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  • 1.
    Alimoradi, Z.
    et al.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Golboni, F.
    Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Griffiths, M. D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, United Kingdom.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Lin, C. -Y
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Weight-related stigma and psychological distress: A systematic review and meta-analysis2019Ingår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background & aims:

    Individuals who are overweight or who have obesity are likely to perceive or experience unfriendly treatment (i.e., weight-related perceived stigma) from different sources such as work colleagues because of the stigma towards excess weight. People who are overweight may accept such stigma and devalue themselves (i.e., weight-related self-stigma).

    Methods:

    A systematic review and meta-analysis was conducted to examine the relationship between weight stigma (including weight-related self-stigma and weight-related perceived stigma) and psychological distress (including depression and anxiety) using random-effects meta-analyses. Utilizing five academic databases (PubMed, Scopus, WOS, Embase and ProQuest) and keywords related to weight stigma and psychological distress, empirical studies focusing on the association between weight stigma and psychological distress were selected. The timeline for the searched papers was from the inception of each database to the end of August 2019.

    Results:

    Eligible studies (N = 30; 25 on weight-related self-stigma and eight on weight-related perceived stigma) were analyzed with a total of 9345 participants experiencing weight-related self-stigma, and 15,496 experiencing weight-related perceived stigma. The pooled associations were moderate between weight-related self-stigma and psychological distress (corrected Fisher's Z = 0.40 for depression; 0.36 for anxiety) and between perceived stigma and depression (Fisher's Z = 0.44).

    Conclusions:

    Results of the meta-analysis demonstrated that weight stigma is associated with psychological distress. The comprehensive search of the literature and rigorous methodology employed are the two major strengths in the present study. Because self-stigma and perceived stigma are different concepts, their associations with psychological distress should not be merged together. 

  • 2.
    Alimoradi, Zainab
    et al.
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Bülow, Pia H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd). Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Bajalan, Zahra
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Ohayon, Maurice M.
    Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, United States.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Internet addiction and sleep problems: A systematic review and meta-analysis2019Ingår i: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 47, s. 51-61Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The pathological use of the internet – conceptualized as ‘internet addiction’ – might be crucial in initiating and increasing sleep disturbances in the community. While inconsistent evidence is reported regarding the association of internet addiction and sleep disturbances, the severity of this association remains unclear. This systematic review and meta-analysis were conducted to increase our understanding of the relationship between internet addiction and sleep disturbances. A systematic review was conducted through Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and EMBASE using keywords related to internet addiction and sleep problems. Observational studies (cohort, case-control or cross-sectional studies) focusing on association between internet addiction and sleep disturbances including sleep problems and sleep duration were selected. A meta-analysis using random-effect model was conducted to calculate the odds ratio (OR) for experiencing sleep problems and standardized mean differences (SMDs) for sleep duration. Eligible studies (N = 23) included 35,684 participants. The overall pooled OR of having sleep problems if addicted to the internet was 2.20 (95% CI: 1.77–2.74). Additionally, the overall pooled SMDs for sleep duration for the IA group compared to normal internet users was −0.24 (95% CI: −0.38, −0.10). Results of the meta-analysis revealed a significant OR for sleep problems and a significant reduced sleep duration among individuals addicted to the internet.

    Publikationen är tillgänglig i fulltext från 2020-07-04 00:00
  • 3.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Factors affecting in-hospital sleep-wake pattern in octogenarians during the early postoperative phase after transcutaneous aortic valve replacement2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S53-S53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Octogenarian patients are an increasing group admitted for advanced cardiac treatment. Little is known about factors disturbing their sleep-wake pattern in the early postoperative phase after transcutaneous aortic valve replacement (TAVI), as current knowledge is based upon studies on younger age groups treated for surgical aortic valve replacement.

    Aim: To determine factors affecting the in-hospital sleep wake pattern in octogenarian patients after TAVI.

    Methods: This is a prospective cohort study in a tertiary university hospital. Inclusion criteria were age > 80 years with severe aortic stenosis accepted for TAVI. Actigraphy was used to identify sleep-wake pattern (sleep time night and sleep time day), and the Minimal Insomnia Symptom Scale (MISS) to measure self-reported insomnia daily during the first five postoperative days. Charlson`s comorbidity index was used as a measure of comorbidities and the Visual Analog Scale (VAS) to rate pain severity. Information regarding duration of anesthesia, blood transfusion and parenteral administration of morphine equivalents were derived from the patients’ medical journals. Multiple regression analysis was used to test associations between variables.

    Results: In all, 65 patients (41 women) were included. Mean age was 85 years (SD 2.8). No significant associations were found between age, comorbidities, blood transfusion and morphine equivalents and sleep. Gender was significantly associated with sleep time night and sleep efficiency as men had shortest duration of sleep from the third to the fifth postoperative night (p < .001, and adjusted R2=.230 to .283). Duration of anesthesia had a significant association with sleep time night and sleep efficiency from the third to the fifth postoperative night (p=.013 to p < .001, and adjusted R2=.230 to .283), where longer duration gave less total sleep and lower sleep efficiency. VAS score correlated with wake time night the third night, where a higher VAS score gave more wake time (p=.006 and adjusted R2 .236).

    Conclusion: Male gender, longer duration of perioperative anesthesia and postoperative pain were associated with disturbances in the postoperative sleep-wake pattern in octogenarian patients in the early postoperative phase after TAVI. This knowledge is important and relevant and should have implications in improving patient care.

  • 4.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Faculty of Health and Social Science, Bergen, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway .
    Factors associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after surgical aortic valve replacement2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S63-S64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Disturbances of the sleep-wake pattern are known phenomenon in the postoperative phase after aortic valve replacement (SAVR) that have negative impact on the morbidity, quality of life and mortality. Octogenarian patients are an increasing group admitted for cardiac surgery, however knowledge is based on younger patients.

    Aims: To determine factors associated with disturbances in postoperative sleep-wake pattern in octogenarian patients after SAVR.

    Methods: A prospective cohort study of octogenarian patients in a single center university hospital. Inclusion criteria were age > 80 years, severe aortic stenosis, accepted for SAVR. Actigraphy was used to identify the sleep-wake pattern (sleep-time, sleep efficiency and wake time night and sleep- and wake-time day) for the five first postoperative days, and the sleep questionnaires Minimal Insomnia Symptom scale (MISS) to measure the selfreported insomnia at baseline and daily for the five first postoperative days. 

    Charlsons comorbidity index was used to score comorbidities and the Visual Analog Scale (VAS), was used to rate pain severity. The patients’ medical journals were used to record duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusions and parenteral administration of morphine equivalents. Multiple regression analysis was used to test associations between variables.

    Results: In all, 78 patients were included (40 women). Mean age was 82 years (SD 2.0). For the sleep-wake pattern first to fifth postoperative night, mean sleep-time night was 330-370 minutes (SD 32-124). Mean sleep efficiency was 68-77% (SD 21-26). Mean sleep-time day was 545-712 minutes (SD 146-169). Mean insomnia score was 1,8-5,3 (SD 2,6-3,8). On the first postoperative night the pain VAS score correlated with wake time night, where a higher VAS indicated more wake time (p=.014, adjusted R2=.213). No other variable; age, gender, duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusion or morphine equivalents showed significant association with the sleep-wake pattern or insomnia.

    Conclusion: Postoperative pain was associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after SAVR. This indicates that pain management may be inadequate for patients after SAVR. More research on this issue is needed to establish data needed to improve treatment and care.

  • 5.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Haaverstad, R.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Instenes, I.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Kuiper, K. K. J.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Ranhoff, A. H.
    University of Bergen, Department of clinical science, faculty of medicine, Bergen, Norway.
    Schjott, J. D.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy2018Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, s. 104-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sleep disturbance and delirium are complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve replacement (TAVI), especially in octogenarian patients. Sedatives and z-hypnotics are medications distributed to promote sleep. However, a knowledge-gap exists on patient experiences with these medications, and sleep and delirium after the cardiac treatment.

    Aim: To explore and describe how octogenarians suffering from delirium after SAVR/TAVI experience their sleep situation related to sedatives and z-hypnotics, in a long-term perspective.

    Methods An explorative and descriptive design with a longitudinal qualitative approach was applied. Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium. Information about administration of sedatives and z-hypnotics was collected from the patients journals. The Confusion Assessment Method (CAM) was used to assess delirium, the Sleep Sufficient Index (SSI) and Minimal Insomnia Symptom Scale (MISS) were used to document self-reported sleep and insomnia. All measures were performed at baseline and daily the five first postoperative days. Ten patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were re-interviewed four years later, focusing on their sleep situation.

    Findings: For the initial interview, five men and five woman, four after TAVI and six after SAVR, mean age 83 were included. One overarching theme revealed; hours in bed represented an emotional chaos. Three sub-themes described the patients experiences with sleep and delirium, a cascade of distressful experiences, the struggle between sleep and activity and elements influencing sleep. In the category physical sleep distractions, sleep medications emerged as a sleep disturbing element but also to evoke delirium. Patients described to be offered sedatives and z-hypnotics in hospital. However, they did not have a positive experience with this as the medication did not make them sleep better. Moreover, they associated the nightmares by the sedatives Four years after the cardiac treatment, the octogenarian patients described that medication did not have a sleep promoting effect, and they did not want it.

    Conclusion: Octogenarian patients are vulnerable to complications like sleep disturbances and delirium. In preventing and treating these conditions, health-care professionals should be aware of the effect and side-effect of sedatives and z-hypnotics in the octogenarian patients. Our findings show that medications should be cautiously used within this group of patients.

  • 6.
    Amofah, Hege A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Bjorvatn, Bjørn
    Norwegian Competence Centre for Sleep Disorders, Bergen, Norway.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement2016Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, nr 2, s. 168-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.

    Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.

    Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.

    Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).

    Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

  • 7.
    Andersson, Bodil T.
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Christensson, Lennart
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Jakobsson, Ulf
    Center for Primary Health Care Research, Faculty of Medicine, Lund University, Lund, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Radiographers' self-assessed level and use of competencies: a national survey2012Ingår i: Insight into Imaging, ISSN 1869-4101, E-ISSN 1869-4101, Vol. 3, nr 6, s. 635-645Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe radiographers' self-assessed level and use of competencies as well as how sociodemographic and situational factors are associated with these competencies, particularly related to work experience.

    METHODS: A cross-sectional design was employed. Radiographers (n = 406) completed the self-administered 28-item questionnaire encompassing two dimensions: 'Nurse-initiated care' and 'Technical and radiographic processes'. The level of competencies was rated on a 10-point scale and the frequency of use on a 6-point scale.

    RESULTS: Most competencies received high ratings both in terms of level and frequency of use. In 'Nurse-initiated care' the competency 'Adequately informing the patient' was rated the highest, while 'Identifying and encountering the patient in a state of shock' and 'Participating in quality improvement regarding patient safety and care' received the lowest ratings. In 'Technical and radiographic processes' the highest rated competencies were 'Adapting the examination to the patient's prerequisites and needs' and 'Producing accurate and correct images'. The lowest frequency of use was 'Preliminary assessment of images'.

    CONCLUSION: The main findings underline the radiographers' high competency in both 'Nurse-initiated care' and 'Technical and radiographic processes'. The lower rated competencies emphasise the importance of continuous professional education and quality improvement.

    MAIN MESSAGES :

    • Assessing radiographers' clinical competencies is fundamental for ensuring professional standards.

    • Most competencies received high ratings both in the nursing and in the radiographic dimensions.

    • The highest rated competencies focussed on information and adaptability to the patients needs.

    • The lowest rated competencies focussed on encountering the patient in shock and image assessments.

    • Age, years in present position and work place only explained a relatively small part of competency.

  • 8.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Arestedt, Kristofer Franzén
    Linköping University.
    Nilsen, Per
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Ulander, Martin
    Linköping University.
    Svanborg, Eva
    Linköping University.
    The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.2010Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, nr 4, s. 603-611Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74-0.86) and acceptable for the subscales (Cronbach's α = 0.62-0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.

  • 9.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Hedberg, Berith
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Futurum – Academy for Health and Care, Region Jönköping County, Sweden.
    Nilsen, Per
    Division of Health Care Analysis, Department of Health and Society, Faculty of Medicine, Linköping University Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital Linköping, Sweden.
    Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic2017Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 3-4, s. 568-577Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated.

    Background: Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence.

    Methods: A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patient's perspective, demonstrate empathy and invest in the end of the consultation) was conducted.

    Results: Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patient's perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end.

    Conclusions: Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel.

    Relevance to clinical practice: A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.

  • 10.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Sunnergren, Ola
    Institution of Experimental and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Nilsen, Per
    Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Department of Health and Society, Linköping University, Linköping, Sweden.
    A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea2013Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, nr 1, s. 173-184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objectives  Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation.

    Educational programme  The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months.

    Methods  A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach.

    Results  72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle.

    Conclusion and practice implications  A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.

  • 11.
    Broström, Anders
    et al.
    Linköping University.
    Johansson, Peter
    Linköping University.
    Sleep disturbances in patients with chronic heart failure and their holistic consequences-what different care actions can be implemented?2005Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, nr 3, s. 183-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sleep disturbances are prevalent among elderly, especially among those with chronic heart failure (CHF) and can affect all dimensions of quality of life (QOL) negatively.

    AIM: To describe the most common causes leading to sleep disturbances in patients with CHF, their consequences from a holistic perspective and different care actions that can be implemented.

    METHODS: MEDLINE and CINAHL databases were searched from 1989 to July 2004.

    FINDINGS: Sleep disordered breathing (SDB), and insomnia were the most common causes for sleep disturbances and occurs in 45--82% (SDB) and one-third (insomnia) of all patients with CHF. SDB cause a disturbed sleep structure with frequent awakenings, as well as several adverse effects on the cardiovascular system causing increased morbidity and mortality. Insomnia, caused by anxiety, an unknown life situation in relation to the debut of CHF, or symptoms/deteriorations of CHF can lead to negative effects on all aspects of QOL, as well as daytime sleepiness.

    CONCLUSION: The high prevalence of sleep disturbances and their holistic consequences should be taken into account when nurses asses and plan the care for patients with CHF. Randomized studies with large sample sizes evaluating non-pharmacological nursing interventions that improve sleep are needed.

  • 12.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nilsen, Per
    Division of Health Care Analysis, Faculty of Health Sciences, Department of Health and Society, Linköping University, 581 83 Linköping, Sweden.
    Gardner, Benjamin
    Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK.
    Johansson, Peter
    Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, 581 85 Linköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
    Validation of the CPAP Habit Index-5: A Tool to Understand Adherence to CPAP Treatment in Patients with Obstructive Sleep Apnea2014Ingår i: Sleep Disorders, ISSN 2090-3545, E-ISSN 2090-3553, nr 929057, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Long-term adherence to continuous positive airway pressure (CPAP) is low among patients with obstructive sleep apnea (OSA). The potential role of "habit" in sustaining adherence to CPAP use has not been studied. This study aimed to establish the relevance of habit to CPAP adherence, via validation of an adaptation of the Self-Report Habit Index (the CPAP Habit Index-5; CHI-5). Analyses focused on the homogeneity, reliability, and factor structure of the CHI-5 and, in line with theoretical predictions, its utility as a predictor of long-term CPAP adherence in middle-aged patients with OSA. A prospective longitudinal design was used. 117 patients with objectively verified OSA intended for CPAP treatment were recruited. Data was collected via clinical examinations, respiratory recordings, questionnaires, and CPAP devices at baseline, 2 weeks, 6 months, and 12 months. The CHI-5 showed satisfactory homogeneity interitem correlations (0.42-0.93), item-total correlations (0.58-0.91), and reliability ( α = 0.92). CHI-5 data at 6 months showed a one-factor solution and predicted 63% of variance in total CPAP use hours after 12 months. Based on the satisfactory measurement properties and the high amount of CPAP use variance it explained, the CHI-5 can be seen as a useful tool in clinical practice.

  • 13.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, P.
    Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    CICE, Linneus University, Växjö, Sweden.
    Ulander, M.
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated2019Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, nr 3, s. 761-768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

    Methods: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

    Results: The reliability of the EBI was confirmed using composite reliability and Cronbach’s alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

    Conclusions: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity. 

  • 14.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Division of Health Care Analysis, Faculty of Health Sciences, Department of Health and Society, Linköping University, Linköping, Sweden.
    Gardner, Benjamin
    Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices2018Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, nr 6, artikel-id UNSP e12675Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners' beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners' beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients' knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions. 

  • 15.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Health and Society, Division of Social Medicine and Public Health Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Hedberg, Berith
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation2018Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, nr 5, artikel-id e12808Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub-populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.

  • 16.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Nilsen, Per
    Division of Social Medicine and Public Health Science Department of Health and Society Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 21-22, s. 4040-4049Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension.

    Design: Cross-sectional design.

    Methods: A total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used.

    Results: Of the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index ≥30 kg/m2). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equation modelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good.

    Conclusion: The initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension.

    Relevance to Clinical Practice: The PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes. 

  • 17.
    Broström, Anders
    et al.
    Linköping University.
    Strömberg, Anna
    Linköping University.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ulander, Martin
    Linköping University.
    Harder, Lena
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS2007Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 16, nr 4, s. 439-447Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires; the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment.

  • 18.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sunnergren, Ola
    Linköping University.
    Johansson, Peter
    Linköping University.
    Svensson, Erland
    Swedish Defence Research Agency.
    Ulander, Martin
    Linköping University.
    Nilsen, Per
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis.2012Ingår i: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 20, nr 4, s. 287-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care.

    AIM: To explore characteristics associated with undiagnosed OSA in hypertensive primary care patients.

    METHODS: Cross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) from four primary care centres. All subjects underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between self-rated symptoms, clinical characteristics and objectively verified diagnosis of OSA. Main outcome: Measures symptom profile of undiagnosed OSA (as measured by the Apnoea/Hypopnoea Index [AHI]) in hypertensive outpatients in primary care.

    RESULTS: Fifty-nine percent of the patients had an AHI ≥ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed.

    CONCLUSION: OSA was highly prevalent and was directly associated with anthropometrics and OSA-related symptoms (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.

  • 19.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sunnergren, Ola
    Linköping University.
    Nilsen, Per
    Linköping University.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ulander, Martin
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 2, s. 140-149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Hypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients. AIM: The aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity. METHODS: A cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health. RESULTS: Pre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders. CONCLUSION: The occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.

  • 20.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sunnergren, Ola
    Ryhov Cty Hosp, Ear Nose & Throat Clin, Jönköping, Sweden.
    Årestedt, Kristofer
    Linköping Univ, Fac Hlth Sci, Div Nursing Sci, Dept Med & Hlth Sci, Linköping, Sweden.
    Johansson, Peter
    Linköping Univ Hosp, Dept Cardiol, S-58185 Linköping, Sweden.
    Ulander, Martin
    Linköping Univ Hosp, Dept Clin Neurophysiol, S-58185 Linköping, Sweden.
    Riegel, Barbara
    Linköping Univ, Fac Hlth Sci, Div Cardiovasc Med, Dept Med & Hlth Sci, Linköping, Sweden.
    Svanborg, Eva
    Linköping Univ Hosp, Dept Clin Neurophysiol, S-58185 Linköping, Sweden.
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients2012Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, nr 2, s. 107-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP > 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration > 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 21.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ulander, Martin
    Linköping University.
    Nilsen, Per
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Arestedt, Kristofer Franzén
    Linköping University.
    The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment2011Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 20, nr 3, s. 460-471Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbach's alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.

  • 22.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Wahlin, Åke
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Alehagen, Urban
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Johansson, Peter
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden.
    Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population2018Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 5, s. 422-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

    OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

    METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

    RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

    CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

  • 23.
    Broström, Anders
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Wahlin, Åke
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Alehagen, Urban
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ulander, Martin
    Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Johansson, Peter
    Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population2018Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, nr 1, s. 290-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this study was to explore whether associations between self-reported sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness differed in older community-dwelling men and women. Design: Cross-sectional.

    Methods: A community-dwelling sample of 675 older men and women (mean age 77.7 years, SD 3.8 years) was used. All participants underwent a clinical examination by a cardiologist. Validated questionnaires were used to investigate sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness. Subjects were divided into short sleepers (≤6 hours), n = 231; normal sleepers (7-8 hours), n = 338; and long sleepers (≥9 hours), n = 61. ancovas were used to explore sex-specific effects.

    Results: Depressive symptoms were associated with short sleep in men, but not in women. Fatigue was associated with both short and long sleep duration in men. No sex-specific associations of sleep duration with daytime sleepiness or anxiety were found.

    Conclusion: Nurses investigating sleep duration and its correlates, or effects, in clinical practice need to take sex into account, as some associations may be sex specific. Depressive symptoms and fatigue can be used as indicators to identify older men with sleep complaints.

  • 24.
    Elfström, Maria
    et al.
    Högskolan i Jönköping, Hälsohögskolan. ENT Clinic, Ryhov County Hospital.
    Karlsson, Susanne
    Högskolan i Jönköping, Hälsohögskolan. ENT Clinic, Ryhov County Hospital.
    Nielsen, Per
    Division of Health and Society, Department of Medical and Health Sciences, Linköping University, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Svanberg, Eva
    Department of Clinical Neurophysiology, University Hospital, Linköping, and Institution of Clinical and Experimental Medicine, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Decisive Situations Affecting Partners' Support to Continuous Positive Airway Pressure-Treated Patients With Obstructive Sleep Apnea Syndrome: A Critical Incident Technique Analysis of the Initial Treatment Phase2012Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 27, nr 3, s. 228-239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND RESEARCH OBJECTIVE: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low. The partner has an important role in supporting the patient, but this role may be adversely affected by difficulties during the early phase of the CPAP initiation. The aim of this study was to explore and describe decisive situations affecting partners' support to patients with OSAS and how the partners manage these situations during the initial phase of CPAP treatment.

    SUBJECTS AND METHODS: A qualitative descriptive design using critical incident technique was used. A total of 542 decisive situations affecting partners' support and 222 situations describing managing were collected by means of interviews with 25 strategically selected partners of patients with CPAP treated OSAS.

    RESULTS: Adverse effects, limited effect, practical and psychosocial problems, limited presence, and inappropriate initiation emerged as negative influences on the partners' support. A well-functioning treatment, improvements, high motivation, and receiving support from others were identified as positive influences on the partners' support. The partner managed the situations by letting the patient handle the CPAP treatment by himself/herself, by handling the treatment together with the patient, or taking over the handling of CPAP treatment.

    CONCLUSION: Increased knowledge about the different situations that affect the partners' support negatively or positively and how these situations are managed by partners can be used in educational situations involving both patients and partners during CPAP initiation.

  • 25.
    Ericsson, Carin
    et al.
    Cardiology and Speciality Medicine Centre, Region Ostergotland, Linkoping, Sweden .
    Skagerström, Janna
    Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.
    Schildmeijer, Kristina
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Region Ostergotland, Linkoping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.
    Can patients contribute to safer care in meetings with healthcare professionals? A cross-sectional survey of patient perceptions and beliefs.2019Ingår i: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, nr 8, s. 657-666, artikel-id bmjqs-2018-008524Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate patients' perceptions of their meetings with healthcare professionals and the extent to which they believe they can influence patient safety in these meetings.

    DESIGN: Cross-sectional survey of patients using a study-specific questionnaire. Data were analysed using both parametric and non-parametric statistics.

    SETTING: The study was conducted in primary and secondary care in three county councils in southeast Sweden by means of a survey questionnaire despatched in January 2017.

    PARTICIPANTS: Survey data were collected from 1445 patients, 333 of whom were complainants (patients who had filed a complaint about being harmed in healthcare) and 1112 regular patients (patients recruited from healthcare units).

    MAIN OUTCOME MEASURES: Patients' perceptions of meetings with physicians and nurses, beliefs concerning patients' contributions to safer care and whether the patients had suffered harm in healthcare during the past 10 years.

    RESULTS: Most respondents reported that it was easy to ask physicians and nurses questions (84.9% and 86.6%) and to point out if something felt odd in their care (77.7% and 80.7%). In general, complainants agreed to a higher extent compared with regular patients that patients can contribute to safer care (mean 1.92 and 2.13, p<0.001). Almost one-third (31.2%) of the respondents (both complainants and regular patients) reported that they had suffered harm in healthcare during the past 10 years.

    CONCLUSIONS: Most respondents believed that healthcare professionals can facilitate patient interaction and increase patient safety by encouraging patients to ask questions and take an active part in their care. Further research will need to identify strategies to support such questioning in routine practice and ensure that it achieves its intended goals.

  • 26.
    Eriksson, Kerstin
    et al.
    Högskolan i Jönköping, Hälsohögskolan. Department of Anesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Wikström, Lotta
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Department of Anesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Predictors for Early Physical Recovery for General and Orthopedic Patients after Major Surgery: Structural Equational Model Analyses2019Ingår i: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Attention to factors that may affect patients’ ability to experience enhanced recovery after surgery is essential in planning for postoperative care.

    Aims:

    To create models of predefined pre,- peri-, and postoperative variables in order to analyze their impact on patients’ physical recovery on postoperative days 1 and 2 after major orthopedic and general surgery.

    Design:

    An exploratory design with repeated measures was used, including 479 patients who had undergone orthopedic (289) or general surgery (190) at three hospitals.

    Methods:

    Pain, nausea, and level of physical ability were measured preoperatively and on postoperative days 1 and 2 by using the Numerical Rating Scale and items from the Postoperative Recovery Profile. Structural equation modeling was used to explore the impact of the predefined variables on patients’ physical recovery.

    Results:

    The orthopedic group contained significantly more women and significantly more patients with pain and opioid use. Although the models showed good fit, “traditional” preoperative (pain, nausea, physical abilities, chronic pain, opioid use) and perioperative variables (anesthesia, length of surgery) constituted few (orthopedic) or no (general surgery) predictive properties for physical recovery. Postoperative average pain intensity, average nausea intensity, and physical ability explained physical recovery on day 1, and physical recovery on day 1 predicted physical recovery on day 2.

    Conclusions:

    “Traditional” predictors had little effect on patients’ postoperative physical recovery, while associations with common postoperative symptoms were shown. Further research is needed to explore additional variables affecting early physical recovery and to understand how soon patients are physically ready to return home. 

  • 27.
    Eriksson, Kerstin
    et al.
    Högskolan i Jönköping, Hälsohögskolan.
    Wikström, Lotta
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Anaesthesia and IntensiveCare, Ryhov County Hospital, Jönköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Association of pain ratings with the prediction of early physical recovery after general and orthopaedic surgery - A quantitative study with repeated measures2017Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, nr 11, s. 2664-2675Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To compare different levels of self-rated pain and determine if they predict anticipated early physical recovery in patients undergoing general and orthopaedic surgery.

    Background: Previous research has indicated that average self-rated pain reflects patients' ability to recover the same day. However, there is a knowledge gap about the feasibility of using average pain ratings to predict patients' physical recovery for the next day.

    Design: Descriptive, quantitative repeated measures.

    Methods: General and orthopaedic inpatients (n = 479) completed a questionnaire (October 2012-January 2015) about pain and recovery. Average pain intensity at rest and during activity was based on the Numeric Rating Scale and divided into three levels (0-3, 4-6, 7-10). Three out of five dimensions from the tool "Postoperative Recovery Profile" were used. Because few suffered severe pain, general and orthopaedic patients were analysed together.

    Results: Binary logistic regression analysis showed that average pain intensity postoperative day 1 significantly predicted the impact on recovery day 2, except nausea, gastrointestinal function and bladder function when pain at rest and also nausea, appetite changes, and bladder function when pain during activity. High pain ratings (NRS 7-10) demonstrated to be a better predictor for recovery compared with moderate ratings (NRS 4-6), day 2, as it significantly predicted more items in recovery.

    Conclusion: Pain intensity reflected general and orthopaedic patients' physical recovery postoperative day 1 and predicted recovery for day 2. By monitoring patients' pain and impact on recovery, patients' need for support becomes visible which is valuable during hospital stays.

  • 28.
    Eriksson, Kerstin
    et al.
    Högskolan i Jönköping, Hälsohögskolan. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Wikström, Lotta
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Patients’ experiences and actions when describing pain after surgery – A critical incident technique analysis2016Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, s. 27-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.

    OBJECTIVES:

    The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.

    METHODS:

    An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.

    FINDINGS:

    In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.

    CONCLUSIONS:

    Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.

  • 29.
    Eriksson, Kerstin
    et al.
    Ryhov County Hospital, Jönköping.
    Wikström, Lotta
    Ryhov County Hospital, Jönköping.
    Lindblad-Fridh, Marianne
    Högskolan i Jönköping, Hälsohögskolan.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery2013Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, nr 5-6, s. 638-647Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: To (1) examine the clinical applicability of compiled mode and maximum values from the Numeric Rating Scale (NRS) by comparing the correspondence between patient perceptions of pain and pain values from monitoring records, as well as (2) to study the relationship between mode and maximum values and self-assessed ability for early postoperative recovery.

    Background: Documentation of pain remains a problem despite recommendations of quality improvements. To examine the correlation between patient perceptions and documented pain therefore becomes important. Few have studied how pain affects recovery.

    Design: A quantitative cross-sectional design was used in which 157 postoperative patients answered a questionnaire on pain intensity and recovery. A parallel examination of pain in monitoring records was conducted.

    Results: A total of 57% had a mode value calculated from records between 0 and 3 on postoperative day 1 and 69% on day 2. A maximum value between 4 and 10 was found in monitoring records for 73% on day 1 and for 67% on day 2. The correspondence between mode value from monitoring records and the patients’ retrospective perceptions was 88% for NRS 0–3 and 92% between maximum value and NRS 4–10. The correlation between documented pain and retrospectively identified pain for mode value of the NRS in all (0–10) was rather weak (r = 0·37), while maximum value had a stronger correlation (r = 0·53).

    Conclusion: Mode and maximum values could be used as outcome measures when evaluating postoperative pain. Pain affects recovery negatively, but more research is needed to strengthen the evidence for the use and clarify the link between pain and recovery.

    Relevance to clinical practice: International organisations emphasise the importance of improving pain assessment. Mode and maximum values are easy to compile for nurses and can, together with assessments of how experienced pain levels affect postoperative recovery, improve treatment of postoperative pain.

  • 30.
    Eriksson, Kerstin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Ryhov Hospital.
    Wikström, Lotta
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Årestedt, Kristofer
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Numeric rating scale: patients' perceptions of its use in postoperative pain assessments2014Ingår i: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 27, nr 1, s. 41-46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim

    The purpose of this study was to describe how patients perceive the use of the numeric rating scale in postoperative pain assessments.

    Background

    There are recommendations to use a pain scale to follow patients' postoperative pain. Most patients prefer the NRS but there is a discrepancy between patients and healthcare professionals how to interpret the ratings from the pain assessments.

    Methods

    A descriptive design with a phenomenographic approach was used. Semi structured interviews were held with 25 patients.

    Results

    Three description categories emerged that illustrate patients' perceptions; use of the NRS facilitated communication of pain, it put demands on healthcare professionals and care routines and it contained interpretation difficulties.

    Conclusion

    The NRS has a place in pain management according to the patients but there is a need for a dialogue to give the patients the opportunity to describe their pain and set a common goal.

  • 31.
    Eriksson, Kerstin
    et al.
    Högskolan i Jönköping, Hälsohögskolan. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Wikström, Lotta
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
    Nausea intensity as a reflector of early physical recovery after surgery2019Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, nr 5, s. 989-999Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To compare different levels of self-rated average nausea intensity with early physical recovery and determine if nausea can reflect recovery in patients undergoing general or orthopaedic surgery.

    Background: Nausea has been found to influence postoperative physical recovery. Despite the incidence of nausea in postoperative care, there is a knowledge gap about the possibility of using average nausea intensity to reflect recovery, motivating further investigation.

    Design: An observational design with repeated measures.

    Methods: General and orthopaedic patients answered a questionnaire (October 2012–January 2015) about nausea and impact on recovery on postoperative days 1 (N = 479) and 2 (N = 441). Questions about average nausea intensity at rest and during activity were answered based on the Numeric Rating Scale (NRS) (0–10). Impact on recovery was evaluated using three dimensions from the postoperative recovery profile tool.

    Results: About one-fifth of the patients reported nausea intensity as moderate to severe on days 1 and 2. Nausea intensity was associated with eight of nine aspects of recovery on postoperative day 1. Nausea intensity on day 1 also reflected four of nine aspects of recovery on day 2. About reflecting physical recovery, the association was strongest between nausea intensity and appetite changes.

    Conclusions: As postoperative nausea is common, regular assessments by healthcare professionals are needed. Assessment of nausea is of importance since it reflects physical recovery. This also shows the importance of treating nausea without delay. Using the NRS to measure nausea intensity is a simple method that is easy to use in clinic. 

  • 32.
    Fridlund, Bengt
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Baigi, Amir
    Region of Halland, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Establishing the psychometric properties of the comprehensive ethos towards wellness questionnaire in a Norwegian population2015Ingår i: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 33, nr 4, s. 366-373Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: to replicate and establish the psychometric properties of the 74-item comprehensive Ethos Towards Wellness Questionnaire in a healthy Norwegian population in terms of content and construct validity as well as homogeneity and stability reliability.

    METHOD: A questionnaire with a methodological and developmental design was sent on two occasions to 214 healthy middle-aged participants and processed in two phases.

    RESULTS: The three life context and the ethos indexes at ordinal scale level showed an overall satisfactory construct validity (communalities > 0.30, factor loadings > 0.30, and factor total variance > 50%). On two occasions 4 weeks apart, reliability in terms of homogeneity (Cronbach's α > .70) and stability (intraclass correlation coefficient > 0.70) were also considered satisfactory for the same four indexes.

    CONCLUSIONS: This newly developed and possibly only questionnaire that focuses on "grasping the big human picture," based on both philosophical reasoning and empirical recommendations of wellness, was found to be valid and reliable in the screening and follow-up of wellness and ethos in a healthy Norwegian population.

  • 33.
    Gardner, Benjamin
    et al.
    Department of Epidemiology and Public Health, University College London, UK.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nilsen, Per
    Department of Health and Society, Linköping University, Sweden.
    Hrubos Ström, Harald
    Department of Otopharyngeology, Akershus University Hospital, Norway.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Skagerström, Janna
    Department of Health and Society, Linköping University, Sweden.
    Johansson, Peter
    Department of Cardiology, Linköping University Hospital, Sweden.
    From 'does it work?' to 'what makes it work?': The importance of making assumptions explicit when designing and evaluating behavioural interventions2014Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, nr 4, s. 292-294Artikel i tidskrift (Refereegranskat)
  • 34.
    Gullvag, M.
    et al.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Gjeilo, K. H.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Falun, N.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Mo, R.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sleepless nights and sleepy days - a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep disordered breathing2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S57-S58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sleep disordered breathing (SDB) is a pathologic, nocturnal breathing pattern present in at least 50% of patients with chronic heart failure (CHF). SDB is categorized as central or obstructive, and both are associated with worsened prognosis, affects physical and mental capacity and influences quality of life. Knowledge of how SDB is experienced by patients with CHF is limited, and has not previously been addressed in qualitative studies.

    Purpose: The aim of this study was to explore the experiences of patients with CHF and newly verified and untreated SDB.

    Methods: The study used an inductive descriptive design, collecting data through semi-structured interviews analysed with qualitative content analysis. Twelve participants (9 men and 3 women, mean age 62 (range 41-80)) diagnosed with CHF and a newly objectively verified (i.e., by polygraphy) SDB (6 obstructive, 5 central and 1 mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals.

    Results: The participants’ descriptions fell into five categories: Sleep disruption causing troublesome nights: Disruptive nights with sleep onset latency, frequent arousals and early morning awakenings caused frustration and a longing for a night of uninterrupted sleep. Daily life challenges due to daytime sleepiness: Excessive tiredness led to a need for sleep during the day, overactivity to avoid tiredness, extra care when operating a vehicle, and a feeling that concentration and memory were impaired. Involvement of a partner: The partners were described as being more affected by the sleep apnea than the participants, and it was apparent that the apneas caused fear and worry for the partners. Self-care strategies: Use of a dark, quiet and well-ventilated bedroom and avoidance of actions that could impair sleep; i.e. daytime naps, coffee, or heavy meals before bedtime were described. Some participants discussed their  sleep problems with their GP, but experienced that the problems were not examined in detail and sleep medication was a common, however unwanted, solution. Awareness of SDB: Some participants were relieved as the finding of the SDB finally gave an explanation to their problems, while others were surprised by the result.

    Conclusion: Patients with CHF and SDB experienced that sleep disturbances influenced their daily life. Raised awareness on sleep is needed for these patients. Possible underlying causes for disruptive sleep, such as SDB, should be identified in order to establish proper treatment strategies and follow-up care for the individual. Future studies on both medical and nursing strategies to improve sleep for patients with CHF and SDB are needed, and intervention studies should be prioritized.

  • 35.
    Gullvåg, Marianne
    et al.
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Gjeilo, Kari Hanne
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Fålun, Nina
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Norekvål, Tone M.
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Mo, Rune
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep-disordered breathing.2019Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, nr 3, s. 750-759Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sleep-disordered breathing, including obstructive sleep apnoea and central sleep apnoea, is a common disorder among patients with chronic heart failure. Obstructive sleep apnoea is often treated with continuous positive airway pressure, but central sleep apnoea lacks a clear treatment option. Knowledge of how sleep-disordered breathing is experienced (e.g. difficulties and care needs) and handled (e.g. self-care actions) by the patients is limited, but needed, to provide patient-centred care.

    AIM: To explore how newly verified sleep-disordered breathing is experienced by patients with chronic heart failure.

    METHODS: Data were collected through semi-structured interviews and analysed with qualitative content analysis. Seventeen participants (14 men, three women), mean age 60 years (range 41-80) diagnosed with chronic heart failure and objectively verified sleep-disordered breathing (nine obstructive, seven central and one mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals.

    RESULTS: Patients with chronic heart failure and newly verified sleep-disordered breathing (SDB) described experiences of poor sleep that had consequences for their daily life and their partners. Different self-care strategies were revealed, but they were based on 'common sense' and were not evidence-based. The awareness of having SDB was varied; for some, it gave an explanation to their trouble while others were surprised by the finding.

    CONCLUSION: Patients with chronic heart failure and sleep-disordered breathing experienced reduced sleep quality, influencing their daily life. Possible underlying causes of disrupted sleep, such as sleep-disordered breathing, should be identified to establish proper patient-centred treatment strategies. There is a need for new strategies to approach patients with chronic heart failure (i.e. those with central sleep apnoea) who are not subject to continuous positive airway pressure treatment for their sleep-disordered breathing.

  • 36.
    Gustafsson, Greta
    et al.
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ulander, Martin
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Vrethem, Magnus
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden.
    Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation2015Ingår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, nr 8, s. 1493-1497Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.

    METHODS:

    We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.

    RESULTS:

    No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12 years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.

    CONCLUSION:

    Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.

    SIGNIFICANCE:

    Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.

  • 37.
    Hedberg, Berith
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Karlsson, J. E. K.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Arestedt, K. A.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Factors associated with involvement in risk communication and confidence in shared decision making among patients with atrial fibrillation.2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S74-S75Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.

    Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.

    Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.

    Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.

    Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.

  • 38.
    Hedberg, Berith
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden.
    Karlsson, Jan-Erik
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, nr 5, s. 446-455Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

    Aim:

    The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

    Methods:

    A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

    Results:

    Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

    Conclusion:

    Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 39.
    Hellstrom, A.
    et al.
    Linnaeus Univ, Dept Hlth & Caring Sci, Kalmar, Sweden.
    Hagell, P.
    Kristianstad Univ, Sch Hlth & Soc, PRO CARE Grp, Kristianstad, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Ulander, M.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Arestedt, K.
    Linnaeus Univ, Dept Hlth & Caring Sci, Kalmar, Sweden.
    Initial psychometric testing of the sleep condition indicator in a Swedish context2017Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, nr Suppl. 1, s. E129-E130Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: There are several rating scales for insomnia; however, diagnostic criteria have changed over time. This means that the usefulness and validity of earlier scales may be compromised. The Sleep Condition Indicator (SCI) is a recently designed scale, developed in the UK, based on the DSM-V criteria of insomnia. The aim of this study was to translate and psychometrically evaluate the SCI in a Swedish context, focusing on its dimensionality.

    Materials and methods: The SCI consists of eight items with 5 ordered response categories (scored between 0 and 4). A total score between 0 and 32 is calculated; higher score indicates better sleep. The SCI was distributed through a web-questionnaire to university students and 634 completed the questionnaire . First we replicated the methodology used in the original testing of the UK SCI using principal component analysis (PCA) as the extraction method with varimax rotation and Kaisers eigenvalue >1 criterion for determination of the number of factors. We then continued with a more appropriate method for ordinal data, an exploratory factor analysis (EFA), using an unweighted least squares (ULS) extraction method based on a polychoric correlation matrix. Parallel analysis was conducted to determine the number of factors. Internal consistency was estimated using an ordinal version of Cronbach's alpha.

    Results: The PCA suggested a one factor model, with eigenvalues of 5.0 for the 1st and 0.9 for the 2nd factor, explaining 62% of the variance. Loadings varied between 0.62-0.86. With the EFA (ULS), 70% of the variance was explained by the first factor. Factor loadings varied between 0.66 and 0.92. Eigenvalues for factors 1 and 2 were 5.6 and 0.8, respectively. Corresponding 95th percentile eigenvalues from the parallel analysis were 5.3 (1st factor) and 0.4 (2nd factor). Reliability (ordinal alpha) of the total SCI score was 0.94.

    Conclusions: Both models support a unidimensional SCI structure in our sample of university students. This is a prerequisite for the calculation and validity of a total SCI score. In addition, the total score exhibited good reliability. These observations support the psychometric integrity of the Swedish SCI and provide a starting point for further testing.

  • 40.
    Hellström, Amanda
    et al.
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Hagell, Peter
    The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of clinical neurophysiology, Linköping University hospital, Linköping, Sweden.
    Ulander, Martin
    Department of clinical neurophysiology, Linköping University hospital, Linköping, Sweden.
    Luik, Annemarie I.
    Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
    Espie, Colin A.
    Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    A classical test theory evaluation of the Sleep Condition Indicator accounting for the ordinal nature of item response data2019Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, nr 3, s. 1-13, artikel-id e0213533Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Insomnia symptoms are common among young adults and affect about 5% to 26% of 19 to 34-year-olds. In addition, insomnia is associated with poor mental health and may affect daily performance. In research, as well as in clinical practice, sleep questionnaires are used to screen for and diagnose insomnia. However, most questionnaires are not developed according to current DSM-5 diagnostic criteria. An exception is the recently developed Sleep Condition Indicator (SCI), an eight-item scale screening for insomnia.

    AIM: The aim of this study was to perform a Classical Test Theory (CTT) based psychometric evaluation of the SCI in a sample of Swedish university students, by taking the ordinal nature of item level data into account.

    METHODS: The SCI was translated into Swedish and distributed online to undergraduate students at three Swedish universities, within programs of health, psychology, science or economy. Of 3673 invited students, 634 (mean age 26.9 years; SD = 7.4) completed the questionnaire that, in addition to the SCI, comprised other scales on sleep, stress, lifestyle and students' study environment. Data were analyzed according to CTT investigating data completeness, item homogeneity and unidimensionality.

    RESULTS: Polychoric based explorative factor analysis suggested unidimensionality of the SCI, and internal consistency was good (Cronbach's alpha, 0.91; ordinal alpha, 0.94). SCI scores correlated with the Insomnia Severity Index (-0.88) as well as with sleep quality (-0.85) and perceived stress (-0.50), supporting external construct validity.

    CONCLUSIONS: These observations support the integrity of the of the SCI. The SCI demonstrates sound CTT-based psychometric properties, supporting its use as an insomnia screening tool.

  • 41.
    Hernar, Ingvald
    et al.
    Department of Medicine, Haukeland University Hospital, Bergen, Norway.
    Haltbakk, Johannes
    Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
    Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy2017Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, nr 23-24, s. 4583-4596Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: To assess the prevalence of lipohypertrophy, and to compare differences in external, personal and regimen factors in adults with type 1 diabetes and different degrees of lipohypertrophy.

    Background: Suboptimal insulin injection behaviour is associated with lipohypertrophy, which may affect insulin absorption and lead to blood glucose fluctuations. Few, if any studies have investigated how external, personal and regimen factors differ in people with type 1 diabetes and different degrees of lipohypertrophy.

    Design: A cross-sectional study including adults with type 1 diabetes at a diabetes outpatient clinic in a Norwegian university hospital. Methods: Participants (n = 215) were included consecutively at scheduled appointments. Sociodemographic, diabetes and insulin treatment data, and self-report questionnaires concerning patient activation (Patient Activation Measure), depression (Patient Health Questionnaire-2), diabetes distress (Diabetes Distress Scale), type D personality (14-item Type D scale), treatment satisfaction (Insulin Treatment Satisfaction Questionnaire) and motivation (Treatment Self-Regulation Questionnaire), were collected. Lipohypertrophic injection sites were identified by palpation by diabetes specialist nurses.

    Results: Lipohypertrophy was present in 53% and was more frequent in insulin pen users (63%) compared to insulin pump users (34%). Participants with two or more lipohypertrophic areas had higher depression scores, lower treatment satisfaction with glycaemic control, higher bolus doses and reported suboptimal injection behaviour compared to those with no lipohypertrophic areas. There were no differences in patient activation, diabetes distress, type D personality or motivation between the groups.

    Discussion and conclusion: Compared to pump treatment, pen treatment requires greater awareness of injection technique. Symptoms of depression and lower treatment satisfaction might affect diabetes self-management and glycaemic control, but the association with lipohypertrophy needs further exploration.

    Relevance to clinical practice: Lipohypertrophy is more frequent in insulin pen users compared to pump users. Nurses should focus on injection technique education, and should also consider screening for depressive symptoms and treatment satisfaction as these factors could be associated with development of lipohypertrophy.

  • 42.
    Hjelm, Carina
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Dahl, Anna
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa. Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Johansson, Boo
    Göteborgs Universitet.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden.
    Factors associated with increased risk for dementia in individuals age 80 years or older with congestive heart failure2014Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, nr 1, s. 82-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and research objective: An increasing body of evidence shows that individuals diagnosed with congestive heart failure (CHF) are at a higher risk for dementia. However, the prevalence rate of dementia among persons with CHF in very old individuals has not been previously reported, and little is known about the comorbidities that place old persons with CHF at a higher risk for dementia. The aim of this study was to compare the prevalence of dementia in individuals 80 years or older who have CHF with that in individuals without CHF and to identify factors related to dementia in individuals diagnosed with CHF.

    Methods: A total of 702 participants from a Swedish population-based longitudinal study (Octogenerian Twin) were included. The group consisted of same-sex twin pairs, age 80 years or older, and 138 participants had CHF. Dementia was diagnosed according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Generalized estimating equations including gender, age and educational level, waist circumference, diabetes, hypertension, smoking, depression, and blood values were used in a case-control analysis.

    Results: Individuals with CHF had a significantly higher prevalence of vascular dementia, 16% vs 6% (P < 0.001), and of all types of dementia, 40% vs 30% (P < 0.01), than those not diagnosed with CHF. The generalized estimating equation models showed that depression, hypertension, and/or increased levels of homocysteine were all associated with a higher risk for dementia in individuals with CHF. Diabetes was specifically associated with an increased risk for vascular dementia.

    Conclusions: The prevalence of dementia was higher among individuals with CHF than in those without CHF. Diabetes, depression, and hypertension in patients with CHF require special attention from healthcare professionals because these conditions are associated with an elevated risk for dementia. Higher levels of homocysteine were also found to be a marker of dementia in patients with CHF. Further research is needed to identify the factors related to dementia in individuals 80 years or older diagnosed with CHF.

  • 43. Hjelm, Carina
    et al.
    Dahl, Anna
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa. Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Johansson, Boo
    Strömberg, Anna
    The influence of heart failure on change in cognition among individuals 80 years of age and older2011Konferensbidrag (Övrigt vetenskapligt)
  • 44.
    Hjelm, Carina
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    Dahl, Anna
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Johansson, Boo
    Department of Psychology, University of Gothenburg.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University.
    The influence of heart failure on longitudinal changes in cognition among individuals 80 years of age and older2012Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, nr 7-8, s. 994-1003Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The aim of this study was to examine the relationship between heart failure and specific cognitive abilities in octogenarians with regard to level and change over time.

    Background. Cognitive impairment is influenced by many factors, and the impact of heart failure is debated. Intact cognitive ability is crucial for successful self-care in patients with heart failure. Middle-aged patients with heart failure seem to have an increased risk of cognitive impairment. No studies have examined the association between heart failure and longitudinal cognitive changes in octogenarians (individuals 80 years and older).

    Design. A prospective longitudinal design.

    Methods. Cognitive tests were carried out five times (1991–2002) in 702 octogenarians from the Swedish Twin Registry, including same-sex twin pairs. The test battery included the measurement of processing speed, visuospatial ability, short-term, episodic and semantic memory. Latent growth curve modelling was employed to measure change and performance over time and compares the group diagnosed with heart failure to individuals without a heart failure diagnosis.

    Results. At baseline, the participants’ mean age was 83·5 years, 67% were women and 13% suffered from heart failure. Individuals diagnosed with heart failure scored significantly lower in spatial abilities and episodic memory than participants not diagnosed with heart failure. Moreover, measures of episodic memory declined more over time in individuals diagnosed with heart failure. There were no significant differences between the groups in other cognitive tests.

    Conclusion. Spatial problems and episodic memory have implications for everyday life. This might contribute to decreased adherence to prescribed therapy and self-care management and lead to socio-behavioural problems because of an impaired capacity to drive, read and write.

    Relevance to clinical practice. Nurses should take into account in their assessment that cognitive impairment may restrain elderly heart failure patient’s ability to make decisions and perform self-care actions. Patient education strategies should also be adapted to cognitive ability.

  • 45.
    Hjelm, Carina M.
    et al.
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, Department of Cardiothoracic Surgery, County Council of Östergötland, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, County Council of Östergötland, Sweden.
    Riegel, Barbara
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, University of Pennsylvania School of Nursing, Philadelphia, USA.
    Årestedt, Kristofer
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, School of Health and Caring Sciences, Linnaeus University Kalmar, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Sweden, Department of Cardiology, County Council of Östergötland, Sweden.
    The association between cognitive function and self-care in patients with chronic heart failure2015Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, nr 2, s. 113-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression. Methods: This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses. Results: Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression. Conclusions: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.

  • 46.
    Högberg, Karin M
    et al.
    University of Borås, Sweden.
    Sandman, Lars
    University of Borås, Sweden.
    Nyström, Maria
    University of Borås, Sweden.
    Stockelberg, Dick
    Southern Älvsborg Hospital, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Caring Through Web-Based Communication: A Qualitative Evaluation of a Nursing Intervention to Create Holistic Well-Being Among Patients With Hematological Disease.2018Ingår i: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 36, nr 3, s. 218-227Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To examine how written communication between patients with hematological diseases and a nurse within a web-based communication service can be caring.

    DESIGN: The study is based on qualitative deductive content analysis of 109 written messages between 10 patients and a responding nurse. The evaluated nursing intervention is a web-based communication service where patients could request support from a responding nurse during 2 months of use. A structured theoretical matrix based on Swanson's theory of caring including compassion, competence, and upholding trust is used for the analysis.

    FINDINGS: Nursing compassion emerges when patients share personal matters and the nurse has an opportunity to explicitly display genuine interest and understanding. Nursing competence is required when patients ask for or are in need of information, advice, and emotional support. The nurse can uphold trust when compassion and competence are exhibited and patients share their innermost feelings.

    CONCLUSIONS: Web-based communication has the potential to contribute to holistic well-being according to Swanson's theory of caring. The written word lasts, can be read repeatedly, and in connection with writing there is time for reflection. However, the lack of nonverbal cues makes it important that the nurse answers in a fully accurate and explicitly caring way.

  • 47.
    Högberg, Karin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sandman, Lars
    School of Health Sciences, University of Borås.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nyström, Maria
    School of Health Sciences, University of Borås.
    Caring through web-based counselling — A nursing intervention2015Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122Artikel i tidskrift (Övrigt vetenskapligt)
  • 48.
    Högberg, Karin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sandman, Lars
    School of Health Science, University of Borås.
    Nyström, Maria
    School of Health Sciences, University of Borås.
    Stockelberg, Dick
    Section for Hematology and Coagulation, Dept of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Prerequisites required for the provision and use of web-based communication for psychosocial support in haematologic care2013Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, nr 5, s. 596-602Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    The purpose of this study was to describe the prerequisites required for the provision and use of web-based communication for psychosocial support within a haematology clinic, from a patient and family perspective.

    Method

    A qualitative design using content analysis was used. A strategically selected sample of patients (n = 11) and family members (n = 6) were offered access to a web-based communication capability with a nurse. After four months, individual interviews were conducted with all participants, in order to identify necessary prerequisites.

    Results

    Preferences and characteristics of the individual patient or family member are crucial as to whether web-based communication for support is perceived as useful. To feel comfortable with writing and to self-identify the need for support are fundamental in getting motivated to use web-based communication. An effective organization around psychosocial support in general is another prerequisite. Goals and responsibilities must be clearly defined for patients and family members to understand their rights and enable the transformation of opportunities into practice. The use of web-based communication must also be a convenient and naturally incorporated part of both individual and organizational use of the web in general.

    Conclusions

    Prerequisites of taking into account caretakers' different preferences and needs, providing highly structured psychosocial support activities and providing a congruent range of web services, are necessary for successful provision and use of web-based communication for psychosocial support.

  • 49.
    Högberg, Karin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sandman, Lars
    School of Health Sciences, University of Borås.
    Stockelberg, Dick
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nyström, Maria
    School of Health Sciences, University of Borås.
    Psychosocial factors associated with anxiety and depression in patients with hematological diseasesManuskript (preprint) (Övrigt vetenskapligt)
  • 50.
    Högberg, Karin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Stockelberg, Dick
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sandman, Lars
    School of Health Sciences, University of Borås.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nyström, Maria
    School of Health Sciences, University of Borås.
    The meaning of web-based communication for support: From the patients' perspective within a hematological healthcare setting2015Ingår i: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 38, nr 2, s. 145-154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Being critically ill with a hematological disease is a challenge, sometimes causing a need for support in the adjustment to the stressful life situation. By providing Web-based communication for support from a nurse, patients get access to an alternative and untraditional way to communicate their issues.

    OBJECTIVE:

    The aim was to describe the meaning of using Web-based communication for support from a patient perspective.

    METHODS:

    A comprehensive randomized pilot study (n = 30) was conducted, allowing 15 patients in the experimental group to have access to the Web-based communication, to evaluate feasibility. Of these 15 participants, 10 were interviewed, focusing on their experiences. An empirical hermeneutical approach was used and the interpretive analysis focused on the meanings.

    RESULTS:

    Web-based communication for support means a space for patients to have their say, consolidation of a matter, an extended caring relationship, access to individual medical assessment, and an opportunity for emotional processing. The main interpretation indicates that the patient's influence on the communication strengthens according to the asynchronous, faceless, and written communication. The increased, and in some sense constant, access to an individual medical and caring assessment, in turn, implies a feeling of safety.

    CONCLUSION:

    Web-based communication for support seems to have the potential to enhance patients' participation on their own terms.

    IMPLICATIONS FOR PRACTICE:

    To achieve the possible advantages of Web-based communication for support, nurses must acquire knowledge about caring writing. It requires respect for the patient and articulated accuracy and attention in the response given.

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