown reasons). Of the 124 participants who completed screening, 40 (34 men/6 women, age range 42‐84 years) were excluded (ISI < 8). In addition, 32 were excluded after telephone contact and clinical examination (declined participation n = 10, no clinical insomnia n = 14, sleep apnea n = 4,restless legs n = 2, epilepsy n = 1, pharmacological side effect n = 1). Currently 46 participants have been randomized in the Hit‐IT study (15 females, 31 males, mean age 71 years/Range 41‐92 years). 19 participants have completed control group (1 dropout related to technical problems, 3 in treatment). In the intervention group, 6 have completed, 4 intentions to treat, 3 dropouts (n = 2 unknown reason, n = 1 technical problems), 10 participants in treatment.

    Conclusions: Clear methodological challenges with regard to the strenuous patient inclusion process are identified. The current study has a higher mean age and higher number of participating men than current ICBTi studies in general population.

    Disclosure: Nothing to disclose.

  • 19.
    Silén, Marit
    et al.
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Sweden.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Aims and theoretical frameworks in nursing students' Bachelor's theses in Sweden: A descriptive study2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, p. 91-96Article in journal (Refereed)
    Abstract [en]

    Background

    Nursing students' independent projects in Sweden not only provide an opportunity to receive a professional qualification as a nurse but also gain a Bachelor's degree in nursing. The aim of these projects is to demonstrate knowledge and understanding within the major field of the education.

    Objectives

    This study aimed to describe and analyze the topics as well as theoretical frameworks and concepts in nursing students' independent projects, which lead to a Bachelor's degree, in a Swedish context.

    Design

    A total of 491 independent projects, written by nursing students in Sweden, were included in the study.

    Methods

    Topics together with theoretical frameworks and concepts in the projects were identified. Similar topics and theoretical frameworks and concepts, respectively, were grouped into subcategories, and similar subcategories were then merged into a main category. The number of entries in each category was counted for descriptive statistics in order to allow for the demonstration of magnitude.

    Results

    The most common topics concerned experiences and managing when having an illness, experiences of care and of being a caregiver, and healthcare staff's care and knowledge. The nursing theories/models that were most often used were Eriksson's Theory of Caritative Caring, Travelbee's Human-to-Human Relationship Model, and Orem's Self-care Theory. Among the non-nursing theories/models, perspectives and concepts lifeworld, ethical values and principles, existential concepts and quality of life/health-related quality of life, were most often used by these students.

    Conclusion

    There may be some difficulty in finding a topic for the project that is relevant for both a professional qualification as a nurse, as well as for achieving the requirements of a Bachelor's degree in nursing. The study indicates that there is a need to widen the student's understanding of different nursing theories/perspectives/models/concepts during nursing education so that students are familiar with a broad range of these when conducting their independent project.

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