Biomedical subjects

B Fridlund

Publications and source records attributed to B Fridlund.

At least 19 recordsLinked to original sources

PubMed2006

Heart failure management programmes in Europe.

BACKGROUND: The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. METHOD: A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. RESULTS: Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. CONCLUSION: Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

Aftercare↗

PubMed2006

Primary Health Care Nurses' conceptions of involuntarily migrated families' health.

BACKGROUND: Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care. AIM: To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs. METHOD: Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data. FINDINGS: Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from society, and (4) a stable and well-functioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family. CONCLUSION: Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Acculturation↗

PubMed2005

Nurse specialists in adult congenital heart disease: the current status in Europe.

AIM: Recommendations for the management of adults with congenital heart disease indicate that specialist referral centres should employ nurse specialists who are trained and educated in the care for these patients. We surveyed the involvement, education and activities of nurse specialists in the care for adults with congenital cardiac anomalies in Europe. METHODS: The Euro Heart Survey on Adult Congenital Heart Disease has previously showed that 20 out of 48 specialist centres (42%) have nurse specialists affiliated with their programme. Fifteen of these 20 centres (75%) validly completed a web-based survey tool. RESULTS: Specialist centres had a median number of 2 nurse specialists on staff, corresponding with 1 full-time equivalent. In most centres, the nurse specialists were also affiliated with other cardiac care programmes, in addition to congenital heart disease. The involvement of nurse specialists was not related to the caseload of inpatients and outpatient visits. Physical examination was the most prevalent activity undertaken by nurse specialists (93.3%), followed by telephone accessibility (86.7%), patient education (86.7%), co-ordination of care (73.3%), and follow-up after discharge (73.3%). Patient education covered mainly prevention and prophylaxis of endocarditis (100%), cardiovascular risk factors (92.3%), sport activities (92.3%), the type and characteristics of the heart defect (92.3%), the definition and aetiology of endocarditis (84.6%), cardiac risk in case of pregnancy (84.6%), and heredity (84.6%). Two third of the nurse specialists were involved in research. CONCLUSION: This survey revealed gaps in the provision of care for these patients in Europe and demonstrated that there is room for improvement in order to provide adequate chronic disease management. The results of this study can be used by individual hospitals for benchmarking.

Adult↗

PubMed2005

Life events, social support and sense of coherence among frequent attenders in primary health care.

OBJECTIVES: The aim of this survey was to compare stressful life events, social support and sense of coherence (SOC) between frequent attenders (FAs) and normal attenders (controls) in primary health care. STUDY DESIGN: A cross-sectional study was conducted in a primary healthcare centre in the south-west of Sweden. METHODS: A postal questionnaire was sent to 263 frequent attenders and 703 normal attenders. The questionnaire comprised sociodemographic variables and scales of stressful life events, social support and SOC. The results from the questionnaire were compared between the groups, and the significance of the variables in terms of attendance was tested in a multiple regression analysis. RESULTS: More of the FAs were secondarily single, they had more chronic diseases and were more often living on a sickness/disablement pension than the controls. FAs did not report more stressful life events than the controls nor was their experience of events more negative. Social support was as strong among FAs as among controls, and it had no significant effect on their frequent attendance. FAs had a significantly weaker SOC compared with controls. The variables that significantly influenced frequent attendance were high age [odds ratio (OR) = 1.02], chronic disease (OR = 3.08), sickness/disablement pension (OR = 2.46) and SOC (OR = 0.97). CONCLUSIONS: SOC had a significant influence on frequent attendance in primary health care, but stressful life events and social support did not. FAs did not report more stressful life events. However, due to an inadequate coping strategy, indicated by a weak SOC, the life events probably caused them more symptoms and diseases, and thereby a higher consulting frequency.

Adolescent↗

PubMed2005

Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression.

AIMS: To determine the effects of a nurse-led intervention designed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression. METHODS: Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster randomised study. A total of 153 patients were included (n=78 in the intervention group, 54% males, mean age 79 years, 59% in New York Heart Association class III-IV). The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse. RESULTS: The effects of the nurse-led intervention were limited. Significant differences were found in the physical dimension measured by the SF-36 health survey, and in depression measured by the Zung Self-rating Depression Scale. In comparison within groups at the 3 and 12-month follow-up, the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey, and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group, especially among women. CONCLUSION: A nurse-led intervention directed toward patients with heart failure in a primary health care setting resulted in limited effects between the groups, although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group.

Aged↗

PubMed2004

Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study.

The value of routine follow-up with frequent visits to a breast cancer specialist-both in terms of detection of recurrence and patient satisfaction-has been questioned. The aim of this study was to compare nurse-led follow-up on demand versus physician follow-up after breast cancer treatment with regards to patients' well-being, satisfaction, access to medical care and medical safety. Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer, classified as UICC stage I or stage II, were randomised to follow-up at two hospitals in Sweden, either by routine medical follow-up, the physician group (PG, n=131), or on demand by a specialist nurse, the nurse group (NG, n=133). Measures were done at baseline and twice a year over a period of 5 years by means of a questionnaire containing the Hospital Anxiety and Depression Scale (HAD), and the Satisfaction and Accessibility (SaaC) scale. Number of contacts with the health care services, number of diagnostic procedures, and time to recurrence or death were monitored. The ratings of HAD and SaaC did not show any statistically significant differences between the groups. The levels of anxiety and depression were generally low and levels of patient satisfaction high. There were no differences between the groups concerning time to recurrence or death. This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety.

Adult↗

PubMed2004

Cancer patients' experiences of care related to pain management before and after palliative care referral.

Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.

Adult↗

PubMed2003

Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial.

AIM: The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge. METHODS: A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2-3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family. RESULTS: There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01). CONCLUSIONS: Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.

Aged↗

PubMed2003

Health-related quality of life in pacemaker patients: a single and multidimensional self-rated health comparison study.

Since implantation of the first permanent pacemaker in 1958, significant advances have been made in pacemaker technology. To date, however, health-related quality of life (HRQoL) in a large pacemaker population has not been investigated. With dwindling clinical resources, it is important to study HRQoL in a pacemaker population in a reliable and straightforward manner. This study aimed to determine and compare single and multidimensional self-rated health (SRH) in a pacemaker population in terms of sociodemographic characteristics, pacemaker mode and symptoms. The findings showed that irrespective of whether the perspective was single or multidimensional, this Swedish pacemaker population (n=697) with a mean age of 76 years had an acceptable HRQoL. Men, aged 65-84 years, persons who were cohabiting, who had their own dwelling, who had a DDD or who had a pacemaker for <or=3 and 4-7 years experienced better HRQoL. Efforts need to be made for women, single persons, the elderly and retired persons. In conclusion, the SRH of a pacemaker population can be trustworthy established by means of a single-dimensional SRH question.

Adolescent↗

PubMed2002

Cardiovascular mortality focusing on socio-economic influence: the low-risk population of Halland compared to the population of Sweden as a whole.

The aim of the study was to investigate the relationship between mortality from cardiovascular diseases (CVD) and socio-economic status (SES) in Sweden and to estimate to what extent the difference between a province with low mortality and the rest of Sweden was dependent on socio-economic factors. A population-based retrospective study with a historical prospective approach was performed covering a 10-y period in the province of Halland, Sweden, as well as Sweden as a whole. Altogether 1,654,744 men and 1,592,467 women were included, of whom 45,394 men and 43,403 women were from Halland, distributed according to SES. Multivariate analysis with Poisson regression was used. Relative risks with 95% confidence intervals were calculated. Both men and women with a low SES showed a significantly higher risk of death from CVD in Sweden as a whole. The risk was 23% higher for male blue-collar workers and 44% higher for female blue-collar workers when compared to their white-collar counterparts. The level of mortality in Halland was 14% lower compared to the country as a whole when only age was taken into account. When the socio-economic variable was also included, this figure was 8%. The results show the substantial significance of social differences with respect to CVD mortality. The effect of SES seems to be more important than that of geographical conditions when the latter are isolated from socio-economic influence.

Adult↗

PubMed2002

Influences on adolescent smoking behaviour: siblings' smoking and norms in the social environment do matter.

The prevalence of smoking among adolescents has stopped declining in spite of all preventative efforts. There is a need for further knowledge and understanding of why adolescents initiate and continue tobacco use. The aim of the present study was to investigate important facets of adolescents' tobacco use, such as their reasons for smoking, and their smoking patterns in relation to smoking habits in the family and the social environment. This study was part of a larger one that used a descriptive, cross-sectional design with questionnaires to 216 pupils in grade 5 (11 years of age) and 225 pupils in grade 8 (14 years of age) in a south-western county in Sweden. Thirteen per cent of the pupils in grade 8 were regular tobacco users. Smoking habits by relatives, especially siblings, influenced tobacco use by adolescents. An association was found between smoking by adolescents and mother's employment, and between the smoking status of girls and family status. The pupils valued their parents' opinions, and wanted parents and other adults to take a clear stand against tobacco. The present study reinforces the importance of norm setting by parents and siblings for adolescents' tobacco use. Preventive measures may be more appropriately directed towards those with the highest risks, i.e. pupils with smoking siblings and smoking peers.

Adolescent↗

PubMed2002

The aphasic person's views of the encounter with other people: a grounded theory analysis.

Being affected by aphasia influences the total life experience. The aim of this study was to generate a theoretical model, from a nursing perspective, of what aphasic persons (n = 12) experience in encounters with other people. Data were collected through interviews which adopted a biophysical, socio-cultural and psychological approach and then analysed using grounded theory method. Two main categories emerged, namely: 'interaction' and 'support'. Encountered experiences led to: 'a feeling of having ability'; 'a feeling of being an outsider'; and 'a feeling of dejection or uncertainty'. The feeling state was dependent on whether the interaction was 'obstructed' or 'secure' and on whether the support resulted in 'strengthened' or 'impaired' self-esteem. Therefore nurses need to give support that enhances patients' self-esteem and which results in them gaining a positive and realistic view of their aphasia, as well as involving those around them in this perspective. This then will give the possibility for the patient to turn the interaction process from an obstructed into a secure one.

Adaptation, Psychological↗

PubMed2001

Nurse-led heart failure clinics in Sweden.

OBJECTIVE: The aim of this study was to describe the nurse-led heart failure care in Sweden. METHODS: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes. RESULTS: Sixty-nine percent of all hospitals (n=86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare. CONCLUSION: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals.

Heart Failure↗

PubMed2001

Malnutrition in patients suffering from chronic heart failure; the nurse's care.

Chronic heart failure is associated with a bad prognosis with considerably shortened survival and repeated hospitalisations. Patients suffering from heart failure also have symptoms that can affect their food intake, for example, tiredness when strained, breathing difficulties and gastrointestinal symptoms like nausea, loss of appetite and ascites. Pharmacological therapy can lead to a loss of appetite, which will make the intake of food inadequate to fill the required energy and nutritional needs. The nurse's interest in and knowledge of diet issues can improve these patients' nutritional status. The aim of this literature review was to describe the nurse's interventions regarding malnutrition in patients suffering from chronic heart failure. The literature search gave 13 articles, which were analysed, and sentences whose content was related to the aim were identified. Three areas of content appeared; drug treatment and consequences, gastrointestinal effects, and information and education. The results show that the nutritional status of these patients can be significantly improved by means of simple nursing interventions. Future research should focus on controlled experimental studies to evaluate differences in body weight, body mass index and quality of life between patients suffering from chronic heart failure, who are taking part in a fully enriched nutrition intervention, and patients suffering from chronic heart failure, who are eating their normal diet.

Chronic Disease↗

PubMed2001

Patients with congestive heart failure and their conceptions of their sleep situation.

AIM: To describe, from a nursing perspective, how patients with CHF conceived their sleep situation. BACKGROUND: Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes. METHODS: A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients. FINDINGS: The findings showed that the patients' sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment. CONCLUSIONS: Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.

Adaptation, Psychological↗

PubMed2001

Patients' perceptions of self-determination as expressed in the context of care.

AIM: The aim of this study was to describe patients' perceptions of how self-determination finds expression in the context of care. BACKGROUND: Self-determination is an important concept within health care as well as an important patient right. New legislation on patient rights in Sweden and Europe is aimed at increased patient self-determination. DESIGN AND METHOD: Data were collected through semi-structured, tape-recorded interviews with 17 strategically chosen patients within somatic care and analysed using a method inspired by phenomenography. RESULTS: The analysis found three descriptive categories of the informants' perceptions: trusting, accepting and a feeling of powerlessness. The patients expressed a great sense of trust and confidence in the care provided and they accepted the health care procedures. At the same time, they expressed a feeling of powerlessness because of not being part of decision-making, as well as lacking knowledge and information about treatment strategies. The patients wished to have the right of more self-determination but lacked the strength and knowledge to be able to influence their own care. CONCLUSIONS: Patients' perceptions of self-determination suggest that, in their encounters with the professional care, knowledge is expressed as power. The feeling of a lack of self-determination can be reduced by help and support from a nurse who allocates time for communication in order to learn the patient's needs and reach a mutual understanding.

Adult↗

PubMed2001

Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study.

The aim of this study was to describe changes in the life situation of patients with an implantable cardioverter defibrillator over a period of 1 year. A sample of 56 consecutive patients took part in the study. Life situation was measured through uncertainty in illness, satisfaction, and fear of the life situation. Descriptive statistics were used to present results, and analytical statistics were used to map out changes over time. Overall uncertainty showed a decrease over time. A statistically significant difference was found within the domain uncertainty related to information (P < 0.001). Satisfaction increased within the domains health-functioning, socio-economic, psychological-spiritual, and family. The ability to act within the domain health-functioning showed a statistical significance (P < 0.05). The domain life changes within fear in the life situation decreased and showed a statistical significance (P < 0.05). The overall life situation showed increased satisfaction as well as lower uncertainty and fear in the life situation. The research indicates that patients need more information about changes in the life situation after the implantable cardioverter defibrillator-implantation. The study encourages more humanistic, holistic research about patients' life situations as well as more education in teaching skills for health care personnel.

Activities of Daily Living↗

PubMed2001

Promoting a tobacco-free generation: who is responsible for what?

The aim of the study was to investigate how adolescents, parents and school staff look upon different agents' responsibilities in relation to the goal 'a tobacco-free generation'. This study was part of a larger study and used a descriptive, cross-sectional three-group design with questionnaires as the means of data collection. The sample comprised 216 pupils in grade five (11 years old) and 225 pupils in grade eight (14 years old) in a south-western county in Sweden, 293 of their parents and 119 school staff (headteachers, teachers, school nurses). All respondents agreed that adults should take a clear stand against adolescent tobacco use. The adolescents ranked their parents as the number one source of tobacco information, while pupils, parents, teachers and headmasters ranked school nurses at the bottom rank. The teaching at school focused on risks from tobacco use. The non-smoking norm at school was viewed differently by pupils, parents and school staff. The actions of family, school and society reflect the norms and these do influence adolescent smoking. The conclusion was that the responsibility to promote a tobacco-free generation was viewed differently by the categories involved in this study. The adolescents put the responsibility mainly on parents, while parents put it on the school, and the school staff on special health educators. Both parents and school staff need to recognize their importance in creating a non-smoking culture. To contribute to the creation of a non-smoking generation, school nurses should abandon their passive role in health promotion, as shown in this study, and instead engage in encouraging pupils, parents and teachers to remain or become tobacco-free.

Adolescent↗