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Congestive heart failure, spouses' support and the couple's sleep situation: a critical incident technique analysis.

Sleep related breathing disorders are common as well as a poor prognostic sign associated with higher mortality in patients with congestive heart failure (CHF). These patients often have a shorter total duration of sleep, disturbed sleep structure and increased daytime sleepiness, which can negatively affect all dimensions of the life situation. The spouse has an important role in supporting the patient in relation to sleep disorders, but this role may be adversely affected by the sleep situation of the couple. The aim of this study was to describe decisive situations that influence spouses' support to patients with CHF in relation to the couple's sleep situation. A qualitative descriptive design using critical incident technique was employed. Incidents were collected by means of interviews with 25 spouses of patients with CHF, strategically selected from two hospital-based specialist clinics in southern Sweden. Two main areas emerged in the analysis: support stimulating situations and support inhibiting situations. Support stimulating situations described how spouses' support was positively affected by their own adaptation in psychosocial or practical situations, and receiving help from others. Support inhibiting situations described how the spouses' support was negatively affected by sleep disturbances as a result of the patient's symptoms, anxiety in relation to the disease, limitations as a result of the sleeping habits, dissatisfaction with care related to the sleep situation, and being left to cope alone with the problems. An increased understanding of the stimulating and inhibiting situations influencing spouses' support for patients with CHF can guide health care personnel in deciding if an intervention is needed to improve the sleep situation for patient and spouse.

Adaptation, Psychological↗

Coronary heart disease: causes and drug treatment--spouses' conceptions.

BACKGROUND: Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event. AIMS AND OBJECTIVES: To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event. DESIGN: Qualitative with an empirical and inductive approach. METHODS: Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework. RESULTS: Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease. CONCLUSION: A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour. RELEVANCE TO CLINICAL PRACTICE: Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.

Adaptation, Psychological↗

[Financial burden on spouses of patients suffering from schizophrenia, depression or anxiety disorder].

The aim of this study was to compare financial burden of spouses, whose relative suffers from schizophrenia, depression or anxiety disorder. 151 spouses filled in the questionnaire about illness related expenses and financial loss. Additionally they estimate their subjective burden according to these experienced costs. Direct cash expenditures on behalf of the patients' illness were reported by 66 % spouses. In the sampling the amount of spent money did not differ statistically, however spouses of patients with anxiety disorder emphasised experiencing financial strain and described more often subjective economic disadvantages. Although most spouses of patients with psychiatric disorders experience illness related financial disadvantages, these costs were usually not considered as serious problem or as burdensome. Based on a subjective hierarchy of burdens financial problems can be regarded as less important for spouses of patients with mental illness. Thus, not only the material, but also the immaterial costs of care giving spouses should be taken into consideration when planning health policy decisions.

Adult↗

[Coping strategies in spouses of schizophrenic patients].

OBJECTIVE: The study was carried out to explore the coping behaviour of spouses of schizophrenic patients. METHODS: 28 in-depth interviews were analysed with a view to discover the spouses' ways of dealing with illness-related burden. RESULTS: Most spouses reported problem-focussed coping strategies, such as information seeking and crisis planning. Release-focussed coping strategies, such as relaxation activities, time-out and temporal disengagement, are likely to be used when the situation is perceived as unchangeable and spouses feel that they have to look after themselves as well. In the long-term, cognitive-emotional strategies are of great importance, aimed at the re-appraisal of the spouses' mental illness and a greater sense of self-efficacy in dealing with acute and everyday burden. CONCLUSION: Spouses' coping strategies not only have a strong influence on their perception of burden, but also on marital satisfaction and on their commitment to the affected spouse.

Adaptation, Psychological↗

Life satisfaction in spouses of patients with stroke during the first year after stroke.

OBJECTIVE: The aims of this study were to investigate whether spouses' life satisfaction changed between their life prior to their partner's stroke, and at 4 months and 1 year after stroke, and to study the association between spouses' life satisfaction and objective characteristics of the stroke patients. SUBJECTS AND METHODS: Sixty-seven consecutively enrolled spouses to first-ever stroke patients < 75 years of age participated. Life satisfaction was measured with the Life Satisfaction Checklist (LiSat-9). RESULTS: Compared with their life before stroke, the spouses' satisfaction with life as a whole, their leisure situation, daily occupation, sexual life, partner relationship and social contacts was lower 4 months after stroke. No significant change in life satisfaction was observed between 4 months and 1 year. Spouses of patients with sensorimotor impairment and low ability in self-care were less satisfied with their leisure situation, daily occupations, own ability in self-care, sexual life and partner relationship. Spouses of patients with cognitive or astheno-emotional impairments were less satisfied with their partner relationship, family life and sexual life. The associations were stronger at 1 year than at 4 months. CONCLUSION: There is a need for support over a long time period that focuses on the social, occupational and leisure situation of spouses as well as that of patients.

Adult↗

The disregarded caregivers: subjective burden in spouses of schizophrenia patients.

Although the burdens of relatives of schizophrenia patients have been the subject of numerous studies, there are hardly any publications on the living situation of the patients' spouses. The findings of this qualitative interview study of 52 spouses of schizophrenia patients are, therefore, especially noteworthy. Spouses not only face illness-specific burdens but also burdens resulting from their partnership and family roles. From a biographical point of view, schizophrenia is often evaluated by the spouse as a decisive point in life that seriously affects the couple's relationship, the family, and the spouse's own life. The chronic burdens of everyday living can profoundly reduce the quality of life and the subject's satisfaction with the partnership. Though partnerships with schizophrenia patients are at risk of breakdown and separation in many respects, they are often maintained for years. Despite the illness-related burdens, many spouses take positive stock of living together. Stable partnerships seem to be achievable when the partner's impairment is perceived as moderate or moderately severe, and when the frequency at which psychotic episodes occur is assessed as still being tolerable. Spouses who suffer from mental illness or impairment themselves often experience the partnership as an appropriate and satisfactory way of life. In these cases, the mutual understanding rooted in the subject's own experiences with the illness is important.

Adult↗

Coping in spouses of patients with acute myocardial infarction in the early phase of recovery.

The purpose of this study was (1) to determine the coping strategies employed by spouses of patients with AMI in the early phase of the crisis, (2) to define the role of age, gender, health perception, time since infarction, spouses' fears, and negative life events in the choice of coping strategies applied, and (3) to test the effect of coping strategies on physical and psychological strain. Fifty-seven spouses participated in the study, 47 were female and 10 were male. Data were collected by structured questionnaires, which were distributed to the spouses from 2 weeks-4 months after the patient's AMI. The researchers found that age, negative life event during the last 12 months, time since infarction, and the spouse's fears influenced the choice of strategies. In the early stage of the crisis, positive reappraisal seems to be a strategy that increased physical strain. Spouses' need for social support in the early stage of the crisis is a factor for health care providers to bear in mind. Besides giving information, empathy, and understanding, health care personnel can try to assist spouses in their efforts to reappraise their situation.

Adaptation, Psychological↗

Comparison of patient and spouse assessments of health related quality of life in men with metastatic prostate cancer.

PURPOSE: We examined the extent of agreement in health related quality of life ratings provided by patients with metastatic prostate cancer and their spouses. This agreement is important for determining the feasibility of using spouses as potential proxy raters in quality of life studies in this patient population. MATERIALS AND METHODS: The study sample consisted of 72 pairs of patients with metastatic prostate cancer in remission or progression and their spouses. Patients and spouses independently completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and a prostate cancer specific questionnaire module. Together the 2 questionnaires assess a wide range of symptoms and functional limitations for a total of 21 quality of life outcomes. RESULTS: For 5 of the 21 patient-proxy comparisons we noted systematic differences in the mean score with spouses rating more impairment in patients than patients indicated. Most patient-proxy correlations were 0.40 to 0.75, indicating moderate to good agreement in patient and spouse ratings. A low patient-proxy correlation of less than 0.40 was noted only for the 2 measures of sexual function. CONCLUSIONS: Our findings suggest that the spouses of men with metastatic prostate cancer evaluate with a fair degree of accuracy how patients experience physical and psychosocial functioning, symptoms and overall quality of life. However, caution should be exercised when relying on proxy raters for assessing sexual functioning and satisfaction.

Disease Progression↗

Patients' and their spouses' needs after total joint arthroplasty: a pilot study.

PURPOSE: To describe the experiences and needs of patients and their spouses during hospitalization and recovery from either total hip or total knee arthroplasty. DESIGN: Descriptive. SAMPLE: A purposive sample of 5 patients and their spouses in one health sciences center. METHODS: Qualitative study using a videotaped focus group interview. FINDINGS: Content analysis revealed two perspectives of one theme: patients and their spouses need "help making transitions." Situational and role transitions that were problematic for patients reflected distress over not being able to resume activities they enjoyed within an expected time frame. Incongruence between expectations and reality was the source of distress. As a consequence of role reversal, spouses experienced feelings of insecurity and being overwhelmed. Health and illness transitions that patients experienced were also related to incongruence between expectations of the recovery period and the reality that recovery is a slow process. Pain experienced during postdischarge recovery and rehabilitation, and problems encountered when applying information and skills learned in the hospital to the home setting were sources of concern. CONCLUSION: The needs and experiences of patients and spouses after total joint arthroplasty reflect transitional change--changes in roles, relationships, abilities, and behaviors. Health care professionals can facilitate transitions by providing education that reflects "best case-worst case scenarios" so that expectations of the recovery process are realistic. By being the link between hospital and home, health care professionals can lend support to patients as they continue the recovery process. As a program evaluation strategy, focus groups provide useful information to health care professionals who are interested in the needs and expectations of health care consumers. IMPLICATIONS FOR NURSING RESEARCH: Further exploration of the needs of patients and their spouses following joint replacement surgery is warranted. Use of focus group methodology might provide additional insight into the needs of this population and suggest ways in which health care professionals can modify existing programs to help these patients and their spouses make the transitions.

Adaptation, Psychological↗

Rehabilitation after coronary heart disease: spouses' views of support.

BACKGROUND: Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles. AIM: The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes. METHOD: Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework. FINDINGS: The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation. CONCLUSION: Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

Adult↗

Health in everyday life among spouses of haemodialysis patients: a content analysis.

Despite the fact that haemodialysis requires that spouses support and assist their partner during the treatment period, little attention has been focused on their health. The aim of this study was to explore experiences of health in everyday life among spouses of haemodialysis patients. The study had an explorative and descriptive design based on content analysis. Thirteen participants were interviewed in their home without the presence of the patient. The results show that arduousness was experienced when that spouses' everyday life was taken up by caring for the patient at the expense of his/her own health. Spouses exhibited stamina and neglected their own health when focusing on the patient and minimising their own condition. Independence in everyday life revealed that spouses who cared about themselves and looked after their own health experienced relaxation and happiness, which protected their health. Clinical interventions should include an assessment of the spouses' health and everyday life in order to plan the care to ensure that it is directed towards increasing their independence. Instruments need to be developed that assess when and how spouses experience the greatest sense of well-being, if they have scope for relaxation and recovery, and what type of support they require in their everyday life.

Activities of Daily Living↗

Periodontitis patient and the spouse: periodontal bacteria before and after treatment.

Suspected periodontal pathogens can be transmitted between spouses. The treatment response may be unsuccessful in periodontitis patients, if the spouse harbors these bacteria. The aim of the present 6-month follow-up study was to clarify whether the microbiological treatment outcome of periodontitis patients is related to the detection of suspected periodontal pathogens in the saliva of the spouse. 10 patients with advanced periodontitis and their spouses were included in the study. The patients received mechanical periodontal treatment and 500 mg metronidazole systemically 2x a day for 7 days. The presence of visible plaque, gingival bleeding after probing, suppuration, supragingival and subgingival calculus and pocket depths were assessed at baseline and 1 and 6 months after treatment. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens, Campylobacter rectus and Peptostreptococcus micros were cultured from pooled subgingival samples from the patients and from salivary samples from the spouses at corresponding occasions. Periodontal conditions in the patients improved after treatment as determined by the significantly lower values of clinical variables 1 and 6 months after treatment compared to those at baseline. However, the re-emergence of periodontal bacteria after treatment of the patients was not related to the concurrent detection of the respective bacteria in the saliva of the spouses. In this study design, it seemed that the salivary bacterial load in the spouse was of minor importance for the microbiological treatment outcome of the patient.

Aggregatibacter actinomycetemcomitans↗

Spouses of demented patients with low cobalamin levels: a new risk group for cobalamin deficiency.

Low serum cobalamin levels are common in conditions such as dementia and often represent mild deficiency. We surveyed serum cobalamin levels prospectively in spouses and blood relatives of demented patients to determine if any familial predisposition exists for the low levels. Cobalamin status in most of the relatives found to have low levels was assessed further by means of blood counts, metabolic tests, neurologic evaluation, absorption studies and response to cobalamin therapy. Serum cobalamin levels in 36 spouses correlated with those of the 36 demented patients related to them (r = 0.46, p = 0.004). A significant association was not seen in 34 blood relatives of 34 demented patients (r = 0.27). Most importantly, 67% of the spouses of demented patients with low serum cobalamin had low values themselves, compared with only 3% of the spouses of patients with normal levels (p = 0.001). Detailed study of 4 of the 5 spouses (and 3 blood relatives) with low cobalamin levels showed no anemia in any case. Nevertheless, 4 of the subjects had metabolic evidence of deficiency and one had electrophysiological abnormalities; all these defects improved with cobalamin therapy. These observations identify a hitherto unsuspected group of people at high risk for cobalamin deficiency and suggest that spouses of demented patients with low cobalamin levels should also have their cobalamin levels measured. The increased frequency of low serum cobalamin levels in spouses of demented patients with low levels represents in most cases a true, mild cobalamin deficiency that responds to treatment.

Adult↗

Social support and psychological and physical states among Japanese patients with breast cancer and their spouses prior to surgery.

PURPOSE/OBJECTIVES: To assess social support and psychological and physical states among Japanese patients with breast cancer and their spouses prior to surgery. DESIGN: Descriptive, comparative, and correlational. SETTING: A general hospital in northern Japan. SAMPLE: 38 Japanese patients with breast cancer and their spouses (N = 76). METHODS: The Japanese versions of three questionnaires were used to collect data before surgery: the Interpersonal Relationship Inventory, the General Health Questionnaire, and the Physical States Interview Form. MAIN RESEARCH VARIABLES: Social support (support, conflict, and reciprocity), social network, and psychological and physical states. FINDINGS: Significant differences were found in support and reciprocity between patients and their spouses. However, no significant differences were found in social network, conflict, or psychological states between patients and their spouses. Moreover, some significant correlations were found in the variables of conflict, social network, and psychological and physical states. CONCLUSIONS: Japanese patients with breast cancer perceived more support and reciprocity than their spouses before their breast surgery. Conflict was significantly correlated with psychological states among Japanese women with breast cancer and their spouses. IMPLICATIONS FOR NURSING: Healthcare professionals need to consider social support as an important factor to help Japanese patients with breast cancer and their spouses cope with the disease.

Adult↗

How do patients and spouses deal with the serious facts of malignant glioma?

Malignant glioma is a severe disease with little chance for recovery. Due to its effect on cerebral function, it is also a disease with an obvious social impact on family life. Brain tumours, therefore, produce much of the anguish associated with cancer diseases. There is a lack of prospective studies concerning how patients and spouses together deal with the serious facts of cancer. In this study, a series of 25 consecutive patients with malignant gliomas and their spouses was followed during the whole course of the disease process by repeated thematic interviews. The spouses were also subjected to a summarizing interview after the patient's death. The interviews were analyzed qualitatively in order to detect the various ways the patient-spouse couples dealt with this severe situation and how they discussed it with each other. Four different social processes were detected: 1) the patient does not seem to be aware, the spouse is aware but pretends not to be; 2) both are aware, but the patient does not want to share; they drift apart; 3) both are aware, they do/do not talk openly about the gravity of the situation; nevertheless, there is a joint platform; and 4) neither patient nor spouse seems to be aware; they carry on living as before. The patients, compared to the spouses, seemed content with received information. A few of the couples openly discussed death and dying. More common, and apparently sufficient, was a mutual acknowledgement of the serious facts, without using the words 'death' and 'dying'. In a sense, the present findings challenge the awareness categories suggested by Glaser and Strauss.

Adaptation, Psychological↗

Patterns of spouse and child maltreatment by discharged U.S. Army soldiers.

The transitional compensation (TC) program of the U.S. Army provides financial and other benefits to the families of service members discharged for child or spouse maltreatment. We analyzed the TC records of the 347 offenders, 337 spouses (160 victims and 177 nonvictims) who were applicants for benefits, and 820 children (244 victims and 576 nonvictims). One hundred fifty-two spouses were physically abused and eight were sexually abused. One hundred eighty-two children were sexually abused, 61 were physically abused, and one was emotionally abused. The Army Central Registry (ACR) of child and spouse maltreatment cases was examined to determine whether the TC offenders and victims had a history of prior maltreatment and to assess its severity. Ninety percent of the TC offenders had an ACR history as child or spouse maltreatment offenders. Seventy-four percent of the TC child abuse victims had an ACR history as victims, and 81 percent of the TC spouse abuse victims had such a history. The severity of maltreatment in the ACR of TC child and spouse victims was greater than the overall severity of maltreatment for those in the ACR database who were not in the TC database. Other children in the family who had not been identified as TC victims also had an ACR history that was more severe. Health and social service agencies should be aware of the TC program and be knowledgeable about its benefits for family members of soldiers discharged for abuse-related offenses.

Adult↗

Impact of aborted sudden cardiac death on survivors and their spouses: the phenomenon of different reference points.

BACKGROUND: Although anecdotal data suggest that spouses of aborted sudden cardiac death survivors become enmeshed in the physical and emotional recovery of their mates, few longitudinal studies address the personal struggle of aborted sudden cardiac death survivors and their spouses during recovery. OBJECTIVE: To identify and explore phenomena experienced by aborted sudden cardiac death survivors and their spouses, and to determine implications for care. METHODS: This was a phenomenological study; qualitative interviews were conducted within 3 weeks of aborted sudden cardiac death and continued through 24 weeks after arrest at 6- to 8-week intervals. A total of 180 interviews were conducted with 40 survivors and 30 spouses. Interviews were tape-recorded, transcribed, and analyzed for recurrent themes. RESULTS: For the spouses the point of focus, or reference point, for future decision making was the arrest; for the survivors the reference point was prearrest life. These different reference points led to different concerns between spouses and survivors, from which spousal protectiveness and entrapment emerged. CONCLUSIONS: Acknowledgment of different reference points is essential in planning interventions for aborted sudden cardiac death survivors and their spouses. This population must be encouraged to express their questions, concerns, and fears early. Differences in perspectives should be identified to avoid troubled communication and conflicts.

Activities of Daily Living↗

Impact of the heart transplant waiting process on spouses.

BACKGROUND: Practitioners working with candidates for heart transplants and their families know that the heart transplant waiting process is psychologically stressful and demanding. Spouses of heart transplant candidates struggle with multiple demands. Although many have studied the impact of heart transplantation on patients, only a few investigators have studied the impact of the heart transplant waiting period on spouses. METHODS: Using survey research methods, we studied the impact of the heart transplant wait on the lives of 85 spouses of heart transplant candidates from three sites using the following: Spouse Transplant Stressor Scale, Jalowiec Coping Scale, Family Inventory of Resources for Management, Quality of Life Index, a six-item rating scale, and a demographic form. RESULTS: One-third of the sample (30.6%) believed that the heart transplant waiting experience had a negative impact on their life, two-thirds (65.9%) believed it had a positive impact, and 3.5% believed that the heart transplant experience had no impact on their life. The longer the patient partner waited for a heart transplant, the more negative the impact was on the spouse's life (r = -0.23, p = 0.04). Spouses experiencing a negative impact from the heart transplant experience reported higher stressor scores (F = 3.74, p = 0.03), used more negative coping strategies (F = 3.69, p = 0.03), and had a lower quality of life (F = 3.28, p = 0.04). CONCLUSIONS: Spouses who reported a more negative impact from the heart transplant waiting experience were under more stress, used negative coping strategies, reported a lower quality of life, and had patient partners who waited longer for a heart.

Adult↗