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  • 51.
    Johansson, Peter
    et al.
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Linköping University.
    Factors and interventions influencing health-related quality of life in patients with heart failure: a review of the literature2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 5-15Article, review/survey (Refereed)
    Abstract [en]

    INTRODUCTION: Because of the lack of a cure for patients with chronic heart failure (HF), there has been a progressive interest in the use of health-related quality of life (Hr-QoL) as complementary end-point to mortality and morbidity.

    AIM: The aim of this review was from a nursing perspective to describe Hr-QoL and the influencing factors of Hr-QoL, as well as to identify interventions aimed at influencing Hr-QoL in HF patients.

    METHOD: Medline, Cinahl and PsycInfo databases were searched from 1995 to 2004. A total of 58 papers were included.

    RESULTS: HF symptoms and activity status influence Hr-QoL negatively. However, several individual characteristics such as personality, gender and age must also be taken into consideration because different values might exist regarding what constitutes a good Hr-QoL. Nurse led interventions based on education, support and exercise can influence Hr-QoL positively. There is also a need of more studies about the effects of depression, sleep disturbances, support as well as education on Hr-QoL. There is also a need of exercise studies with larger sample sizes and older patients in higher NYHA classes.

    CONCLUSION: Several individual factors impact Hr-QoL, therefore, must nursing interventions are individually adapted to the patient's resources.

  • 52.
    Johansson, Peter
    et al.
    Department of Medicine and Health Sciences, Linköping University, Sweden.
    Svensson, Erland
    Swedish Defence Research Agency, Sweden.
    Alehagen, Urban
    Department of Medicine and Health Sciences, Linköping University, Sweden; Department of Cardiology, Linkoping University, Sweden .
    Jaarsma, Tiny
    Department of Cardiology, Linköping University, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 3, p. 222-231Article in journal (Refereed)
    Abstract [en]

    Aims: This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality. Method: A total of 331 community-dwelling elderly aged 71-87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years. Results: In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002). Conclusion: In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.

  • 53. Kristofferzon, ML
    et al.
    Johansson, I
    Brännnström, M
    Arenhall, E
    Baigi, A
    Brunt, D
    Fridlund, Bengt
    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, U
    Persson, S
    Rask, M
    Wieslander, I
    Ivarsson, B
    Evaluation of a Swedish version of the watts sexual function questionnaire (WSFQ) in persons with heart disease:: a pilot study2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 3, p. 168-174Article in journal (Refereed)
  • 54.
    Lainscak, M.
    et al.
    General Hospital Celje, Department of Cardiology, Celje, Slovenia.
    Sedlar, N.
    National Institute of Public Health, Ljubljana, Slovenia.
    Socan, G.
    University of Ljubljana, Department of psychology, Faculty of Arts, Ljubljana, Slovenia.
    Farkas, J.
    National Institute of Public Health, Ljubljana, Slovenia.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Stromberg, A.
    Linkoping University, Department of Medical and Health Sciences, Division of Nursing Science, Linkoping, Sweden.
    Jaarsma, T.
    Linkoping University, Department of Social and Welfare Studies, Faculty of Health Science, Linkoping, Sweden.
    Psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS)2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S74-S74Article in journal (Refereed)
    Abstract [en]

    Background: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours that heart failure patients perform to maintain daily life activities, healthy functioning, and wellbeing. Psychometrics validation of several language versions has been published.

    Purpose: The aim of this study was to review the psychometric properties of the scale.

    Methods: Following PRISMA guidelines, PubMed, Scopus and ScienceDirect were searched in November 2015. Papers examining the psychometric properties of the EHFScBS-12 and/or the EHFScBS-9 were included to analyse validity and reliability.

    Results: From total of 1357 potentially eligible abstracts screened 74 full-text papers were retrieved and reviewed and 13 studies were eventually included in the review. Nine of the included studies investigated the psychometric properties of the EHFScBS-12 and five of the EHFScBS-9.The results demonstrated satisfactory content, discriminantand convergent validity of the translated versions of both scales across the samples. Discriminant validity of the scale was confirmed through its low associations with measures of the quality of life, while its convergent validity was supported through its small/moderate associations with measures of adherence. Regarding the construct validity, the factorial structure of the scales was inconsistent, but the consulting behaviour factor was recognized in all of the studies. Most commonly used reliability estimates (e.g.Cronbach’s alpha) for the total scale were satisfactory.

    Conclusion(s): Published data demonstrate satisfactory psychometric properties of the EHFScBS, indicating that the scale is a reliable and valid tool for clinical practice. 

  • 55. Lenzen, Mattie
    et al.
    Scholte op Reimer, Wilma
    Norekvål, Tone M
    De Geest, Sabina
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Heikkilä, Johanna
    Jaarsma, Tiny
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Moons, Philip
    Smith, Karen
    Stewart, Simon
    Strömberg, Anna
    Thompson, David R
    Wijns, William
    Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization: Results from the Euro Heart Survey on Coronary Revascularization.2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 2, p. 115-121Article in journal (Refereed)
  • 56.
    Luttik, M.L.A.
    et al.
    Hanze University of Applied Sciences, Research Group Nursing Diagnostics, Groningen, Netherlands.
    Goossens, E.
    KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Ågren, S.
    Linköping University, Department of Medicine and Health Sciences, Department of Cardiothoracic Surgery, Linköping, Sweden.
    Jaarsma, T.
    Linköping University, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Thompson, D. R.
    Australian Catholic University, Centre for the Heart and Mind, Melbourne, Australia.
    Moons, P.
    KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Strömberg, A.
    Linköping University, Division of Nursing Science, Department of Medicine and Health Sciences, Linköping, Sweden.
    Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 299-308Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.

    AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.

    METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).

    RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.

    CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.

  • 57.
    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.

  • 58.
    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)
  • 59. Moons, Philip
    et al.
    Scholte op Reimer, Wilma
    De Geest, Sabina
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Heikkilä, Johanna
    Jaarsma, Tiny
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Smith, Karen
    Stewart, Simon
    Strömberg, Anna
    Thompson, David R
    Nurse specialists in adult congenital heart disease: the current status in Europe2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 60-67Article in journal (Refereed)
  • 60.
    Mårtensson, Jan
    et al.
    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.
    Dahlström, Ulf
    Johansson, Gunilla
    Lernfelt, Bodil
    Persson, Hans
    Willenheimer, Ronnie
    Nurse-led heart failure follow-up in primary care in Sweden2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 2, p. 119-124Article in journal (Refereed)
  • 61.
    Neher, M. S.
    et al.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Johansson, P.
    Linkoping University, Department of Cardiology and Department of Social and Welfare studies, Linkoping, Sweden.
    Nilsen, P.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nygårdh, Annette
    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).
    Exploring implementation issues when introducing a novel internet-based intervention to treat cardiovascular disease-associated mental health issues- the Implement-IT project.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S52-S53Article in journal (Refereed)
    Abstract [en]

    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.

  • 62.
    Nilsen, Per
    et al.
    Linköping University.
    Gardner, Benjamin
    University College London.
    Broström, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Accounting for the role of habit in lifestyle intervention research.2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 5-6Article in journal (Other academic)
  • 63.
    Norekvål, Tone M.
    et al.
    Haukeland University Hospital, Bergen, Norway.
    Fålun, Nina
    Haukeland University Hospital, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Patient-reported outcomes on the agenda in cardiovascular clinical practice2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 108-111Article in journal (Other academic)
  • 64. Norekvål, Tone M
    et al.
    Moons, Philip
    Hanestad, Berit R
    Nordrehaug, Jan E
    Wentzel-Larsen, Tore
    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.
    The other side of the coin: perceived positive effects of illness in women following acute myocardial infarction.2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 1, p. 80-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although myocardial infarction (MI) is linked with both physical and psychological impairments, the possibility of patients also experiencing positive outcomes of MI has received far less attention in research and in clinical practice. In particular, this aspect has been under-investigated in older persons and in women. AIM: The purpose of this study was to investigate possible positive effects of illness, describe the patient characteristics and explore the nature and frequency of these effects in older women after MI. METHODS: A cross-sectional postal survey was conducted in 145 women aged 62-80 years, three months to five years after MI. Self-reported socio-demographic and clinical data, in addition to data from medical records, were collected. A single-item question--"All in all, was there anything positive about experiencing an MI?"--was used to assess positive effects of illness, in addition to an open-ended question on the nature of possible positive effects. RESULTS: A majority of the women (65%) reported positive effects from their MI experience. The women perceiving positive effects did not differ from those who did not on socio-demographic and clinical variables, except for being older (p=0.007) and less often readmitted (p=0.029). The groups did not differ significantly as to disease severity and time since MI. Four themes emerged from the open-ended questioning on the nature of perceived positive effects of the illness: Appreciating Life (55%), Getting Health Care (42%), Making Lifestyle Changes (36%), and Taking More Care of Self and Others (29%). CONCLUSIONS: The findings contribute to a more complete picture of psychosocial issues in women after MI by providing evidence that positive effects are often experienced despite physical limitations. Nurses may use this knowledge as a tool in patient education and communication, although further research is needed to determine the most optimal interventions for MI patients.

  • 65.
    Nygårdh, Anette
    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).
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Allemann, H.
    Linköping University, Department of Medical and Health Science, Linköping, Sweden.
    Strömberg, A.
    Linköping University, Department of Medical and Health Science, Linköping, Sweden.
    Aidemark, J.
    Linneaus University, Department of Informatics, Vaxjö, Sweden.
    Fruberg, C.
    Qulturum, Centre for Learning and Innovation in Health Care, Jönköping, Sweden.
    Karlsson, J.-E.
    Ryhov county Hospital, Deparment of Development (Qulturum), Jönköping, Sweden.
    Askenäs, L.
    Linneaus University, Department of Informatics, Växjö, Sweden.
    An experience-based co-design to accomplish person-centered self-care support for elderly persons with heart failure2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, p. 51-52, article id 139Article in journal (Refereed)
    Abstract [en]

    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.

  • 66.
    Olsen, Siv J. S.
    et al.
    Division of Internal Medicine, University Hospital of North Norway, Harstad, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, Leslie S. P.
    Department of Clinical Science, University of Bergen, Norway.
    Hufthammer, Karl O.
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Nordrehaug, Jan E.
    Department of Clinical Science, University of Bergen, Norway.
    Skaar, Elisabeth
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Changes in self-reported health and quality of life in octogenarian patients one month after transcatheter aortic valve implantation2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 1, p. 79-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In addition to favourable results regarding mortality and morbidity it is important to identify the impact transcatheter aortic valve implantation (TAVI) has on patients' quality of life.

    AIMS: The aims were: (i) to describe clinical characteristics, self-reported health and quality of life in octogenarians before TAVI intervention; (ii) to determine changes in self-reported health and quality of life one month after TAVI; and (iii) to establish the clinical importance of the findings.

    METHODS: A prospective cohort study was conducted on consecutively enrolled octogenarians with severe aortic stenosis undergoing TAVI (N = 65). Self-reported health and quality of life were recorded at baseline and one month later using two global questions from the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF), the generic Short Form Health 12 and the disease-specific Minnesota Living with Heart Failure Questionnaire.

    RESULTS: One month after TAVI, WHOQOL-BREF showed that self-reported health improved moderately (p < 0.001), while quality of life improved slightly, but not statistically significantly (p = 0.06). There were changes in all Short Form Health 12 domains, except social functioning and role emotional. The estimated changes were 3.6 to 5.8 with large confidence intervals. The Physical Component Summary increased statistically significantly from baseline to 30 days (30.6-34.7; p = 0.02), but the Mental Component Summary did not (46.9-50.0; p = 0.13).

    CONCLUSION: Despite being an advanced treatment performed in a high risk population, TAVI in octogenarians improves short-term self-reported global health and generic physical health and quality of life. These patient-reported outcomes have importance, particularly in this age group.

  • 67.
    Oterhals, Kjersti
    et al.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Deaton, Christi
    School of Nursing, Midwifery and Social Work, University of Manchester, and Central Manchester NHS Foundation Trust, UK.
    De Geest, Sabina
    Centre for Health Services and Nursing Research, KU Leuven, Belgium.
    Jaarsma, Tiny
    Linköpings Universitet.
    Lenzen, Mattie
    Department of Cardiology, Clinical Epidemiology Unit, Erasmus MC, The Netherlands.
    Moons, Philip
    Centre for Health Services and Nursing Research, KU Leuven, Belgium.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Smith, Karen
    Department of Cardiology, Ninewells Hospital, UK.
    Stewart, Simon
    Baker IDI Heart and Diabetes Institute, Australia.
    Strömberg, Anna
    Linköpings Universitet.
    Thompson, David
    Cardiovascular Research Centre, Australian Catholic University, Australia.
    Norekvål, Tone
    Department of Heart Disease, Haukeland University Hospital, Norway.
    European cardiac nurses' current practice and knowledge on anticoagulation therapy2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 3, p. 261-269Article in journal (Refereed)
    Abstract [en]

    Background: Successful management of warfarin, new anti-thrombotic agents and self-monitoring devices requires that health care professionals effectively counsel and educate patients. Previous studies indicate that health care professionals do not always have the knowledge to provide patients with the correct information.

    Aims: The purpose of this study was to investigate European cardiovascular nurses’ knowledge on the overall management of anticoagulation therapy and examine if this knowledge was influenced by level of education and years in clinical practice.

    Methods: A questionnaire including 47 items on practice patterns and knowledge on warfarin, new anticoagulants, warfarin-drug and warfarin-food interactions, and self-management of International Normalized Ratio (INR) was distributed to the attendants at a European conference in 2012.

    Results:The response rate was 32% (n=206), of whom 84% reported having direct patient contact. Warfarin was the most common used oral anticoagulation in daily practice. One third offered their patients both patient self-testing and patient self-management of INR. The mean total score on the knowledge questions was 28±6 (maximum possible score 53). Nurses in direct patient care had a higher mean score (p=0.011). Knowledge on warfarin and medication-interactions were low, but knowledge on warfarin-diet interactions and how to advise patients on warfarin as somewhat better.

    Conclusion:European cardiac nurses need to improve their knowledge and practice patterns on oral anticoagulation therapy. This area of knowledge is important in order to deliver optimal care to cardiac patients and to minimise adverse effects of the treatment.

  • 68.
    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.

  • 69.
    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.

  • 70.
    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.

  • 71.
    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.

  • 72.
    Pettersen, Trond R.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Axelsson, Åsa
    Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Jørgensen, Marianne
    Department of Cardiology, Stavanger University Hospital, Norway.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Thompson, David
    Department of Psychiatry, The University of Melbourne, Australia.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    European cardiovascular nurses' and allied professionals' knowledge and practical skills regarding cardiopulmonary resuscitation.2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 4, p. 336-344Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results.

    METHODS: This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training.

    RESULTS: Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not.

    CONCLUSION: Our study indicates a positive association between participants' performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

  • 73.
    Pihl, Emma
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Cider, Åsa
    Physiotherapy Department, Sahlgrenska University Hospital.
    Strömberg, Anna
    Department of medicine and health sciences, division of nursing, Linköping University.
    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.
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Exercise in elderly patients with chronic heart failure in primary care: effects on physical capacity and health-related quality of life2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, p. 150-158Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL).

    AIM: The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care.

    METHODS: An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12months.

    RESULTS: Exercise significantly improved muscle endurance in the intervention group (n=29, mean age 76.2years) compared to the control group (n=31, mean age 74.4years) at all follow-ups except for shoulder flexion right at 12months (shoulder abduction p=0.006, p=0.048, p=0.029; shoulder flexion right p=0.002, p=0.032, p=0.585; shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3months (p=0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12months (p=0.016 and p=0.034) and SF-36, general health (p=0.048) and physical component scale (p=0.026) significantly improved at 3months compared to the control group.

    CONCLUSION: This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population.

  • 74.
    Rönning, Helén
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nielsen, Niels Erik
    Linköping University Hospital, Linköping, Sweden .
    Strömberg, Anna
    Linköping University, Linköping, Sweden.
    Thilen, Ulf
    Lund University Hospital, Lund, Sweden.
    Swahn, Eva
    Linköping University, Linköping, Sweden.
    Development and evaluation of a computer-based educational program for adults with congenitally malformed hearts2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 78-86Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a lack of educational material for adults with congenitally malformed hearts. Computer-based education has shown to have significant effects on knowledge and management of chronic diseases. AIM: The aim of this study was to develop and evaluate a computer-based educational program for adults with congenitally malformed hearts. METHODS: The program was developed by a multidisciplinary team. Data were collected by questionnaires, observations, and structured interviews. RESULTS: The final product was a computer-based educational program consisting of ten separate modules, one for each particular malformation. The program was experienced as stimulating and easy to use. The appearance and quantity of the text was graded as good and the content as relevant and very useful. CONCLUSION: This is the first computer-based program developed for adults with congenitally malformed hearts. The evaluation found the program to have great potential as an important tool for improving care. Further studies are needed to test the outcomes of the program on knowledge, perceived control over the heart condition, anxiety/depression. and health-related quality of life. PRACTICE IMPLICATIONS: The program may be used as a complement to verbal information and every adult with a congenitally malformed hearts can receive individualized information from a personal CD.

  • 75. Scholte op Reimer, Wilma J M
    et al.
    Moons, Philip
    De Geest, Sabina
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Heikkilä, Johanna
    Jaarsma, Tiny
    Lenzen, Mattie
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Norekvål, Tone M
    Smith, Karen
    Stewart, Simon
    Strömberg, Anna
    Thompson, David R
    Cardiovascular risk estimation by professionally active cardiovascular nurses: results from the Basel 2005 Nurses Cohort.2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 4, p. 258-263Article in journal (Refereed)
  • 76.
    Sedlar, Natasa
    et al.
    National Institute of Public Health, Ljubljana, Slovenia.
    Lainscak, Mitja
    Department of Internal Medicine, General Hospital Murska Sobota, Slovenia.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Farkas, Jerneja
    National Institute of Public Health, Ljubljana, Slovenia.
    Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 272-282Article in journal (Refereed)
    Abstract [en]

    Background: Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing.

    Aims: The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS.

    Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored.

    Results: We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies.

    Conclusion: A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors. 

  • 77.
    Siebmanns, Sandra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, M.
    Linkoping University Hospital, Department of clinical neurophysiology, Linkoping, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Johansson, P.
    Linkoping University Hospital, Department of Cardiology and Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Insomnia in patients with cardiovascular disease - a review of causes, consequences and nursing interventions2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S31-S31Article in journal (Refereed)
    Abstract [en]

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

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

    Design: Literature review.

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

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

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

  • 78.
    Siebmanns, Sandra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ulander, M.
    Linkoping University Hospital, Department of clinical neurophysiology, Linkoping, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Linda
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Johansson, P.
    Linkoping University Hospital, Department of Cardiology and Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Internet-based Intervention to treat insomnia in patients with cardiovascular disease2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S75-S75Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 79.
    Siouta, Eleni
    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.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 47-55Article in journal (Refereed)
    Abstract [en]

    Aim: To describe (i) the topics participants talk about, (ii) the use of discursive space in consultations between patients with atrial fibrillation (AF) and their nurses and physicians, and (iii) the frequencies of the ways the patients, nurses and physicians introduce the topics.

    Methods: Data were collected from 23 videotaped consultations concerning patients with AF as well as physicians and nurses, respectively. To obtain a description of topics discussed, the transcripts were analysed using content analysis. The patterns of dominance for the respective topic and participant were explored from the framework of analysis that treats dominance.

    Results: Four topics were used by both nurses and physicians in the consultations. These were ‘pathophysiology’, ‘diagnostic procedures’, ‘treatment’ and ‘activity’. In the nurse–patient consultation an additional topic, ‘routines related to the physician’s responsibilities’, emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between the nurses and patients and unequal between the physicians and patients. The healthcare professionals initiated the topics more frequently compared to the patients, whereby the medical approach recommended in the guidelines for AF could be recognized. The patients were the dominating initiators in the topic ‘activity’, which refers to the adaptation of activities in daily life in relation to the AF.

    Conclusions: The medical-driven agenda dominates over the patient-driven agenda in consultations between healthcare professional and patients with AF. The patients initiated the conversations when discussing living with AF and were more talkative during conversations in nurse consultations.

  • 80. Strömberg, A
    et al.
    Dahlström, U
    Fridlund, Bengt
    Växjö universitet.
    Computer-based education for patients with chronic heart failure: A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 64, no 1-3, p. 128-135Article in journal (Refereed)
  • 81. Strömberg, Anna
    et al.
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    Gender differences in patients with heart failure2003In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, no 1, p. 7-18Article, review/survey (Other academic)
  • 82.
    Valaker, I.
    et al.
    Western Norway University of Applied Sciences , Faculty of Health Studies, Førde, Norway.
    Norekvaal, T. M.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Raaholm, M-B
    Western Norway University of Applied Sciences , Faculty of Health Studies, Førde, Norway.
    Nordrehaug, J. E.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Rotevatn, S.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Relational continuity with healthcare providers after percutaneous coronary interventions: the patient perspective2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S89-S89Article in journal (Refereed)
    Abstract [en]

    Background: Relational continuity plays an important role when organizing the health care services for patients after early discharge. However, little is known about how patients experience relational continuity after percutaneous coronary interventions (PCI). Relational continuity has been defined as an ongoing therapeutic relationship between a patient and one or more healthcare providers.

    Purpose: To explore how patients undergoing PCI experience relational continuity after early discharge.

    Methods: Patients undergoing PCI hospitalized 6-8 weeks earlier, ⩾ 18 years and living at home at the time of inclusion were eligible for the study. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. The study used an explorative design, and semistructured interviews were conducted with nine women and 13 men. The majority were older than 67 years, suffered an ST-elevation infarction and did not participate in cardiac rehabilitation. Interviews were analyzed using qualitative content analysis according to Graneheim and Lundman.

    Results: Important dimensions inherent in relational continuity found in this study were: (1) genuine interest in the patient as a person, (2) fostering a trusting relationship,(3) knowledge about the patient’s current health status (4) the importance of a motivated and supportive healthcare provider, and (5) being in competent and safe hands.

    Conclusions: Establishing trusting relationships with multiple healthcare providers and especially with the GP provide patients with a sense of security and predictability. At present, GPs are joined by numerous of other healthcare providers offering supplemental services. Developing clinical pathways, interdisciplinary teams, and adding more nursing personnel on advanced level in primary careseems to be important. Furthermore, collaboration with user organizations could be an arena for better communication between healthcare providers and patients undergoing PCI. There is a need for new knowledge about relational continuity through research and education within this field.

  • 83.
    Valaker, Irene
    et al.
    Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Råholm, Maj-Britt
    Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway.
    Nordrehaug, Jan Erik
    Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Rotevatn, Svein
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Continuity of care after percutaneous coronary intervention: The patient's perspective across secondary and primary care settings2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 5, p. 444-452Article in journal (Refereed)
    Abstract [en]

    Background: Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI.

    Aim: To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge.

    Methods: The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6-8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis.

    Findings: Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments.

    Conclusions and implications: As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system.

  • 84.
    Verheijden Klompstra, Leonie
    et al.
    Department of Social and Welfare studies, Linköping University.
    Jaarsma, Tiny
    Department of Social and Welfare studies, Linköping University.
    Moons, Philip
    Centre for Health Services and Nursing Research, Kathlieke Universiteit, Belgium.
    Norekvål, Tone
    Department of Heart Disease, Haukeland University Hospital.
    Smith, Karen
    School of Nursing and Midwifery, University of Dundee.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Thompson, David
    Cardiovascular Research Centre, Australien Catholic University Melbourne.
    De Geest, Sabina
    Institute of Nursing Science, University of Basel.
    Lenzen, Mattie
    Department of Cardiology, Rotterdam.
    Strömberg, Anna
    Division of Nursing Science, Department of Medicine, Linköping University.
    Anaemia and iron deficiency in cardiac patients: what do nurses and allied professionals know?2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no Suppl. 1, p. S90-S95Article in journal (Refereed)
    Abstract [en]

    Background: Cardiac nurses and allied professionals often take care of patients who also have anaemia or iron deficiency. To deliver optimal care, professionals should be knowledgeable about the prevalence, diagnosis, pathophysiology, and therapeutic management of these conditions. We therefore set out a survey to get a first impression on the current knowledge of nurses and allied professionals on anaemia and iron deficiency.

    Method: A questionnaire was designed for this study by the Undertaking Nursing Interventions Throughout Europe (UNITE) Study Group. Data were collected from 125 cardiovascular nurses and allied professionals visiting the 11th Annual Spring Meeting of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology.

    Results: Most respondents had general knowledge on the definition of anaemia and iron deficiency and 54% of the respondents rated anaemia and iron deficiency as important when evaluating a cardiac patient. Specific knowledge regarding anaemia and more prominently of iron deficiency was not optimal.

    Conclusion: Although cardiac nurses and allied professionals have basic knowledge of anaemia and iron deficiency, they would benefit from additional knowledge and skills to optimally deliver patient care.

  • 85. Weslien, M
    et al.
    Nilstun, T
    Lundqvist, A
    Fridlund, Bengt
    Lunds universitet.
    Narratives about resuscitation: family members differ about presence2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 68-74Article in journal (Refereed)
  • 86. Wickholm, M
    et al.
    Fridlund, Bengt
    Högskolan i Halmstad.
    Women's health after a first myocardial infarction: a comprehensive perspective on recovery over a 4-year period2003In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, no 1, p. 19-25Article in journal (Refereed)
  • 87. Wieslander, I
    et al.
    Baigi, A
    Turesson, C
    Fridlund, Bengt
    Högskolan i Halmstad.
    Women's social support and social network after their first myocardial infarction: a 4-year follow-up with focus on cardiac rehabilitation2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 278-285Article in journal (Refereed)
  • 88. Winberg, B
    et al.
    Fridlund, Bengt
    Högskolan i Halmstad.
    Self-reported behavioural and medical changes in women after their first myocardial infarction: a 4-year comparison between participation and non-participation in a cardiac rehabilitation programme2002In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 1, no 2, p. 101-107Article in journal (Refereed)
  • 89.
    Wu, E.
    et al.
    Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
    Mårtensson, Jan
    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.
    Enhanced external counterpulsation as an intervention for patients with refractory angina pectoris - a review of performed research2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S38-S38Article in journal (Refereed)
    Abstract [en]

    Background: Despite optimal pharmacological treatments and invasive procedures, patients with refractory angina pectoris (RAP) remain symptomatic. Enhanced External Counterpulsation (EECP) is a non-invasive therapy based on 35 one-hour sessions. External pneumatic cuffs wrapped around the patient’s lower extremities inflate during cardiac diastole to create retrograde diastolic counterpulsation which leads to an improved coronary perfusion. EECP has for the past decade been used in European countries and has recently been updated in the European Guidelines as a clinical treatment option for patients with RAP.

    Purpose: The purpose was to describe the design and outcome variables of studies using EECP as a treatment for RAP.

    Methods: Search methods: Databases (i.e., PubMed,Wiley Online Library, Science Direct) were used to identify abstracts, reviews and journal articles related to this subgroup and EECP. Selection criterias: The chosen key words were EECP and refractory angina pectoris. Between time period 2000 to October 2016. Data collection and analysis: The literature search resulted in a total of 155 hits. Detected duplicates, irrelevant studies and others (i.e., editorials, letters) were removed (n=75). Research area and study design were reviewed in all remaining articles (n=80). In 56 of these, where design and content allowed, further analyses regarding follow-uptime and outcomes variables were performed.

    Results: An uneven distribution regarding research area was found among the analysed papers with dominance (48%) of studies within medicine and biology. Only 12% of the studies were performed within nursing. Prospective and longitudinal designs dominated (47%). Out of eight retrospective studies five were registry studies. Only two studies used a RCT design. No study used a qualitative approach. Out of 24 prospective studies 18 (75%) had a follow-up of 12 months or longer. 52% used biomedical outcomes (i.e., hemodynamic, biomarker, arterial stiffness, peripheral vascular reactivity) and 41% used clinical/patient reported outcomes (i.e., quality of life, functional classes, physical capacity, psychological aspects). Cost effectiveness was calculated in 7% of the studies.

    Conclusions/implications: EECP is recommended in guidelines as a possible treatment for patients with RAP. There is, however, a great need for increased nursing research both with qualitative and quantitative approaches. RCTs are sparse, as well as cost-effectiveness-studies.

  • 90.
    Wu, Eline
    et al.
    Hjärtkliniken, Karolinska Universitetssjukhuset.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Enhanced external counterpulsation in patients with refractory angina pectoris: A pilot study with six months follow-up regarding physical capacity and health-related quality of life2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 5, p. 437-445Article in journal (Refereed)
    Abstract [en]

    Background: Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients.

    Aims: The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP.

    Methods: This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up.

    Results: Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment.

    Conclusion: Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

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