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Biomedical subjects

Regina Wredling

Publications and source records attributed to Regina Wredling.

At least 19 recordsLinked to original sources
PubMed2006

The impact of gender regarding psychological well-being and general life situation among spouses of stroke patients during the first year after the patients' stroke event: a longitudinal study.

BACKGROUND: The informal caregivers perceive lack of choice to take on the role of caregiving, receiving little or no preparation for the caregiving role at home. The typical informal caregiver is female, either a spouse or adult child of the care recipient, and seldom shares the responsibilities of caregiving with other family members. The spouses worry about the ill relative, but also about what consequences the disease might have for their own life. The worries seem to vary with gender and disease. There are, to our knowledge, few previous longitudinal studies that have focused on gender differences among spouses of stroke patients. OBJECTIVES: To explore gender differences among spouses in perceived psychological well-being and general life situation, during the first year after the patients' stroke event. DESIGN: Longitudinal study with three assessments regarding psychological well-being and general life situation during 1 year. SETTINGS: The study took place at a stroke ward, Stockholm, Sweden. PARTICIPANTS: Consecutively 80 female and 20 male spouses of stroke patients admitted to a stroke unit participated. METHODS: Data were analysed using analyses of variance. RESULTS: Female spouses have a negative impact on psychological well-being, while male spouses have a lower occurrence of emotional contacts in their social network. Consistently, the female spouses reported lower quality of life and well-being than the male spouses. CONCLUSIONS: This study generates the hypotheses that there are gender differences among spousal caregivers of stroke patients; female spouses are more negatively affected in their life situation due to the patients' stroke event than the male spouses. It is important to take the individual differences under consideration when designing a nursing intervention, to meet the different needs and demands of male and female caregivers. The interventions should focus on individual support, so that the caregivers can adapt to their new role and be comfortable and effective as informal caregivers.

Female↗
PubMed2006

Differences within couples' experience of their hospital care and well-being three months after experiencing a stillbirth.

BACKGROUND: The present study aimed to investigate possible differences, within the couple, in their encounter with their stillborn child and the assistance of caregivers during the event and to evaluate the parents' psychological well-being three months after the stillbirth. METHODS: Twenty-two couples, who experienced a stillbirth, participated in the study. A study-specific questionnaire and a previously evaluated well-being questionnaire were used to assess the parents' psychological condition. Chi-square analysis, Wilcoxon's signed rank test, Student's paired t-test, and Spearman's rank correlation coefficient were used to detect differences within the couples. RESULTS: The parents had feelings of fear when they conceptualized the stillborn child, but with support from staff all but one couple held their child. The fathers had the same strong feelings of warmth, pride, tenderness, and grief as the mothers when they held the child. Most parents reported that the staff had treated them with understanding during the delivery. Three months after the event the mothers scored significantly higher on Negative Well-being, lower on Positive Well-being, and lower on General Well-being than the fathers. A majority of the mothers, but no fathers, were on sick leave three months after the event. CONCLUSIONS: Our study suggests that mothers and fathers need to be emotionally supported in the encounter with their stillborn child. The mothers' scoring of lower well-being may be due to a stronger antenatal attachment to the child. This should, however, be a subject of further studies.

Adult↗
PubMed2006

Post-stroke depression - effect on the life situation of the significant other.

The aim of this study was to describe the life situation among 'significant others' to patients with post-stroke depression, and to identify associations between the life situation of the significant others and patient characteristics. Seventy-one dyads consisting of patients with a diagnosed post-stroke depression and their significant others were included. The patients were assessed for depression with the Montgomery-Asberg Depression Rating Scale and diagnosed according to the DSM-IV. The assessments of significant others included their own life situation and proxy assessments of the patients' state of depression, anger, change of personality, and need of assistance. Significant others of male stroke patients reported a more negative impact on their life situation, than did significant others of female stroke patients (p = 0.04). There was a significant association between the patient's level of depression and physical function [activities of daily living (ADL)], with those with less impaired ADL having more major depression than those with more impaired ADL (p = 0.007). This study indicates that major post-stroke depression is more common among patients with limited functional deficits. This highlights the importance of assessment for depression also among seemingly recovered stroke patients in order to treat and support those in need. This study also stresses the importance of identifying different needs of the significant others in order to provide appropriate support in their caregiving role.

Activities of Daily Living↗
PubMed2005

Patient management of long-term continuous subcutaneous insulin infusion.

AIM: This paper reports a study of patients' current practice with continuous subcutaneous insulin infusions, particularly with respect to the management of the pump. BACKGROUND: Successful implementation of continuous subcutaneous insulin infusion requires a motivated patient with a range of technical skills and self-management capabilities. The therapy should be prescribed, implemented and monitored by a skilled professional team familiar with it and capable of supporting the patient. METHODS: A questionnaire was mailed to 102 continuous subcutaneous insulin infusion treated patients at a Swedish university hospital with experience of pump treatment for at least 6 months. RESULTS: The questionnaire was answered by 88% of the patients, 53 women and 37 men, aged 22-71 years with a duration of continuous subcutaneous insulin infusion use of between 7 months and 19 years. The changing interval for soft infusion set ranged from 2.0 to 10.0 days (mean 4.8) and for metal needles from 1.5 to 7.5 days (mean 3.8), P = 0.001. Catheter occlusions were significantly more often reported in patients with presence of bleeding at the infusion site (P = 0.011) and among those using insulin lispro (P = 0.032). CONCLUSIONS: Patients having long-term continuous subcutaneous insulin infusion should be carefully audited with respect to the management of the insulin pump and its accessories. In patients who frequently experience problems, shorter intervals between changes of infusion sets are strongly advocated and type of insulin preparation may be of importance in some cases.

Adult↗
PubMed2005

Spouse's life situation after partner's stroke event: psychometric testing of a questionnaire.

AIM: This paper reports a study to validate and test the reliability of a questionnaire constructed to evaluate the life situation of spouses after their partners have had a stroke. BACKGROUND: Stroke is a disease with great consequences for survivors and their families. Most survivors return home after the hospitalization and rehabilitation due to the stroke event. Relatives, primarily spouses, often feel obligated to care for the survivor at home, providing emotional support or assisting the person in activities of daily living. More specific information is needed about the spouse's life situation after the stroke event in order to develop effective supportive strategies. METHODS: Psychometric testing of the Life Situation Questionnaire was undertaken with 99 spouses of stroke survivors. The 13-item questionnaire consists of four subscales: 'Worries', 'Powerlessness', 'Personal adjustment' and 'Social isolation'. RESULTS: Item analysis showed that each item correlated with its own subscale (r = 0.63-0.78). The instrument had high internal consistency, with Cronbach's alphas of 0.80-0.86 and reasonable high congruent validity when correlated with a Wellbeing instrument, with a correlation of 0.59 (P = 0.001). Exploratory factor analysis confirmed the subscales, accounting for 77% of the variance. CONCLUSION: The Life Situation Questionnaire is a valid and reliable instrument, and could serve as an assessment tool after a stroke event to identify family caregivers who have problems in their life situations and need support from healthcare services.

Adaptation, Psychological↗
PubMed2005

The impact of a nurse-led support and education programme for spouses of stroke patients: a randomized controlled trial.

AIMS AND OBJECTIVES: The aim of the present study was to determine the impact of a nurse-led support and education programme for improving the spouses' perceived general quality of life, life situation, general well-being and health state. BACKGROUND: Stroke is a disease with great consequences for the patients and their families. The spouses often feel obligated to care for the patient, providing psychological and physical support and having to cope with the patient's physical and cognitive impairments. This might lead to increased problems, as family members struggle to adapt to their new roles and responsibilities. DESIGN AND METHODS: Longitudinal, randomized controlled trial. One hundred spouses were randomly assigned to intervention or control groups, 50 in each group. The intervention group participated in a support and education programme, six times during six months, led by stroke specialist nurses. Both groups were followed for 12 months. RESULTS: No significant differences were found, between intervention and control groups, over time. In the sub analyses, we found that the group attending 5-6 times had a significant decrease in negative well-being and increased quality of life over time, while the group attending fewer times had a significant decrease in positive well-being and health state, similar to the control group, which also had a significant decrease in negative and general well-being. CONCLUSIONS: A support and education programme might have a positive effect on spouses' well-being, on condition that they attend at least five times. RELEVANCE TO CLINICAL PRACTICE: To facilitate the spouses' role as informal caregivers to the stroke patients, further development of the support and education programme used in the present study is needed, including empowerment approach and implementation of coping strategies.

Adaptation, Psychological↗
PubMed2005

Predictors of quality of life among spouses of stroke patients during the first year after the stroke event.

BACKGROUND: Stroke, a disease with severe consequences for patients and their families, often lead to psychosocial stress, and a decline in the quality of life (QoL) among carers. Predicting the QoL is essential in the development of effective nursing support interventions. AIM: The aim of the present study was to identify predicting factors for the general QoL among spouses of stroke patients, and to determine whether these predictors change during the first year after the patient's stroke event. DESIGN: One hundred spouses were followed three times during 1 year regarding QoL, own illness, economic situation, well being, life situation, sense of coherence, social network and the patients' ability in activities of daily living (ADL). Stepwise multiple linear regression analyses were conducted for the baseline, 6- and 12-month assessments respectively, with the present QoL as the dependent variable. RESULTS: Over time during the first year after the patients' stroke event, there were significant differences in the spouses perceived general QoL. Life situation and economic situation were the only predictors of the spouses' QoL, which emerged during the entire year after the patient's stroke event, while well being, education, own illness, social network and ADL ability (patient) emerged at one or two occasions. CONCLUSION: The psychosocial factors -- life situation, well being, social network, education and economy -- are important in predicting QoL among spouses of stroke patients, and these predicting factors change over time. Determining the predictors at an early stage, and continuously over time, will help to focus clinical nursing interventions on the spouses' changing needs.

Aged↗
PubMed2005

Bases for assessments made by telephone advice nurses.

Telephone advice nursing includes triage, advice, referral, information and coordination. The aim of the study was to explore what telephone nurses base their assessments on. We conducted 14 interviews with seven telephone nurses at a health-care call centre in Sweden. Two authentic calls per nurse were used in stimulated recall interviews, where the nurses commented on the basis for their assessments. A qualitative manifest content analysis was employed. Three major categories emerged in the analysis: care-seeker, e.g. 'symptomatic sounds'; nurse, e.g. 'nurse's own experience'; and organization, e.g. 'health-care accessibility'. The findings show that the telephone advice nurses' bases for assessments appear to be very broad. They include both verbally and nonverbally communicated information, and care-seeker-, nurse- and certain organization-related factors influence the assessments. We found that an individualistic view of the care-seeker seems to dominate the assessments in non-urgent calls to a health-care call centre.

Communication↗
PubMed2005

Drug use and perceived health in recently hospitalized older people.

Older patients often have multiple diseases, resulting in treatment with many drugs. This may increase the risk for drug-related problems. This study aimed to analyse the congruence between the patient's self-reported drug use and the medical record, and the relationship to perceived health among older patients recently discharged from hospital. A total of 200 patients over 65 years of age who were admitted to a medical ward and were treated with at least one drug participated in an interview study one week after discharge from the hospital. The patients provided information on their current drug therapy. This information was compared to the prescriptions documented in the medical record. Thirty per cent of the study population reported a drug use which was in congruence with the medical record, 28% used less drugs than prescribed, and 42% more. Statistical analysis showed a high probability of non-congruence with prescriptions among patients who reported poor health.

Adaptation, Psychological↗
PubMed2004

The role of caregivers after a stillbirth: views and experiences of parents.

BACKGROUND: The clinical role of the caregiver to parents in the event of a stillbirth has yet to be defined. The aim of this paper was to focus on the caregivers' support as revealed by the parents' experiences. METHOD: One or both parents of 31 stillborn infants (> or =28 weeks) were interviewed twice, for a total of 57 interviews. The data analysis was conducted using a qualitative approach. RESULTS: Parents identified the caregivers' behavior and handling of the stillbirth as important. Findings showed that caregivers should support parents in moments of chaos and at other difficult times. The parents needed assistance in both facing and separating from the baby. The six "qualities" that summarized the findings were "support in chaos,""support in the meeting with and separation from the baby,""support in bereavement,""explanation of the stillbirth,""organization of the care," and "understanding the nature of grief." Findings indicate that the hospital is under an obligation to organize the care and make it possible for parents to see the same caregivers again, and to offer extra ultrasound investigations and checkups without unnecessary bureaucracy. CONCLUSION: We suggest that the "qualities" identified by the study findings should be implemented in clinical care, and could facilitate active guidance and counseling for bereaved parents who have experienced a stillbirth.

Adaptation, Psychological↗
PubMed2004

Testing of an audit instrument for the nursing discharge note in the patient record.

OBJECTIVES: This study validates and tests the reliability of an audit instrument constructed to evaluate the content of nursing discharge notes. DESIGN: Instrument validation and reliability testing. MAIN OUTCOME MEASURES: Factor analysis identifying structure through data summarization of the instrument, association between scores in test-retest, and interrater reliability between auditors. RESULTS VALIDITY: Three factors emerged in the factor analysis: 'General information', 'Planning', and 'Assessment', accounting for 76% of the variance regarding the quantitative aspect and 79% of the variance regarding the qualitative aspect, confirming the distinctiveness. Reliability: The Spearman rank-order correlation coefficient calculated per item in the test-retest ranged from 0.72 to 1.0 (p=0.01). The correlation coefficient for the total score was 0.98 (p=0.01). There were no differences in item scores between the test and retest in 93% of the comparisons (n=486). Between the two auditors, the Spearman rank-order correlation coefficient in each item ranged from 0.83 to 1.00 (p=0.01) and weighted kappa values from 0.70 to 1.00 with the exception of one item in both calculations. The correlation coefficient for the auditors' total score was 0.99 (p=0.01). The Student's paired t-test comparing the two auditors' mean values in five different parts of the instrument showed no significant differences in score. CONCLUSION: The Cat-ch-Ing EPI instrument shows a high reliability and validity as an audit instrument to evaluate the content of nursing discharge notes.

Analysis of Variance↗
PubMed2003

Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression.

OBJECTIVE: The aim of the investigation was to study the effects of withdrawing selective serotonin reuptake inhibitor (SSRI) drugs in nursing home patients, who had no documented diagnosis or symptoms of depression. SETTING: The setting of the study was in 11 nursing homes in the county of Stockholm, Sweden. PARTICIPANTS: Participants were patients without dementia or history of depression who had received treatment with SSRI drugs for more than 6 months and who had no indications of anxiety disorder or major depression DESIGN: The included patients ( n=70) were randomized to either the intervention group (withdrawal of SSRI) or the control group (no change in treatment), 35 patients to each group. MAIN OUTCOME MEASURES: The patients were subjected to assessment using the following instruments: Montgomery-Asberg depression rating scale, global assessment for functioning, health index and a symptom assessment form. Assessment was made at the start of the study and at the 3-month and 6-month follow-ups. RESULTS: We found no significant difference between the intervention and control groups in any outcome measure. CONCLUSION: Treatment with SSRI drugs in patients without clinical major depression or anxiety disorder is often unjustified and should be discontinued.

Aged↗
PubMed2003

Alteration of the counterregulatory responses to insulin-induced hypoglycemia and of cognitive function after massive weight reduction in severely obese subjects.

The autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis are reported as activated in excess in the morbidly obese state and, therefore, changes after weight loss can be anticipated. The aim of this study was to investigate the impact of a massive (approximately 30%) weight reduction on the activation of the HPA axis and the ANS following bariatric surgery. Eight (7 women, 1 man) severely obese (125+/-12 kg; body mass index [BMI], 45+/-4 kg/m2) nondiabetic subjects, underwent a 3-hour hyperinsulinemic (1,034 pmol/kg/h) glucose clamp study at hypoglycemia of arterial B-glucose concentration of 3.4 mmol/L. Cognitive function was evaluated by a visuospatial computerized problem-solving test, the Perceptual Maze Test (PMT). The mean weight loss was 40+/-9 kg approximately 12 months postsurgery when their weight was stabilized (85+/-6 kg; BMI, 31+/-3 kg/m2), and insulin sensitivity improved to an average increase of 376%+/-250% (P<.01) of initial value. Before weight reduction, all patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide (PP), norepinephrine, and cortisol, indicative of preserved or exaggerated activation of ANS and HPA axis. In the reduced-obese state, all these responses were attenuated and most markedly so for glucagon, which was totally abolished. In contrast, the growth hormone (GH) response was increased after weight reduction. The cognitive function was clearly modified by weight reduction both during normoglycemia and hypoglycemia and was changed preferentially to a speed-preferring strategy in the reduced-obese state compared with a more accuracy preferred problem-solving process of PMT test presurgery. These results demonstrate a reduction of the glucose counterregulatory hormonal responses, increased insulin sensitivity, and perturbed cognitive function after massive weight reduction. It may be speculated on if the increased insulin sensitivity and reduced counterregulation to hypoglycemia could predispose to low plasma glucose concentrations.

Adrenal Glands↗
PubMed2003

Experiences of using the VIPS-model for nursing documentation: a focus group study [corrected].

BACKGROUND: The present investigation is part of a study where the Registered Nurses on three hospital wards received a 2 year intervention programme on nursing documentation in accordance with a keyword structure based on the nursing process. AIM: To describe the Registered Nurses' perceptions of and attitudes towards the effects of the intervention, and to generate hypotheses for further research. METHOD: Focus group discussions were used to collect data, with a qualitative content analysis method for the processing of the data. FINDINGS: The most interesting finding in these group discussions was the statements made by participants that the structured way of documenting nursing care made them think more, and think in a different way about their work with their patients. Two types of role changing were reported; from a medical technical focus to a more nursing expertise orientation and from a "hands on clinician" to more of an administrator and secretary. CONCLUSION: A number of issues debated among the participants in this study could be seen as organizational matters and lead to the important issue of multidisciplinary and organizational work when implementing innovations within nursing.

Attitude of Health Personnel↗
PubMed2003

Telephone nurses' experience of problems with telephone advice in Sweden.

By telephoning a healthcare call centre, individuals in Sweden can consult a nurse to discuss medical problems and health care accessibility, and to receive professional information on how to find their way about the health care system. The aim of the study was to identify problems, difficulties and disadvantages that telephone nurses with varying degrees of experience had met during their professional careers. The Delphi technique was used with three sets of questionnaires. Twenty-five nurses with varying experience of working with telephone advice from six 24-hours call centres participated in the study. The response rate was 100%. An open-ended question generated 154 statements. Comments were categorized into 24 different problem categories. Ten problem categories were mainly related to the nurse perspective, i.e. the problems experienced were associated with the qualities of the nurse, eight principally to the patient perspective, i.e. problems associated with caller characteristics and six mostly to the organizational perspective, i.e. problems linked to the organization of the national health service. 'Lack of health care resources' was rated as the biggest problem, 'second-hand consultations' as the second and 'always making a decision' as the third biggest problem. Decision-making seems to be the core of telephone advice nursing and problems related to the nurses, patients and organization seem to influence the telephone nurses' working situation. Training should focus on active listening and handling social conflicts.

Adult↗
PubMed2003

Prerequisites and consequences of nursing documentation in patient records as perceived by a group of Registered Nurses.

The issue of nursing documentation and care planning has been discussed in numerous articles, revealing barriers and few facilitators in nursing practice. Few of these articles are scientifically researched and they are often based on small samples. This study aimed to illuminate the factors that Registered Nurses (RNs) in acute care perceived as prerequisites and consequences relevant to their documentation of nursing care when using the VIPS model (VIPS is an acronym formed from the Swedish words for Well-being, Integrity, Prevention and Security). In total 377 RNs divided into two groups (Groups A and B) completed a questionnaire concerning opinions about nursing documentation. Both groups had received a 3-day course on nursing documentation based on the VIPS model. Group A had also participated in a 2-year comprehensive intervention programme. The findings showed that most participants, regardless of group, perceived nursing documentation to be beneficial to them in their daily practice and to increase patient safety, and that use of the VIPS model facilitated documentation of nursing care. The inhibitors, facilitators and consequences of nursing documentation identified here should help both RNs in practice and their leaders to be more attentive to the prerequisites needed to achieve satisfactory nursing documentation in patient records.

Adult↗
PubMed2003

Factors and circumstances related to complaints in emergency medical dispatching in Sweden: an exploratory study.

There are 20 SOS Alarm emergency dispatch centres in Sweden, and from these centres approximately one million ambulances are dispatched each year. The aim of the study was to explore factors and circumstances that contributed to misjudgements or filed complaints in emergency medical dispatching filed at the Patient Advisory Committees (n=24), the Swedish National Board of Health and Welfare (n=20) and the Medical Responsibility Board (n=10). This is a retrospective study of all decisions on complaints made between 1991 and 2000, and the data were analysed in two phases. In the first phase, categories of cause were revealed, and in the second phase, factors and circumstances were identified that related to misjudgements or filed complaints. The findings show that in nearly half (23/54) of the complaints, the assessments were stated as been made on the basis of second-hand consultations, e.g. the SOS operators had not spoken directly to the ill person. In 19 out of 21 complaints dealing with the decision-making process, the assessments were made on second-hand information. Second-hand information may constitute an aggravating circumstance in assessing the urgency of the care needed on the telephone. The findings suggest that the call receivers should be more cautious when undertaking assessments on the basis of information provided by a third person.

Ambulances↗