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  • 1. Arenhall, Eva
    et al.
    Kristofferzon, Marja-Leena
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Nilsson, Ulrica
    The male partners' experiences of the intimate relationships after a first myocardial infarction2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 2, p. 108-114Article in journal (Refereed)
    Abstract [en]

    Background: Stress in the intimate relationship is found to worsen the prognosis in women suffering from myocardial infarction (MI). Little is known about how male spouses experience the intimate relationship.

    Aim: This study aimed to explore and describe the experience of men's intimate relationships in connection to and after their female partner's first MI.

    Methods: An explorative and qualitative design was used. Interviews were conducted with 16 men having a partner who the year before had suffered a first MI. The data were analysed with qualitative content analysis.

    Results: Three themes emerged: masculine image challenged; life takes another direction; and life remains unchanged. The men were forced to deal with an altered image of themselves as men, and as sexual beings. They were hesitant to approach their spouse in the same way as before the MI because they viewed her to be more fragile. The event also caused them to consider their own lifestyle, changing towards healthier dietary and exercise habits.

    Conclusions: After their spouse's MI, men experienced a challenge to their masculine image. They viewed their spouse as being more fragile, which led the men to be gentler in sexual intimacy and more hesitant to invite sexual activity. This knowledge about how male spouses experience the intimate relationship could be helpful for health personnel in hospitals and primary care when they interact with couples where the woman suffers from cardiac disease or other chronic disorders.

  • 2. Bergman, Eva
    et al.
    Malm, Dan Anders John
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Berterö, Carina
    Karlsson, Jan-Erik
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Does one's sense of coherence change after an acute myocardial infarction?: A two-year longitudinal study in Sweden2011In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 13, no 2, p. 156-163Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess changes in the sense of coherence of patients who had suffered their first myocardial infarction. Out of 100 patients at the start of the study, these changes were evaluated in 66 men and 18 women aged 36-70 years. Generally, the sense of coherence was found to be stable among the whole group, but there were significant individual variations in its development in some of the participants over the following years. Even the individuals with an initally high sense of coherence could experience a decrease in its level. The changes that were found in the men can be explained by their marital status, level of treatment satisfaction, disease perception/quality of life, physical limitation, and alcohol intake and/or tobacco use at the baseline. An unexpected finding was that the single men with an initially high sense of coherence experienced a decreased level over time. In order to maintain or increase patients' sense of coherence, it is important for nurses to help them identify their risk factors and to provide conditions for individualized cardiac rehabilitation in order to avoid another myocardial infarction.

  • 3. Bergman, Eva
    et al.
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Berterö, Carina
    Karlsson, Jan-Erik
    Longitudinal study of patients after myocardial infarction: sense of coherence, quality of life, and symptoms2009In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 38, no 2, p. 129-140Article in journal (Refereed)
    Abstract [en]

    Background: Myocardial infarction has pronounced effects on an individual that demand changes in lifestyle. Health is influenced by whether the individual experiences the world as comprehensible, meaningful, and manageable, that is, has a sense of coherence (SOC). High SOC scores indicate that the individual probably manages the situation by understanding the context and connections: action and effect.

    Objective: The study objective was to identify the SOC, assess the quality of life (Short Form-12 Health Survey Questionnaire), assess the symptoms using the Seattle Angina Questionnaire, and create health curves from a baseline for patients with a first myocardial infarction.

    Methods: A longitudinal and predictive study of 100 participants in the heart care unit of a county hospital in southern Sweden was performed.

    Results: Women score lower on SOC than men. Persons with high SOC scores have fewer angina attacks, are more physically active, drink more alcohol, are more satisfied with their treatments, and have better disease perception.

    Conclusion: By following SOC scores, a trend emerges that suggests it may be a useful tool for identifying those who will need extra support.

  • 4.
    Bergman, Eva
    et al.
    Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden .
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Ljungqvist, Birgit
    Jönköping University, School of Health and Welfare.
    Karlsson, Jan-Erik
    Department of Medicine and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Berterö, Carina
    Department of Medicine and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Jan-Erik
    Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
    Meaningfulness is not the most important component for changes in sense of coherence2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 3, p. 331-338Article in journal (Refereed)
    Abstract [en]

    Background Sense of coherence is a theoretical construct which is used to measure the degree to which a person finds the world comprehensible, manageable and meaningful.

    Aim The main aim of the present study was to assess the hypothesis of Antonovsky that meaningfulness is the most crucial component in sense of coherence. The second aim was to explore the importance of its components and factors at baseline on sense of coherence changes and if the findings can be used in cardiac rehabilitation.

    Methods One hundred patients, who suffered a primary myocardial infarction were followed during two years. The instruments used were; sense of coherence questionnaire-13, 12-item short-form health survey questionnaire, the Seattle Angina Questionnaire and Health Curve.

    Results Thirty-nine percent of the participants fulfilled Antonovsky's hypothesis. Comprehensibility and the baseline factors of smoking, alcohol use, marital status and disease perception proved to be of importance for sense of coherence changes over time.

    Conclusion The hypothesis that meaningfulness is the most crucial component in sense of coherence is rejected for patients with primary myocardial infarction. Comprehensibility is more important than meaningfulness for changes in sense of coherence. Nurses therefore have an important task to increase comprehensibility and sense of coherence by providing information and knowledge about myocardial infarction and lifestyle changes at an early stage. The information should be given in an individualized and easily understandable way from a salutogenic perspective, which means to identify and work with factors that can contribute to preserving and promoting health.

  • 5.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Benzein, Eva
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Cardiac Disease and its Consequences on the Partner Relationship: a Systematic Review2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, p. 140-149Article in journal (Refereed)
    Abstract [en]

    Introduction

    Cardiac disease is a chronic illness that has extensive impact on patients and their partners. No previous review has been made on how the partner relationship is affected following cardiac disease. The review limited itself to the main cardiac disease of myocardial ischemia, arrhythmia and heart failure.

    Aim

    The aim of this review was to identify how the partner relationship is affected following cardiac disease after hospital discharge.

    Method

    CINAHL, PubMed and PsycINFO were searched from 1999 to 2009. Quality assessment of included articles was made using the Joanna Briggs Institute Reviewers' Manual. A total of 20 articles were included.

    Results

    Five themes identified how the partner relationship is affected following cardiac disease, namely: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Patients reported feeling overprotected by their spouses which occasionally served as a fertile ground for arguments or conflicts. Most couples experienced some implications concerning their sexual life following cardiac disease, though in various degrees. Both patients and partners seemed to experience communication deficiency concerning emotions within their relationship following the event. Most couples experienced a shift in roles and responsibilities within their partner relationship. Even though most couples experienced great distress following being afflicted with cardiac disease they reported that the disease had brought them closer together.

    Conclusion

    The review found that though couples found the cardiac event distressful they conformed and adjusted their relationship to the new situation.

  • 6.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Benzein, Eva
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Sandgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Managing uncertainty in couples living with atrial fibrillation2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, p. E1-E10Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 7.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Benzein, Eva
    Linnaeus University, Sweden.
    Sandgren, Anna
    Linnaeus University, Sweden.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). County Hospital Ryhov, Jönköping, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Sweden .
    Associations of emotional distress and perceived health in persons with atrial fibrillation and their partners using the Actor–Partner Interdependence Model2016In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 22, no 3, p. 368-391Article in journal (Refereed)
    Abstract [en]

    Individual behavior affects and is affected by other people. The aim of this study was to examine if emotional distress in patients with atrial fibrillation (AF) and their spouses was associated with their own and their partner’s perceived health. Participants included 91 dyads of patients and their spouses. Emotional distress was measured using the Hospital Anxiety and Depression Scale and perceived health was measured with the Short Form 36 Health Survey. The Actor–Partner Interdependence Model was used for dyad-level analyses of associations, using structural equation modeling. Higher levels of anxiety and depression were associated with lower levels of perceived health in patients and spouses. Higher levels of depression in patients were associated with lower levels of vitality in spouses and vice versa. As AF patients and their spouses influence each other, health-care interventions should consider the dyad to address dyadic dynamics. This may benefit the health of the individual patient and of the couple.

  • 8.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Internal Medicine County Hospital Ryhov Jönköping Sweden.
    Sandgren, Anna
    The Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Benzein, Eva
    The Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    The heart is a representation of life: an exploration of illness beliefs in couples living with atrial fibrillation2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 21-22, p. 3699-3709Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore illness beliefs in couples where one spouse has atrial fibrillation.

    Background: Beliefs are the lenses through which we view the world, guiding our behaviour and constructing our lives. Couples evolve an ecology of beliefs from their interaction whereby their actions and choices arise from their beliefs. Atrial fibrillation is a common cardiac arrhythmia that has implications for both patients and partners. A couple's illness beliefs play an important role in convalescence and illness management, and no previous studies have explored illness beliefs in couples living with atrial fibrillation.

    Design: A qualitative hermeneutic design.

    Methods: Data collection constituted in-depth interviews with nine couples (patient and partner together). Hermeneutic philosophy as described by Gadamer was used to interpret and to understand illness beliefs in couples living with atrial fibrillation.

    Results: The findings revealed both core illness beliefs and secondary illness beliefs. From the core illness belief 'The heart is a representation of life', two secondary illness beliefs were derived: atrial fibrillation is a threat to life and atrial fibrillation can and must be explained. From the core illness belief 'Change is an integral part of life', two secondary illness beliefs were derived: atrial fibrillation is a disruption in our lives and atrial fibrillation will not interfere with our lives. Finally, from the core illness belief 'Adaptation is fundamental in life', two secondary illness beliefs were derived: atrial fibrillation entails adjustment in daily life and atrial fibrillation entails confidence in and adherence to professional care.

    Conclusion: Couples' interaction has developed mutual illness beliefs regarding atrial fibrillation that guide them in their daily lives and influence their decisions. The adoption of a family-centred perspective in cardiovascular care settings is warranted. 

  • 9.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Sandgren, Anna
    Linnaeus University, The Center for Collaborative Palliative Care, Vaxjo, Sweden.
    Benzein, Eva
    Linnaeus University, The Center for Collaborative Palliative Care, Vaxjo, Sweden.
    The heart is a representation of life: an exploration of illness beliefs in couples living with atrial fibrillation2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S41-S41, article id 116Article in journal (Refereed)
    Abstract [en]

    Background: Beliefs are the lenses through which we view the world, guiding our behaviour and constructing our lives. Couples evolve an ecology of beliefs from their interaction whereby their actions and choices arise from their beliefs. Atrial fibrillation is a common cardiac arrhythmia that has implications for both patients and partners. A couple’s illness beliefs play an important role in convalescence and illness management, and no previous studies have examined illness beliefs in couples living with AF.

    Purpose: To explore illness beliefs in couples where one spouse has atrial fibrillation.

    Methods: Data collection constituted in-depth interviews with nine couples (patient and partner together). Hermeneutic philosophy as described by Gadamer was used to interpret and to understand illness beliefs in couples living with AF.

    Results: The findings revealed both core illness beliefs and secondary illness beliefs. From the core illness belief “Theheart is a representation of life,” two secondary illness beliefs were derived: atrial fibrillation is a threat to life and atrial fibrillation can and must be explained. From the core illness belief “Change is an integral part of life,” two secondary illness beliefs were derived: atrial fibrillation is a disruption in our lives and atrial fibrillation will not interfere with our lives. Finally, from the core illness belief “Adaptation is fundamental in life,” two secondary illness beliefs were derived: atrial fibrillation entails adjustment in daily life and atrial fibrillation entails confidence in and adherence to professional care.

    Conclusion: Couples’ interaction has developed mutual illness beliefs regarding atrial fibrillation that guide them in their daily lives and influence their decisions. The adoption of a family-centred perspective in cardiovascular care settings is warranted.

  • 10.
    Ekblad, Helena
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Conlon, Lisa
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Rönning, Helén
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    The well-being of relatives of patients with atrial fibrillation: a critical incident technique analysis2014In: Open Nursing Journal, ISSN 1874-4346, E-ISSN 1874-4346, Vol. 8, p. 48-55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient's condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed.

    AIM: To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations.

    DESIGN AND METHOD: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF.

    RESULTS: The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement).

    CONCLUSION: The well-being of relatives of patients with AF was affected depending on the patients' well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together.

  • 11.
    Ekblad, Helena
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Rönning, Helen
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Patients' well-being: experience and actions in their preventing and handling of atrial fibrillation2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 2, p. 132-139Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation (AF) influences the lives of patients in the form of worsened well-being. Patients’ own experience of and how to handle AF is rarely investigated. These are important aspects for healthcare services to understand in order to support the well-being of patients with AF.

    Aim: To explore and describe critical incidents in which patients experience how AF affects their well-being and what actions they take to prevent and handle it.

    Design and methods: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 25 patients (16 men and 9 women) with AF in a healthcare area in southern Sweden.

    Results: Patients experienced discomfort and limitations in daily life. The actions they took were self-care related actions and healthcare related actions.

    Conclusion: AF affects well-being when it is uncomfortable and leads to pronounced limitations in daily life with the patients trying to maintain or restore well-being through adapting and developing strategies for self-care. Patients base the handling of AF on their personal experience.

  • 12.
    Fransson, Eleonor I.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Stadin, Magdalena
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nordin, Maria
    Umeå Universitet.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Knutsson, Anders
    Mittuniversitetet.
    Alfredsson, Lars
    Karolinska Institutet.
    Westerholm, Peter J. M.
    Uppsala universitet.
    The association between job strain and atrial fibrillation: Results from the Swedish WOLF Study2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2015, p. 1-7, article id 371905Article in journal (Refereed)
    Abstract [en]

    Introduction. Atrial fibrillation (AF) is a common heart rhythm disorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods. Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results. In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10–3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67–1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion. This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF.

  • 13.
    Fransson, Eleonor
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. ADULT.
    Stadin, Magdalena
    Jönköping University, School of Health Science, HHJ. ADULT.
    Nordin, Maria
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Knutsson, Anders
    Alfredsson, Lars
    Westerholm, Peter
    Job strain and the risk of atrial fibrillation: Results from the Swedish WOLF study2015Conference paper (Refereed)
  • 14.
    Fridlund, Bengt
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Malm, DanJönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.Mårtensson, JanJönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Kardiologisk Omvårdnad2012Collection (editor) (Other academic)
  • 15.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, 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
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. 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.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S74-S75Article in journal (Refereed)
    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.

  • 16.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden.
    Karlsson, Jan-Erik
    Jönköping University, School of Health and Welfare, 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
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, 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 fibrillation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed)
    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.

  • 17.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Yaseri, Mehdi
    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Burri, Andrea
    Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
    Webb, Thomas L.
    Department of Psychology, The University of Sheffield, Sheffield, United Kingdom.
    Can a multifaceted intervention including motivational interviewing improve medication adherence, quality of life, and mortality rates in older patients undergoing coronary artery bypass surgery? A multicenter, randomized controlled trial with 18-month follow-up2017In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 34, no 2, p. 143-156Article in journal (Refereed)
    Abstract [en]

    Background: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important.

    Objective: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

    Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

    Results: Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04).

    Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.

  • 18.
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Health-related quality of life in patients with pacemakers: a descriptive and experimental study2005Doctoral thesis, comprehensive summary (Other academic)
  • 19.
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Livet med pacemaker: Nationellt informationshäfte för patienter med pacemaker1997Other (Other (popular science, discussion, etc.))
  • 20.
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Vård och omvårdnad av patient med pacemaker1998In: Kardiologisk omvårdnad: Cirkulation, Lund: Studentlitteratur , 1998, p. 92-108Chapter in book (Other academic)
  • 21.
    Malm, Dan
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Hallberg, Lillemor R-M
    Patients' experiences of daily living with a pacemaker: a grounded theory study.2006In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 11, no 5, p. 787-798Article in journal (Refereed)
  • 22.
    Malm, Dan
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Karlsson, Jan-Erik
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Effects of a self-care program on the health related quality of life of pacemaker patients: A nursing intervention study2007In: Canadian Journal of Cardiovascular Nursing, ISSN 0843-6096, Vol. 17, no 1, p. 15-26Article in journal (Refereed)
  • 23.
    Malm, Dan
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Karlsson, Jan-Erik
    Fridlund, Bengt
    Quality of life in pacemaker patients from a  nursing perspective1998In: Coronary Health Care, ISSN 1362-3265, E-ISSN 1532-2025, Vol. 2, no 1, p. 17-27Article in journal (Refereed)
  • 24.
    Malm, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ekblad, Helena
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Impact of a cognitive behavioral intervention on quality of life and psychological distress in patients with atrial fibrillation: the importance of relatives2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S49-S50Article in journal (Refereed)
    Abstract [en]

    Background: Although there is an evidence to support the efficacy of cognitive behavioral therapy (CBT) in improving quality of life and decreasing psychological distress in patients with cardiovascular diseases but involving patient’s and relatives in the CBT and its effect on patient’s general health, has not been evaluated.

    Aim: The aim was to determine whether involving the relatives in CBT for patients with Atrial Fibrillation (AF) enhances treatment outcomes relative to treatment as usual group (TAU).

    Method: In a randomized controlled trial, 78 patients diagnosed with AF were randomly assigned to experimental (EXP) or TAU groups. In the EXP group, patients and relative participated in a 6-week program while the patient in the TAU group received standard care. Short Form 36(SF-36), Hospital Anxiety and Depression Scale (HADS),Euro-QoL 5-Dimension Self-Report Questionnaire (EQ-5D) and Sense of Coherence (SOC-13) were completed at  baseline and at 12-month follow-up. 

    Results: In all 78 patients completed the assessment at 12 months. The two groups were similar for sociodemographic and clinical variables at baseline. The EXP group reported significantly higher scores in EQ-5D (F= 6.18, p = 0.01) and SOC (F= 4.15, p = 0.04) than TAU group. Compared with TAU group, patients in EXP group reported significantly lower depression (F= 4.58, p = 0.04). Thirteen percent of Indirect effect of the intervention on improving patient’s quality of life in the EXP group was related to the SOC improvement (z = 11.83, p < .01).

    Conclusions: This study provides evidence that patients and their relatives’ involvement is more effective in improving quality of life and decreasing psychological distress than those who receiving standard care. Our results also indicate that interventions should initially focus on increasing patient’s sense of coherence.

  • 25.
    Malm, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Rolander, Bo
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Futurum Academy for Healthcare, Jönköping, Sweden.
    Ebefors, Eva-Marie
    Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Conlon, Lisa
    Futurum Academy for Healthcare, Jönköping, Sweden.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Reducing the prevalence of catheter-related infections by quality improvement: Six-year follow-up study2016In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, no 2, p. 79-87Article in journal (Refereed)
    Abstract [en]

    Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases.

    Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs.

    Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001).

    Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.

  • 26.
    Malm, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sandgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Regaining normalcy in relatives of patients with a pacemaker2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 4, no 3, p. 139-149Article in journal (Refereed)
    Abstract [en]

    Patients with chronic diseases, such as those with pacemakers, have shown that they have a worsened well-being, which means an increased interest in investigating how relatives of patients with pacemakers experience their situations and how the disease affects their life situations. The aim of this study was to explore the main concerns for the relatives of patients with a pacemaker and how they resolve these issues. A classic grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with ten participants. Striving for normalcy emerged as the main concern for relatives of patients with a pacemaker and was handled through a process of regaining normalcy where the relatives strive to find a way to live as normal as possible. Regaining normalcy is done through developing trust, dwindling and finally life stabilizing, in which they are either holding back or new normalizing. Distinguishing signs are constantly done during the process to quickly notice possible symptoms of the patient. Increased knowledge and understanding of how the relatives of patients with a pacemaker regain normalcy can be used as a guide in order to support and inform the patient as well as their relatives in conjunction with implantation occasions but also in connection with recurring and lifelong follow-up occasions.

  • 27.
    Malm, Dan
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Svensson, E
    Karlsson, J-E
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Health-related quality of life in pacemaker patients: a single and multidimensional self-rated health comparison study.2003In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, no 4, p. 291-302Article in journal (Refereed)
  • 28.
    Malm, Dan
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Svensson, O
    Karlsson, J-E
    Binner, L
    Brobe, R
    Höhler, H
    Matheis, G
    Pietersen, A
    Schenkel, W
    Vesterlund , T
    Comparison of threshold values between steroid and nonsteroid unipolar membrane leads1994In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 17, no 11, p. 2008-2011Article in journal (Refereed)
  • 29.
    Nilsson, Ulrica
    et al.
    Department of Nursing, Umeå University .
    Svedberg, Petra
    School of Social and Health Sciences Halmstad University, Halmstad, Sweden .
    Malm, Dan Anders John
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Baigi, Amir
    General Practice and Public Health, Halland County Council, Falkenberg, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Brännström, Margaretha
    Department of Nursing, Umeå University .
    Brunt, David
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Alm -Roijer, Carina
    The Faculty of Health and Society, Malmö University, Sweden .
    Sjöström Strand, Annelie
    The Faculty of Health and Society, Malmö University, Sweden .
    Johansson, Ingela
    Department of Medical and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping, .
    Sex knowledge in male and females in a myocardial infarction populationIn: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
  • 30.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Linneus University.
    Ahlström, Gerd
    Swedish Institute for Health Sciences, Department of Health Sciences, Lund University.
    Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis2012In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 39, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Empowering interventions can improve person-centered care. A pre- and post-evaluation using interactive research involving two years of empowering interventions was designed to improve quality of care in outpatients with chronic kidney disease who were pre-dialysis. The results showed significantly increased empowerment in the intervention group. Interactive research facilitated the implementation of the empowerment intervention, which may increase sustainability over time.

  • 31.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Ahlström, Gerd
    Facilitators and barriers in the implementation process of an improvement intervention in chronic kidney care: a case studyManuscript (preprint) (Other academic)
  • 32.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Linneus University, Växjö SE- 351 95, Sweden.
    Ahlström, Gerd
    Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 187, Lund SE-221 00, Sweden.
    The complexity in the implementation process of empowerment-based chronic kidney care: a case study2014In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 13, no 22, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care.

    Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis.

    Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process.

    Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

  • 33.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Wikby, Kerstin
    Jönköping University, School of Health and Welfare.
    Ahlström, Gerd
    Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden.
    The experience of empowerment in the patient-staff encounter: the patient's perspective2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 5/6, p. 897-904Article in journal (Refereed)
    Abstract [en]

    Aim and objective.  The aim was to explore empowerment within the patient–staff encounter as experienced by out-patients with chronic kidney disease.

    Background.  Empowerment has an important role to play in the patient–staff relationship in the case of patients with a chronic disease. When it comes to patients with chronic kidney disease, there has been little research on empowerment, for which reason interviewing such patients about their experiences of empowerment will provide useful knowledge within the context of out-patient care.

    Design.  A qualitative interview study was chosen to gain an understanding of empowerment from the patient perspective.

    Method.  The study was carried out at an out-patient clinic in Sweden and involved 20 patients with chronic kidney disease. The interviews were subjected to latent content analysis.

    Results.  Five of the seven sub-themes emerging from the analysis represented empowerment: Accessibility according to need, Confirming encounter, Trust in the competence of the healthcare staff, Participation in decision-making, Learning enables better self-management. The other two represented non-empowerment: Meeting with nonchalance, Lack of dialogue and influence. From the seven sub-themes, one comprehensive theme was generated: Creation of trust and learning through encounter.

    Conclusion.  The main finding regarding the central role of the creation of trust and learning through the patient–staff encounter underlines the importance of understanding empowerment from the patient’s perspective.

    Relevance to clinical practice.  Nursing and other healthcare staff need knowledge and understanding of the meaning of empowerment from the patients’ perspective to meet their needs in out-patient care.

  • 34.
    Nygårdh, Annette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Wikby, Kerstin
    Malm, Dan Anders John
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ahlstrom, Gerd
    Empowerment in outpatient care for patients with chronic kidney disease - from the family member's perspective.2011In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 10, no 21, p. 2-8Article in journal (Refereed)
    Abstract [en]

    Background: Family members of persons with pre-dialysis chronic kidney disease may experience feelings of vulnerability and insecurity as the disease follows its course. Against this background, the aim of the present study was to explore empowerment in outpatient care as experienced by these family members.

    Methods: An inductive approach for qualitative data analysis was chosen. The study sample comprised 12 family members of pre-dialysis patients at an outpatient kidney clinic. Two interviews with each family member were subjected to content analysis to gain an understanding of empowerment from the family members' perspective.

    Results: Having strength to assume the responsibility was the main theme that emerged from the following five sub-themes: Being an involved participant, Having confirming encounters, Trusting in health-care staff, Comprehending through knowledge, and Feeling left out. Four of these five sub-themes were positive. The fifth subtheme illuminated negative experience, indicating the absence of empowerment.

    Conclusions: Family members' experience of empowerment is dependent on their ability to assume the responsibility for a relative with chronic kidney disease when needed. The findings emphasise the need for a family perspective and the significance of a supportive environment for family members of persons in outpatient care.

  • 35.
    Pakpour, Amir H.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Saffari, M.
    Baqiyatallah Medical Sciences University, Tehran, Iran.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Prospective case-control study of sexual dysfunction in female patients with Takotsubo cardiomyopathy2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S85-S86Article in journal (Refereed)
    Abstract [en]

    Background: Regarding the lack of earlier studies on sexual function in female patients with Takotsubo cardiomyopathy (TSCM), the current study aimed at an investigation of psychological and quality of life measures associated with sexual function in female patients with TSCM.

    Methods: In this Prospective case-control study, female patients with TSCM from university hospitals in Tehran and Qazvin were enrolled and matched (1:1.1) with acute myocardial infarction (AMI) along with healthy controls (94 patients per group). Data on hospital anxiety and depression scale, SF-12, female sexual function index and female sexual distress scale were assessed at baseline, 6 months and 18 months. Multilevel logistic regressions ought associations between variables.

    Results: Sexual function, anxiety and depression at baseline were different among the groups with worse situations in female patients with TSCM (p < 0.01). Quality of life at baseline was similar among patient groups but at lower state than healthy controls. Overall, quality of life subscales especially among female patients with TSCM showed a downward trend, indicating deterioration overtime. Higher prevalence of sexual dysfunction in TSCM group was seen compared to female patients with AMI and control group over time (OR, 3.10 and 2.28 respectively). Sexual functioning was found to be a mediator between anxiety and quality of life which positively impacts on patient’s quality of life.

    Conclusions: Since the psychological and quality of life measures as well as sexual function indicated a descending trend across time, there is a necessity to intervene for these women by focus on problems like anxiety to control health deterioration.

  • 36.
    Pakpour, Amir H.
    et al.
    Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Help seeking behavior for sexual dysfunction in female patients with Takotsubo cardiomyopathy: A longitudinal application of the theory of planned behavior2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S32-S33Article in journal (Refereed)
    Abstract [en]

    Background: Many cardiac female patients suffer from sexual dysfunction and do not seek appropriate help. Understating help-seeking intentions and behavior is fundamental to develop interventions targeted to increase using sexual health services in the patients with Takotsubo cardiomyopathy (TSCM). TSCM is a reversible weakening of the left ventricle that produces symptoms that are similar to acute myocardial infarction (e.g., shortness of breath or chest pain). A variety of psycho-affective triggers and predispositions such as stress, anxiety, depression, phobia, and anhedonia have been recognized as risk factors for TSCM. The aim of the study was to investigate the application of the Ajzen’s theory of planned behavior (TPB) in explaining female TSCM patient’s behavior in seeking treatment for sexual dysfunction.

    Methods: In this longitudinal study, one hundred and sixty-three female patients with TSCM were screened for sexual dysfunction by the Female Sexual Function Index (FSFI ⩽ 26.55) at eight referral hospitals in Iran (i.e.Tehran, Qazvin, Tabriz and Zahedan). The patients were then asked to complete study measures including attitude, subjective norm, perceived behavioral control, behavioral intention, self-stigma and perceived barriers at baseline. A measure of using sexual health services was obtained from electronic patient’s records. Hierarchical linear regression and logistic regressions were used to assess how well the variables of the TPB predicted behavioral intention and using sexual health services.

    Results: Seventy-eight female patients with TCSM were diagnosed to have sexual dysfunction (mean age 62.19 ± 8.03 years). Attitudes, perceived behavioral control (PBC) and subjective norms all predicted charitable giving intentions. Patients with strong behavioral intention (OR = 1.92, 95% CI, 1.36 to 2.73) were more likely to use sexual health services at 18 months of follow-up. Patients with high Self stigma (OR = 0.664, 95 % CI, 0.48 to 0.92) and perceived barriers (OR = 0.93, 95 % CI, 0.89 to 0.98) were less likely to use sexual health services at 18 months of follow-up.

    Conclusions: The results suggest that interventions designed to promote help seeking behavior for sexual dysfunction in TSCM patients should focus on reducing barriers and self-stigma and the development of a positive attitude as well the PBC.

  • 37.
    Pakpour, Amir H.
    et al.
    Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Cardiac rehabilitation teams‘ psychosocial determinants for sexual counseling of women with Takotsubo cardiomyopathy: A theory-based longitudinal study2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S53-S54Article in journal (Refereed)
    Abstract [en]

    Background: Patients with Takotsubo cardiomyopathy (TSCM) especially female, may be at risk of poor psychological adjustment and deteriorated health related quality of life. Sexual dysfunction is a significant problem for patients with TSCM. Therefore, Sexual counseling should be integrated into the cardiac rehabilitation services. However, cardiac rehabilitation teams reluctant to address patient’s sexual problems. The aim of this study was to determine factors which effect on performing sexual counseling among cardiac rehabilitation team.

    Methods: In this longitudinal study, two hundred and forty-four specialists (i.e., physical therapists, nurses, psychologists, social workers, rehabilitation specialists and cardiologists), who were working in cardiac rehabilitation teams participated in the study at eight referral hospitals in Iran (i.e., Tehran, Qazvin, Tabriz and Zahedan). The teams were asked to complete study measures including sexual knowledge (25 items), attitude (12 items), subjective norm (5 items), perceived behavioral control (8 items), behavioral intention (2 items) and perceived barriers (17 items). Six month later, the teams were then contacted to ask the frequency of the sexual counseling sessions during the past six months.

    Results: Cardiac rehabilitation teams reported that sex was rarely discussed with patients (14.3%). Attitudes, subjective norms and perceived behavioral control (PBC) emerged as significant direct predictors of intention to perform sexual consulting. Multiple logistic regression analysis showed that cardiac rehabilitation teams with strong behavioral intention (OR = 1.83, 95 % CI, 1.08  to 3.10) and low perceived barriers (OR = 0.69, 95 % CI, 0.49 to 0.97) were more likely to perform the subsequent sexual consulting.

    Conclusions: Existing cardiac rehabilitation activities are likely to continue to fail to promote patient’s sexual functioning after cardiac events in the absence of effective strategies to reduce the underlying barriers toward sexual counseling. Interventions should be targeted on reducing barriers toward sexual counseling in cardiac rehabilitation teams.

  • 38.
    Pakpour, Amir H.
    et al.
    Qazvin University of Medical Sciences, Qazvin, Iran.
    Lin, C-Y
    Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Webb, T. L.
    University of Sheffield, Department of Psychology, Sheffield, United Kingdom.
    Can a multifaceted intervention including motivational interviewing improve medication adherence, quality of life and mortality rates in older patients undergoing coronary artery bypass surgery?2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S1-S2Article in journal (Refereed)
    Abstract [en]

    Objective: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for a long time, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence is therefore important. The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

    Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment as usual (TAU; n = 144) groups using cluster randomization with center level. Medication adherence was evaluated using Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL using Short-Form 36.Data were collected at baseline; three, six, and eighteen months after intervention. Survival status was followed up at eighteen months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

    Results: Compared to patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved six months after surgery (p <0.01) and remained so eighteen months after surgery (p< 0.01). QoL also increased among patients in the EXP group as compared to those who received TAU at eighteen month post-surgery (physical component summary score p= 0.02; mental component summary score p = 0.04). HR in the EXP group compared to the TAU group was 0.38 (p = 0.04).

    Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after eighteen months. QoL and survival rates increased as a function of better medication adherence.

  • 39.
    Saffari, Mohsen
    et al.
    Health Research Center, Baqiyatallah University of Medical Sciences Tehran, Iran.
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Burri, Andrea
    Health and Rehabilitation Research Institute, Auckland University of Technology, New Zealand.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Investigating sexual problems, psychological distress and quality of life in female patients with Takotsubo cardiomyopathy: A prospective case-control study2017In: European Journal of Cardiovascular Nursing, Vol. 16, no 7, p. 614-622Article in journal (Refereed)
    Abstract [en]

    Background: Takotsubo cardiomyopathy (TSCM) has detrimental effects on both physical and psychological health of sufferers. However, little is known whether TSCM also affects sexual functioning in female patients.

    Aim: The aim of this study was to investigate psychological distress (depression and anxiety), health-related quality of life, and sexual functioning in women with TSCM and compare them with women with acute myocardial infarction and with healthy controls.

    Methods: A three group prospective case-control design was used. Female patients with TSCM or acute myocardial infarction, as well as healthy controls (94 in each group), were recruited across eight Iranian university hospitals. Data were collected at baseline and after six and 18 months using the Hospital Anxiety and Depression Scale, the Short Form-12, the Female Sexual Function Index and the Female Sexual Distress Scale. Multilevel logistic regression was conducted.

    Results: The TSCM group showed worst sexual functioning and the highest level of anxiety and depression at baseline (p<0.01) compared with the two other groups. The TSCM and AMI groups showed comparable health-related quality of life at baseline, which was lower in both groups compared with the healthy controls (p<0.01). Overall, depression, anxiety and health-related quality of life showed a significant change over time, especially in the TSCM group, with health-related quality of life decreasing, while anxiety and depression were increasing. Compared with the acute myocardial infarction and healthy control groups, the TSCM group showed a higher prevalence of sexual problems (odds ratios = 3.10 and 2.28, respectively) across time. Moreover, sexual functioning was found to be a mediator between anxiety and health-related quality of life in the TSCM group.

    Conclusion: Depression, anxiety, health-related quality of life, and sexual dysfunction tend to increase over time in female patients with TSCM; thus, healthcare providers should pay attention to these problems and provide appropriate treatment where necessary. 

  • 40.
    Stålkrantz, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Wiberg, Jan
    Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Everyday life for the spouses of patients with untreated OSA syndrome2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 324-332Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to generate a theoretical model describing concerns for spouses of patients with untreated obstructive sleep apnoea syndrome (OSAS) and how they manage these concerns in their everyday life. Twelve spouses were interviewed about their experiences and how they manage everyday life. The interviews were analysed according to the Grounded Theory method as described by Strauss and Corbin. Two main categories emerged from the data: ‘Social adjustment’ and ‘New feelings’. ‘Social adjustment’ reveals how the spouses made adjustments in their daily lives, both according to their partners’ tiredness and owing to their own fatigue. ‘New feelings’ reveals emotional reactions related to the effects of their partner’s illness and the impact it had on the spouse’s everyday life. These two main categories could be seen in relation to four dimensions describing how the spouses manage their everyday life: ‘Sacrificing’, ‘Controlling’, ‘Changing’ and ‘Understanding’. The results show how the spouses made adjustments in everyday life and how their feelings were affected by their partner’s OSAS. Healthcare personnel could use information from this study to gain a deeper understanding and knowledge of what spouses of untreated patients with OSAS experience as their main concerns and how they manage their everyday life. This knowledge can be used to improve the support to the spouses, as well as in the educational situation concerning the illness, as well as the treatment.

  • 41.
    Svedberg, Petra
    et al.
    School of Social and Health Sciences Halmstad University, Halmstad.
    Johansson, Ingela
    Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping.
    Persson, Sylvie
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Roxberg, Åsa
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Baigi, Amir
    General Practice and Public Health, Halland County Council, Falkenberg.
    Brunt, David
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Roijer, Carin Alm
    The Faculty of Health and Society, Malmö University, Malmö.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Rask, Mikael
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Nilsson, Ulrica
    Centre of Heath Care Sciences Örebro County Council and School of Health and Medical Sciences, Örebro University, Sweden.
    Psychometric evaluation of 'The 25-item Sex after MI Knowledge Test' in a Swedish context2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 203-208Article in journal (Refereed)
    Abstract [en]

    The patients' sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of 'The 25-item Sex after MI Knowledge Test' in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients' National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test-retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test-retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.

  • 42. Svensson, O
    et al.
    Karlsson, J E
    Binner, L
    Brobe, R
    Höhler, H
    Kreuzer, J
    Malm, Dan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Matheis, G
    Pietersen, A
    Schenkel, W
    Comparison of threshold values between steroid and nonsteroid unipolar membrane leads1994In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 17, no 11 Pt 2, p. 2008-2011Article in journal (Refereed)
  • 43.
    Ulin, Kerstin
    et al.
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    What is known about the benefits of patient-centered care in patients with heart failure2015In: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 12, no 6, p. 350-359Article, review/survey (Refereed)
    Abstract [en]

    Treatment for chronic heart failure (CHF) has improved, and symptom burden has been identified as an important treatment goal. Because patient-centered care may ease the burden, we need to know its benefits for patients with CHF, hence this systematic literature review. We found that one benefit of person-centered care is an increase in quality of life in patients with CHF. Improvements were found in self-care, physical and mental status, health care costs, general uncertainty regarding illness and recovery, patient dignity, treatment, and systems of care. Improvements also were observed in symptom burden, self-efficacy, and quality of life. These findings indicate that person-centered care is a powerful approach to current and future health care. However, because an appropriate tool to measure person-centered care does not yet exist, it will be a challenge to determine whether the goal has been reached from a long-term and patient perspective.

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