Aim: To describe how the nurse anaesthetist empowers the patient in the perioperative dialogue. Design: A qualitative descriptive design with interviews with 12 nurse anaesthetist (NA). Method: A hermeneutic text interpretation with a foundation in Gibson's empowerment model. Result: The results highlight Gibson's nursing domain: Helper, Supporter, Counsellor, Educator, Resource Consultant, Resource Mobilizer, Facilitator, Enabler and Advocate. The overall understanding is revealed as a relationship can be built through closeness between the patient and the NA. The NA helps the patient master the situation by talking to and touching the patient. The patient is helped to find their own strengths and to cope with their fears. The patients decide over their own bodies. When the patients do not want to or cope with protecting themselves, the NA protects and represents the patient.

Background In the perioperative dialogue, pre-, intra- and postoperatively, the patient shares their history. In the dialogue, the nurse anesthetist (NA) gets to witness the patient's experiences and can alleviate the patients' suffering while waiting for, or undergoing surgery. The aim of this study was to describe the nurse anesthetist's experiences of the perioperative dialogue. Methods The study had a qualitative design. Interviews were conducted with 12 NA and analyzed with interpretive content analysis. The methods were conducted in accordance with the COREQ guidelines. Results In the result, three categories emerge: A mutual meeting (the preoperative dialogue) where the patient and the NA through contact create a relationship. The NA is present and listens to the patient, to give the patient confidence in the NA. In the category, On the basis of the patient's needs and wishes (the intraoperative dialogue), the body language of the NA, as well as the ability to read the body language of the patient, is described as important. In the category, To create a safe situation (the postoperative dialogue) the NA ensures that the patient has knowledge of what has happened and of future care in order to restore the control to the patient. Conclusion The patient is met as a person with their own needs and wishes. It includes both a physical and a mental meeting. In a genuine relationship, the NA can confirm and unreservedly talk with the patient. When the patients leave their body and life in the hands of the NA, they can help the patients to find their inherent powers, which allows for participation in their care. Understanding the patient is possible when entering in a genuine relationship with the patient and confirm the patient. The perioperative dialogue forms a safety for the patients in the operating environment.

By educating laymen, survival after cardiac arrest can increase in society. It is difficult to reach the entire population with cardiopulmonary resuscitation (CPR) training. However, if 15% of the population knows how to perform CPR, an increase in short- and long-term survival in patients suffering a cardiac arrest could be seen. To educate youth is a way to reach parts of the population. This study aimed to investigate the effect of a 2-h CPR intervention for youth.

BACKGROUND:

A rapid emergency care intervention can prevent the cardiac arrest from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to have any real significance for the survival of the patient, it requires an educational effort educating the large masses of people of whom the youth is an important part. The aim of this study was to investigate the effect of a two-hour education intervention for youth regarding their self-confidence in performing Adult Basic Life Support (BLS).

METHODS:

A quantitative approach where data consist of a pre- and post-rating of seven statements by 50 participants during an intervention by means of BLS theoretical and practical education.

RESULTS:

The two-hour training resulted in a significant improvement in the participants' self-confidence in identifying a cardiac arrest (pre 51, post 90), to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and use a defibrillator (pre 61, post 81). In addition, to have the self-confidence to be able to perform, and to actually perform, first aid to a person suffering from a traumatic event was significantly improved (pre 54, post 89).

CONCLUSION:

By providing youth with short education sessions in CPR, their self-confidence can be improved. This can lead to an increased will and ability to identify a cardiac arrest and to begin compressions and ventilations. This also includes having the confidence using a defibrillator. Short education sessions in first aid can also lead to increased self-confidence, resulting in young people considering themselves able to perform first aid to a person suffering from a traumatic event. This, in turn, results in young people perceiveing themselves as willing to commence an intervention during a traumatic event. In summary, when the youth believe in their own knowledge, they will dare to intervene.

Purpose: Insomnia has adverse effects on people with epilepsy. We aimed to test a novel cognitive behavioral therapy for insomnia (CBT-I) app-based intervention on insomnia symptoms and social psychological factors in people with epilepsy and to examine the possible mechanisms among the factors.

Methods: Participants were recruited from neurology clinics in Iran and comprised individuals diagnosed with epilepsy and having moderate to severe insomnia. A two-arm randomized controlled trial design was used, consisting of a treatment group (CBT-I; n = 160) and control group (patient education; n = 160). Primary outcomes were self-reported sleep quality, insomnia severity, and sleep hygiene behavior and objective sleep characteristics measured by actigraphy. Secondary outcomes were attitude, perceived behavioral control, intention, action planning, coping planning, behavioral automaticity, self-monitoring, anxiety, depression, and quality of life (QoL). All outcomes were measured at baseline, and at one, three, and six months postintervention, except objective sleep, which was assessed at baseline, and one and six months postintervention. Data were analyzed using linear mixed models.

Results: Current findings showed that sleep quality, insomnia severity, sleep hygiene behavior, and sleep onset latency were significantly improved in the CBT-I group compared with the patient education group at all measurement points. Also, the CBT-I group had significantly improved anxiety, depression, and QoL compared with the patient education group. Mediation analyses showed that attitude, intention, coping planning, self-monitoring, and behavioral automaticity significantly mediated the effect of the intervention on sleep outcomes.

Conclusion: Results support the use of the CBT-I app to improve sleep outcomes among people with epilepsy.

In this paper the nature of user involvement in a co-design process will be explored. The outlines of a research project aiming at developing support systems for self-care inpatients suffering from chronic heart failure will be presented. The project is planned to perform a co-design effort where users (patients and healthcare professionals) will be given the opportunity to influence the development of support systems. We will discuss a number of possibilities and challenges that lie in the design of this kind of project and also some findings from its early stages. This report presents the experiences of users’ input, which are discussed in the context of previous research on benefits of user contributions in systems development.

Lipoedema is a disease in adipose tissue associated with multiple health problems that negatively impact the quality of life. However, due to body appearance, the disease is frequently misunderstood as lifestyle-induced obesity, and the affected women are at risk of being fat-shamed and lacking prerequisite support from healthcare providers and other people. Although the negative impact lipoedema has on health and social life, research from the affected women´s perspective is relatively sparse. Therefore, we conducted a Swedish national survey to explore healthcare experiences, health-related stigma, and social support among women with lipoedema. 

Methods

An online survey with closed and open questions assessing sociodemographic, lipoedema characteristics, health-care experiences, health-related stigma, and perceived social support was sent out to all Lipoedema Association groups across Sweden. 

Participants

In total, 245 women with lipoedema responded to the survey. The majority of participants were aged 40-59, and over half were in lipoedema stage 3. Most of the women had a combination of lipoedema type 3 and type 4.

Results

The result showed that it often takes decades, including many healthcare visits, from disease onset to diagnosis. Moreover, participants reported an overall significantly lower patient satisfaction with healthcare compared to a general Swedish female population. Especially low scores were found in the dimensions of Emotional support, Continuity and coordination, and Information and knowledge, which related to participants’ dissatisfaction with healthcare providers’ availability, responsiveness, commitment, and compassion for the patient’s worries and needs. Furthermore, compared to a general Swedish female population, women with lipoedema scored significantly more health-related social impairment. When analyzing data for stigma and health-related quality of life, significant correlations across higher levels of stigma and lower physical and social functioning and emotional well-being were found. In this study, participants generally reported a strong perception of social support, with having particularly good support from significant others (i.e., perceived support from a particular person who is not a family member or friend). Moreover, we found that the association between higher levels of social support and better emotional well-being was significant.

Conclusion

The challenges associated with diagnosis delay and the low satisfaction with healthcare underscore an urgent need for healthcare improvements in the management of lipoedema. The impact health-related stigma and social support have on various aspects of functioning and well-being in women with lipoedema is crucial to acknowledge and address in healthcare to enhance the affected women's quality of life. 

Background: Lipoedema is a chronic disease in adipose tissue that almost exclusively affects women during periods of hormonal alterations. Its main symptoms include an abnormal accumulation of subcutaneous fat in the buttock, hips, and legs, which is associated with pain, swelling, and easy bruising. Herein, a grading in three stages is used to determine disease progression. Problematically, lipoedema manifestations are often confused with lifestyle-induced obesity, which is why the various health problems among affected women often remain unrecognized. Overall, research on lipoedema is scarce. As such, this study examined the health, health-related quality of life (HRQOL), and sense of coherence (SOC) among women with lipoedema. Methods: We conducted a national cross-sectional study using an online survey assessing sociodemographic data, lipoedema characteristics, symptom severity, comorbidities, HRQOL (RAND-36), and SOC (SOC-13). In total, 245 women with lipoedema, recruited from all Lipoedema Association groups in Sweden, participated. Data were compiled with descriptive statistics, and mean differences between groups were analysed by using parametric and non-parametric tests. Results: Moderate and severe leg heaviness, pain, numbness, cold skin, feeling cold, easy bruising, and sleep problems were found to occur in all lipoedema stages. Moreover, almost all participants reported having comorbidities. Worse physical health and most substantial limitations in daily life were reported among women with the most progressive lipoedema (i.e., stage 3). Social and emotional functioning and SOC were found to be, on the other hand, primarily related to respondents’ sociodemographic data and their ages at lipoedema onset. Even though approximately 70% of the women had experienced lipoedema onset before age 30, only three (1.6%) had been diagnosed by a healthcare professional before that age. Conclusion: Having lipoedema is associated with several health problems and a lower HRQOL. In addition, the extent of delay in diagnosis within this sample indicates that many women with lipoedema are often underdiagnosed and are left without support from healthcare. These findings call for the need for greater attention on lipoedema. Moreover, further studies on how women with lipoedema manage their health and symptoms, as well as on their experiences of healthcare services and lipoedema treatments, are needed.

Objectives 

Lipedema is associated with multiple health problems which limit daily life. Still, the disease is frequently misunderstood in healthcare, and research from the patient’s perspective is relatively sparse. A Swedish national survey was conducted, to comprehensively examine health and quality of life among women with lipedema. Furthermore, the study explored participants’ self-care, self-reported effects of different treatments, and experiences when seeking healthcare.

Results

In total, 245 women with lipedema responded to the survey. The majority were 40-59 years old, and over half of the participants were in lipedema stage 3. Overall, in most age groups, women with lipoedema scored approximately 25-35 points lower in their physical and mental health than an age-matched general Swedish female population. Moreover, it often took decades from disease onset, including many healthcare visits, to be correctly diagnosed. Compared to a general female population, women with lipedema scored significantly lower on satisfaction with healthcare in dimensions of availability, information and knowledge, Experiences of emotional support, continuity and coordination, respect and treatment, and participation and involvement. Particularly low scores were recorded in participants’ overall impression of healthcare, including expectations of care, perceived efficiency, being cared for, and accessing information about treatment alternatives. Women with lipedema used several different treatments to manage their health problems. Most common were performing low-intensity exercise and using compression garments, of which approximately half of the participants rated as having a good or a very good effect. Less used, but self-reported as more effective, were conservative and surgical treatments performed by healthcare professionals.  

Conclusion

Lipedema has a significant negative impact on health and quality of life. Still, the diagnosis delay is extensive, and women with lipedema generally report low levels of satisfaction with healthcare. Although managing lipedema symptoms with self-care is common, treatments performed in healthcare were identified as having the most positive effects. Unfortunately, these are less likely to be used, suggesting barriers to healthcare. 

Learning objectives

This research aims to contribute to a holistic understanding of lipedema, including the management of lipedema symptoms from the patient’s perspective and the challenges these women face in healthcare. This is essential when implementing effective treatment plans and prioritising healthcare interventions.

At the conclusion of this activity, participants should be able to: 

1. Recognize and describe experiences that women with lipedema have regarding their treatment and healthcare
2. Identify healthcare improvements for women with lipedema

The extant literature has suggested relationships between an individual's chronotype (in relation to morningness/eveningness) and several outcomes, including addictive disorders, psychological distress and daytime sleepiness. Moreover, sleep quality has been proposed to be a mediator in the aforementioned relationships. Consequently, the aim of the present study was to investigate the complex relationship between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness, with the potential mediators of sleep quality and insomnia. All participants (N = 1,791 [30.1% males]; mean age = 27.2 years, SD = 10.1) completed a battery of psychometric scales, including a reduced version of the Morningness-Eveningness Questionnaire (at baseline), the Pittsburgh Sleep Quality Index and Insomnia Severity Index (1 month after baseline assessment), the Bergen Social Media Addiction Scale, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale (2 months after baseline assessment). The impacts of morningness-eveningness on problematic social media use, anxiety, depression and daytime sleepiness were found in the mediation models. Furthermore, the mediated effects of insomnia and sleep quality were observed. The present study's results emphasize the importance of promoting healthy sleep habits and sleep hygiene behaviours, and that of early detection of sleep problems among individuals who have the eveningness chronotype, because this would significantly improve their health outcomes.

Objective: Health education programs using group learning sessions for patients with long-term conditions have been tested, but not evaluated. In order to evaluate such sessions, the purpose was to explore experiences from patients with long-term conditions after participating in group learning sessions.

Methods: A descriptive design based on qualitative content analysis was used. Interviews were conducted with 19 patients with different long-term conditions, and participants were asked about their experiences after taking part in the group learning sessions.

Results: Sharing experiences with one another gave them opportunities for learning. Patients described a metaphorical "expanded window," which opens in the group learning sessions; comparable to encounters during regular visits to health care providers. The nature of the learning environment that follows the educational model, together with describing lived experiences, allowed patients to share capability and resources, which was found to be foundational.

Conclusions: The health education program as a format was important for shared learning. The facilitator can support the learning by structuring the format, but most essential was sharing experiences that facilitated each patient's learning that can aid the support of individual self-management.

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.

Background: Mental health (MH) problems such as depression and insomnia are prominent among patients with cardiovascular disease (CVD). They are associated with a negative impact on quality of life, higher health care costs and a poorer prognosis. Despite this most patients with CVD will not receive support or treatment for their MH problems. Studies in other patient groups have described internet based cognitive behavioral treatment (I-CBT) as a promising intervention, but I-CBT has not been tested in CVD patients. The I-CBT HEART research project aims specifically to develop and evaluate I-CBT programs for CVD patients with psychological distress. The programs, both of which are in early stages of clinical evaluation, respectively target patients with depressive symptoms and patients with insomnia. Two randomized controlled trials will be carried out, I-CBT for insomnia (HiT-IT) and I-CBT for depression (DOHART). Implementation research has shown overwhelming evidence of the difficulties that are often encountered in the diffusion and dissemination of novel treatments, such as I-CBT for CVD. To smooth the way for future use of a successful intervention in clinical practice, a better knowledge is needed of the factors that may hinder or support implementation in practice.

Purpose: The overall aim of the IMPLEMENT-IT study, a part of the I-CBT HEART project, is to achieve a better understanding of potential future implementation issues by exploring barriers and facilitators from different stakeholder perspectives that may be of importance in future implementation.

Methods: Both qualitative and quantitative data will be collected in conjunction with the RCT studies HiT-IT and DOHART. Interviews with stakeholders at different levels focusing on perceptions of the role of eHealth in traditional healthcare in general, and of the I-CBT HEART intervention in particular. Informants are recruited in groups of healthcare-tasked representatives of political parties at the regional level, local decision-makers in higher healthcare administration, clinical decision-makers, healthcare profe ssionals (providers), as well as patients. Our intention is to measure implementation leadership,empowerment and implementation climate in the clinical contexts, but also to develop valid and reliable instruments to be used in future studies.

Conclusion: Studying factors that may potentially influence the implementation of a novel I-CBT program for treatment of MH problems in CVD patients through a mixed methods approach may assist the design of future implementation strategies in clinical cardiac care.

BACKGROUND: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. OBJECTIVE: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. METHODS: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. RESULTS: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. CONCLUSIONS: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.

BACKGROUND: Comorbid psychological distress (i.e. insomnia and depression) is experienced by 20-40% of patients with cardiovascular disease. This has a considerable impact on their health and quality of life, leading to frequent re-hospitalisations, higher healthcare costs and a shorter life expectancy. Internet-based cognitive behavioural therapy shows great potential for treating psychological distress in cardiovascular disease. Effective and feasible treatments can, however, only benefit patients if they are fully implemented in clinical care.

AIM: This scoping review aimed to explore the literature for internet-based cognitive behavioural therapy in cardiovascular disease and for strategies to implement the intervention.

METHODS: We searched electronic databases, journals and internet sources to find original studies about internet-based cognitive behavioural therapy in cardiovascular disease, adhering to scoping methodology guidelines. After identifying 267 titles, we screened 40 abstracts and chose 11 full-text articles for full-text screening. The results sections in four articles were searched for outcomes that related to the effectiveness and implementation of internet-based cognitive behavioural therapy by directed qualitative content analysis using an implementation framework.

RESULTS: Three of the four articles fulfilling the inclusion criteria concerned internet-based cognitive behavioural therapy for treating mild to moderate depressive symptoms in cardiovascular disease, and none focused on insomnia. The studies showed evidence for the effectiveness of internet-based cognitive behavioural therapy, and/or described patient factors influencing clinical effectiveness. Our qualitative content analysis showed that many implementation aspects and stakeholder perspectives remain unexplored.

CONCLUSIONS: Internet-based cognitive behavioural therapy promises to alleviate patient suffering in cardiovascular disease. There is, however, little research about internet-based cognitive behavioural therapy for cardiovascular disease, and about how this evidence-based intervention is implemented.

One way of improving health care has been conceptualized as personcentred care. In person-centred care the concept of empowerment is crucial. This thesis aims was to explore the meaning of empowerment from the perspective of persons with chronic kidney disease (CKD) and their family members and to evaluate the outcomes of an improvement intervention (QI) for the persons with CKD. Furthermore, to explore the implementation of an QI for empowerment in the context of chronic kidney care from a professional perspective. The research was based on an interactive approach in which the findings relating to the experiences of empowerment by persons with CKD and their family members in chronic kidney care were used in developing the QI. The methods of data collection were both qualitative and quantitative. In all, 20 persons with CKD (Study I) and 12 family members (Study II) participated in the interviews. In the quasi-experimental evaluation of the QI, 25 individuals took part in the intervention group and 21 persons in the comparison group (Study III). Twelve healthcare professionals participated in the case study of the QI (Study IV). Empowerment in chronic kidney care for the persons with CKD was described in terms of creation of trust and learning through encounters. The family members of the persons with CKD described empowerment as having the strength to assume responsibility. The outcomes of the QI after 2 years showed significantly higher scores for individualized care in the intervention group than in the comparison group. The facilitators in the QI were the healthcare professionals' moving spirit and encouragement from involved persons. As a barrier, the healthcare professionals referred to the limitation of the organization. In conclusion, the individual’s perspective of empowerment is important, both for quality of care and as a facilitator for QI in chronic kidney care.

Från inledningen: I detta paper är min avsikt att beskriva och diskutera den interaktiva forsk-ningen och hur kunskap kan skapas i denna ansats samt öka förståelsen för hur jag som forskare bör interagera med praktiken för att skapa ett gemen-sam lärande. Jag kommer att utgå från min metoddesign och kritiskt disku-tera huruvida den beskrivna ansatsen kan öka kunskapsbildningen och va-liditeten i min forskning.

Aim

To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons.

Background

Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care.

Method

Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis.

Findings

A main theme, ‘Moving forward by adjusting to the circumstances’, described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance.

Conclusion

The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice.

Implications for nursing management

The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.

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.

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.

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.

Introduction: Self-care refers to activities performed with the intention of improving or restoring health and well-being. A good understanding of the adaptations needed in daily life is a prerequisite to motivate individuals to implement such changes. Facilitating the person with heart-failure’s (HF) understanding of the diagnosis, how to handle symptoms, and when to seek healthcare, is one way of proactive self-care. Previous Information and communication technology (ICT) support has proved to be effective in younger patients, but the development has not been user-driven, i.e. involving references and experiences from the patient, their family members or healthcare professionals and have rarely been implemented in clinical practice. In addition, disregard of the user hands over control and responsibility to the healthcare professionals and misses the patient’s desires and requirements.

Aim: To describe an experience-based co-design of ICT for self-care support in the context of heart failure care

Methods: The steps in the process of developing ICT support programs for self-care were guided by an experienced based co-design methodology including: 1) Workshops regarding self-care needs. 2) Workshops regarding self-care support as a means to cope with the phases of the disease. 3) Workshops to assess the usability of the suggested ideas. 4) Workshops to test the different supports in action. The project involved older persons with HF, their family members, healthcare professionals, IT-developers, informatics, development leaders, and researchers. There was also a quality improvement process involved to improve working routines and communication between the person with HF and the healthcare professionals, which in turn, increases the value of the innovation. Data collection include tape- and video recorded workshops and diary notes supplied by the informants. All data are to be analyzed by content analysis to identify needs, opportunities and challenges of self-care.

Results and conclusion: This design was found to be a useful method for finding and assess usability of person-centered self-care ICT support. To involve users in the development of self-care support has improved the opportunities to realize support needed. Sharing these perspectives increases professionally and organizationally learning in order to accomplish person-centered self-care. Preliminary findings show that ICT will be a part of solving some of the self-care needs described by patients, family member and health care providers and the next step in the project will be to test and adapt these tools.

BACKGROUND: Prospective nurses need specific and sufficient knowledge to be able to provide quality care. The Swedish Society of Nursing has emphasized the importance of the six quality and safety competencies (QSEN), originated in the US, in Swedish nursing education.

PURPOSE: To investigate the visibility of the QSEN competencies in the assessment tools used in clinical practice

METHOD: A quantitative descriptive method was used to analyze assessment tools from 23 universities.

RESULTS AND CONCLUSION: Teamwork and collaboration was the most visible competency. Patient-centered care was visible to a large degree but was not referred to by name. Informatics was the least visible, a notable concern since all nurses should be competent in informatics to provide quality and safety in care. These results provide guidance as academic and clinical programs around the world implement assessment of how well nurses have developed these essential quality and safety competencies.

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.

Introduction: Interventions that support patients to handle the emotional and medical aspects of a long-term health condition is important. One way is to use peer-support groups, to help patients solving problems, increasing their knowledge and making decisions.

Aim: was to investigate the impact on shared decision-making, empowerment and coping after participation in group-learning sessions for patients with long-term conditions (N = 42).

Design: An intervention following a health education programme based on group-learning sessions was established. Eight different programmes were held in five different departments at a regional county hospital in Sweden.

Methods: Questionnaires were analysed using paired-sample t-test.

Results: Results showed that patients might have better opportunities to be more active during their patient encounter after attending the group learning sessions. Interventions directed to patient activation may be one key in future healthcare management, especially concerning long-term conditions. Empowering patients is central in healthcare, and using different approaches is important.

What does this paper contribute to the wider global clinical community? 

• Patients with long-term conditions should be encouraged to share their knowledge to others, which can give support in managing their disease
• Group-learning sessions can add a perspective of patients' lived knowledge which is one of the key aspects concerning treatment of patients with long-term conditions

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.

Background: Chronic obstructive pulmonary disease (COPD) is the fourth most prevalent cause of death in the world and contributes to higher economic and social burden. Health coaching, which is an approach to support self-management, has proven to be effective in health outcomes for patients with COPD in developed countries. However, no study has evaluated a systematic and structured health-coaching COPD programme to support self-management in China.

Objectives: To evaluate the effects of a health coaching self-management programme on lung function, physical activity and quality of life in patients with COPD

Design: A randomised controlled trial in patients with COPD

Methods: The participants were randomised to either an intervention group (n = 48) or a control group (n = 49) during hospitalisation. The intervention group received usual care combined with a health coaching self-management programme; the control group received only usual care. The intervention programme was performed for six months, and the effects of the intervention were assessed for FEV1%, FVC%, hand grip strength and 1-minute sit-to-stand (STS); and by the Global Physical Activity Questionnaire (GPAQ), Clinical COPD Questionnaire (CCQ) at baseline, 6th week, 6th month and 12th month follow-ups post-discharge.

Results: Of the 97 patients, 88% completed the 12-month follow-up (94% in the intervention group and 82% in the control group). The interaction effect between time and group (control or intervention) for lung function, physical activity and quality of life showed that the intervention group improved significantly compared to the control group in all measures: FEV1% (P =0.003), FVC% (P = 0.001), GPAQ (P = 0.001), 1-minute STS (P = 0.005) and Grip strength (P<0.001), as well as the CCQ-symptom (P <0.001), CCQ-emotion (P <0.001), CCQ-activity (P<0.001) and CCQ (P <0.001).

Conclusion: The health coaching self-management programme can improve lung function, physical activity and quality of life in patients with COPD.

Purpose: To describe the experiences of patients with COPD participating in a health coaching self-management program.

Patients and methods: Twenty patients who had participated in a 6-month health coaching self-management program intervention were purposefully selected for a qualitative evaluation of the program using semi-structured interviews. The interviews were analyzed using inductive qualitative content analysis.

Results: Four categories and 13 subcategories emerged describing the participants' experiences of the program. Their experiences were expressed as gaining insight into the importance of knowledge and personal responsibilities in the management of COPD, taking action to maintain a healthy lifestyle, feeling supported by the program, and being hindered by individual and program limitations.

Conclusion: Iterative interactions between patients and health care professionals together with the content of the program are described as important to develop skills to manage COPD. However, in future self-management programs more awareness of individual prerequisites should be considered.

Objectives: To evaluate the effects of a health coaching self-management programme intended to improve self-management skills and psychological status for patients with Chronic Obstructive Pulmonary Disease.

Design: Randomized controlled trial.

Methods: A randomized controlled study was conducted among patients with COPD. The participants who met the inclusion criteria were randomized to either an intervention group (n=48) or a control group (n=49). The intervention group received the health coaching self-management programme, while the control group received usual care. The programme were performed during six months, and the effects of the intervention were assessed by the COPD Self-management Scale (CSMS) and Hospital anxiety and depression scale (HADS) at baseline, 6th week, 6th month and 12th month post discharge.

Results: Of the 97 patients, 45 (94%) in the intervention group and 40 (82%) in control group, completed 12-month follow-up. The interaction effect between time and group (control or intervention) showed that the intervention group improved significantly compared to the control group for all five dimensions in self management skills, Symptom management (P<0.001), Daily life management (P<0.001), Emotion management (P<0.001), Information management (P<0.001) and Self-efficacy (P<0.001), as well as psychological status with anxiety (P<0.001) and depression (P<0.001).

Conclusion: This trial shows that a nurse-led Health Coaching Self-management Programme has the potential to significantly improve the effects on the self management skills, as well as reducing anxiety and depression for patients with COPD.

PURPOSE: This study aimed to examine the status of self-management in patients with COPD and its associations with sociodemographic and clinical variables.

METHODS: This cross-sectional study included 154 patients with COPD (mean age, 73 years) at four hospitals in Tianjin, China. The COPD Self-Management Scale was used to describe the level of self-management, and its associations with sociodemographic and clinical variables were examined with multiple regression analysis.

RESULTS: More than half of the patients with COPD had a low (30%) or moderate (27%) level of self-management. Self-management was rated highest in management of daily life and lowest in information management. Higher physical activity, higher salary, and lower age affected self-management the most positively.

CONCLUSION: The overall burden of COPD in China is greater than that found in other countries. Healthcare professionals need to improve their understanding of the importance of self-management and specifically focus on increased physical activity targeting patients with poor literacy skills.