The present study addresses factors that contributed to explaining the variance in health-related quality of life (HRQOL) one year after myocardial infarction, considering both illness-related and health-promoting factors. The aim was to elucidate the influence of depression, fatigue, optimism and sense of coherence on HRQOL. The sample consisted of 95 persons who had been treated for myocardial infarction. Correlation and multiple regression analyses were performed. The results showed that depression, fatigue, optimism and sense of coherence variables were all correlated with both the physical and the mental dimensions of HRQOL. In two multiple regression analyses where the physical component score (PCS) and the mental component score (MCS) were the criterion variables, fatigue contributed to the explained variance in the PCS (p< 0.001), and both depression (p< 0.01) and fatigue (p< 0.01) contributed to explained the variance in the MCS, after controlling for age and gender. To conclude, fatigue was the most significant variable associated with HRQOL, which was interpreted as having the following clinical implication: When a person suffers from post-myocardial infarction fatigue, this must be addressed first. Clearly, it is time to take the problems of patients who suffer from post-myocardial infarction fatigue seriously. It is of vital importance to develop and evaluate fatigue relief strategies in cardiovascular nursing and to test them in interventional studies. This does not exclude investing in health-promoting factors, e.g. sense of coherence, in coronary care interventions. Intervention strategies focusing on both illness-related and salutogentic factors may be optimal. This is a question for further research.
When people’s health is threatened, they generally develop illness perceptions to make sense of their illness. The Illness Perception Questionnaire (IPQ-R), developed by Moss-Morris et al (2002), has been widely used in many countries to measure such representations. However, since studies in this crucial research area are lacking in Sweden a Swedish version of IPQ-R was validated with a focus on the seven subscales: timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representations. Using confirmatory factor analysis, the aim of the present study was to validate the internal structure of the Swedish version in a sample of 202 persons (144 men and 58 women) who had been diagnosed with myocardial infarction four months earlier. Additionally, inter-correlations among the seven subscales and external concurrent validity were also investigated. The results of confirmatory factor analysis revealed that, in line with the English version of the IPQ-R, the specified seven-factor model had a satisfactory fit. One item was however not considered reliable and was therefore excluded from the instrument. The internal consistency (Cronbach’s alpha coefficients) and the inter-factor correlations were relatively similar to those reported in the validation study of the original English IPQ-R. In tests of concurrent validity, the seven IPQ-R subscales were, as hypothesized, mainly associated with external variables. To conclude, the Swedish version of the IPQ-R’s seven dimensions, with one item removed, (total 37 items) was found to be a reliable and valid measure of illness perception.
Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.
The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1 year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1 year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1 year after first-time myocardial infarction.
AIM: This paper reports on an interview study exploring the self-regulation process in women and men, 5 months after a first-time myocardial infarction. BACKGROUND: Somatic, psychological and social factors affect readjustment after a first-time myocardial infarction, and studies have demonstrated substantial rates of depression in patients after myocardial infarction Women report poorer mental health and physical condition than do men. Reconstruction of the self begins when disease poses novel problems and is more likely to occur in cases of long-lasting and disruptive illnesses. Experiencing myocardial infarction is likely to alter a person's mental representation of self. However, the self-regulation process following first-time myocardial infarction is not yet fully understood. METHOD: Twenty-one people (11 women, 10 men) were interviewed 5 months after first-time myocardial infarction. The grounded theory method provided the strategies for data collection and analysis. FINDINGS: Interviewees' definition of themselves as active was threatened by fatigue and other health problems that kept them from taking part in activities as they had done before the heart attack. Although reorienting the active self was central to the process of recovery from myocardial infarction, reorienting was restricted by illness perception and coping. CONCLUSION: Participants had not established a stable health condition 5 months after first-time myocardial infarction. They mainly preferred to moderate rather than radically change their daily life activities. They needed more knowledge and support. Nurses can help with information and advice on managing daily life activities, including dialogue about lifestyle changes at this phase of readjustment.
Coping with myocardial infarction: evaluation of a coping questionnaire The negative effects of emotional distress on the recovery following myocardial infarction make it important to study coping strategies in this situation. The present study aimed to evaluate the psychometric properties and the validity of a 10 dimensions questionnaire labelled The General Coping Questionnaire (GCQ). The structure of the questionnaire was based on a previous interview study with 26 persons with different diseases. The 10 dimensions are called self-trust, problem-reducing actions, change of values, social trust, minimization, fatalism, resignation, protest, isolation and intrusion. The present study comprised 114 first-time myocardial infarction patients (37 women, 77 men). Five months after myocardial infarction, they answered questions about health-related quality of life, health complaints, sense of coherence and the GCQ. A multi-trait/multi-item analysis showed good item-scale convergent and discriminatory validity when the GCQ was reduced from 47 to 40 items. In conclusion, the results showed that the 40-item GCQ is a well-structured and reliable questionnaire for measuring coping strategies in myocardial infarction patients.
In the present article, we emphasize the symptom experience perspective in person-centred care and discuss barriers to implementation of this approach. There are obstacles to overcome: the diversity of understandings of symptoms in clinical settings, the current biomedical discourse and the incompleteness of symptom research. Since the 19th century, the bio-medical perspective has been powerful in conceptualizing symptoms in terms of pathology and diagnosis. Many diagnoses conjure up preconceived notions about the persons receiving them. This perspective may influence person-centred care negatively. Yet symptoms often mean something beyond the diagnosis. Recognizing this discrepancy, it is crucial that we consider a perspective that starts from each person’s symptom experience, thus complementing the biomedical perspective. Using the notion caring about symptoms, we advocate a person-centred approach that includes a symptom experience perspective. This requires that health-care professionals be skilled in listening to patient narratives and acquire knowledge about how symptom experiences can be individually expressed and interpreted. Listening to symptom experiences may give insights into the personal meaning of illness as well as information about bodily and social restrictions caused by symptom distress. In this way, caring about symptoms will improve the prerequisites for establishing person-centred care planning.
Background:
There are several reasons why children are born with Autism Spectrum Disorder. The diagnosis is usually obtained in the child´s early years, often before the age of three years. Limits in social interaction, communication and emotions follow with the Autism Spectrum Disorder.
Aim:
To describe parents´ experiences of living with a child with Autism Spectrum Disorder in the daily life.
Method:
A literature-based study of nine articles with qualitative approach. The authors analyzed the articles with the purpose to obtain a greater understanding of parents´ experiences.
Results:
Three themes were constructed with suitable sub-themes. The main findings were that parents experienced isolation from their child and the community. Parents also described their life situation as greatly changed. Emotions that parents felt were anxiety, stress, grief, anger and frustration.
Conclusion:
This study provides information about how parents experience living with a child who has Autism Spectrum Disorder. One of the major problems was that the parents felt isolated both from their own child and the community. Parents also found it troublesome to complete family activities. This information gives the nurse opportunity to support and help the parents in an adequate way. Despite this, more study needs to be done to achieve an even better care for these families.
Suicide is a globally problem and it is the commonest cause of death among young men. Inmates in correctional facilities have higher suiciderate than general population. More knowledge about riskfactors could prevent suicide.
The aim of this study was do describe suicide riskfactors among men in correctional facilities.
A literature review where both qualitative and quantitative articles were included. Twelve articles were analyzed and thematised into three themes and twelve subthemes.
Three themes were identified as the main riskfactors of suicide. The first theme is individual riscfactors, such as psychiatric disorders and substance abuse. The second theme is riskfactors related to incarceration, which involves enviromental aspects and lack of social relations. The last theme is riskfactors related to history of psycological, physical and social trauma.
Awareness of riskfactors for suicide in correctional facilities is necessary to take adequate actions, in purpose to prevent suicide
Health is a broad definition and can be explained in different ways. Regardless of how different individuals perceive health, all clients need a good relationship towards professionals to achieve health. To create and maintain a good professional relationship can be demanding for care assistants, especially when working with adolescents under difficult circumstances.
The aim was to enlighten challenges that care assistants encounter while creating and maintaining a professional relationship with adolescents at transit accommodations.
The study had a qualitative approach and was based on five semi-structured interviews with care assistants at transit accommodations. The interviews were transcribed with the use of qualitative content analysis.
Results showed the importance for care assistants to separate private life while working and to have clear boundaries to create a good professional relationship towards the adolescents. During the interviews all the participants agreed on the importance of theoretical and practical knowledge to accomplish a professional relationship towards the adolescents. Results also showed how various factors such as age, gender and culture can affect the care assistants ability to create and maintain a professional relationship.
The conclusion was that care assistants encounter many challenges while working with adolescents. The care assistants need to build up a good professional relationship towards the adolescents in the transit accommodations for adolescents to feel safe and secure. To be able to do so the care assistants need theoretical knowledge and to have a unified staff group through explicit rules and policies.
This study describes the care provided by a diabetes nurse specialist, and the care needs expressed by people with type 2 diabetes mellitus and an immigrant background. Clinical encounters between a diabetes nurse specialist and 10 people diagnosed with type 2 diabetes mellitus were observed and analyzed by means of qualitative content analysis. One theme, "the diabetes nurse specialist as the conductor of the visit", and four categories emerged from the findings, illustrating the power imbalance between the patients and the diabetes nurse specialist, as well as the lack of an individual perspective. Shifting from a medical perspective to one of openness towards the people's experiences provides a possibility for caregivers to empower patients suffering from type 2 diabetes mellitus. The medical perspective seemed to steer the visit towards curative activities. Thus, technique-centered care should be developed by including individualized care. © 2012 Blackwell Publishing Asia Pty Ltd.
Aim: The aim of the study is to examine register nurses experiences of collaboration between community healthcare and psychiatric in- patient care.
Background: Register nurses indicate a need of routines in collaboration between community health care and psychiatric inpatient care in the western Sweden region.
Method: Qualitative content analyses of focus group interviews.
Results: Register nurses experienced the healthcare communication program as a big obstacle in a developing process of a collaboration plan. The deficiencies in collaboration between the register nurses were due to poor knowledge about each group of nurses working tasks.
Conclusion: The findings contribute an understanding of the barriers in collaboration between register nurses in the Community healthcare and Psychiatric in- patient care. That requires improvement from the nurse managers to contribute well function routines.
Implications for Nursing Management: Nurse Managers need to develop a more structured collaboration plan between units to create a better collaboration in caring of the patient
Aim The aim of the study was to examine registered nurses’ (RNs) experiences of collaboration in the community health care and psychiatric inpatient care systems. Background RNs in one area in the west of Sweden have indicated the need for collaborative routines between the community health care and psychiatric inpatient care systems. Method Qualitative content analysis of focus group interviews. Results RNs felt the web-based health-care communication programme was a major obstacle to the development of a collaboration plan. The poor collaboration between RNs was due to the absence of knowledge about the duties of each nursing team. Conclusion The findings contribute to the understanding of the barriers to collaboration between RNs in community health care and psychiatric inpatient care, and highlight the need for nurse managers to ensure well-functioning routines.
In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged
Abstract:
Malnutrition is a widespread problem in India and the rest of the developing countries. Children, adolescents and especially female children are suffering from it. Poor diet leads to an increased health risk in terms of infections, neurological diseases and stunting. The aim of the study was to illuminate what nurses do in order to promote wellbeing for children suffering from malnutrition in India. The study was a qualitative interview study with an inductive approach. The seven informants worked as nurses or clinical teachers at a pediatric clinic in a private hospital, East India. All informants had a long working experience of children care. Content analysis has been used to analyze the data material. The informants underlined the fact that there is an overall lack of knowledge about nutrition in the Indian society. The concept of a balanced diet is missing. The result also showed that the children´s wellbeing is promoted by playing and building their self-esteem. The findings can be used by nurses choosing to work in developing countries or when they meet refugees with a bad nutritional status.
The main question is whether chemically induced mood enhancement is (if successful) likely to make us happier, or whether it may rather have detrimental effects on our long-term happiness. This question is divided into three: (i) What effects are mood-enhancing drugs likely to have on the long-term happiness of the person who takes these drugs? (ii) How would these drugs affect the happiness of the immediate environment of the people who take them, e.g. children or spouses? (iii) What effects would a wide-spread use of mood-enhancing drugs have on society as a whole, and how would this affect the long-term happiness of its citizens? My answers to these questions are very tentative, partly because we know too little about what non-hedonic effects these drugs can be expected to have. It is possible that these drugs would have detrimental effects on some determinants of happiness, however, e.g. marriage and friendship, social and physical activity, rational problem-solving and mental effectiveness, political participation and interpersonal trust. But on the other hand, there are also a number of determinants of happiness that might be positively affected by a wide-spread and frequent use of mood-enhancing drugs.
Vad är lycka och lidande och hur kan vi påverka vår egen och andras lycka? Hur hänger lycka ihop med livskvalitet – är det samma sak eller finns det även andra saker som gör ett liv bra? Hur stark är vår moraliska plikt att att göra världen lyckligare och hur kan man i detalj formulera en etisk ”lyckoprincip” så att den blir så rimlig som möjligt?
Första delen av den här boken handlar om grundläggande frågor som en lyckans och lidandets etik måste besvara. Men den stannar inte där utan går vidare till hur vi praktiskt kan gå tillväga för att öka lyckan och minska lidandet i världen. Vilka förhållningssätt bör vi försöka tillägna oss? Vilka karaktärsdrag bör vi utveckla? Hur bör vi bemöta andra människor? Hur bör samhället organiseras? Hur bör de globala spelreglerna utformas? För att svara på sådana frågor behöver vi kunskap om vilka faktorer som påverkar lycka och lidande hos människor och andra levande varelser och boken innehåller därför även en översikt över de senaste decenniernas empiriska lyckoforskning.Boken ger inga detaljerade recept på hur man gör sig själv eller andra lyckligare, men den ger en karta över ett spännande territorium och ett användbart sätt att tänka för världsförbättrare och andra lyckofrämjare.
It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to some specific evaluative standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase.
The recent discussion of the concept of mental disorder has focused on what makes a mental disorder a disorder. A question that has received less attention is what makes a mental disorder mental rather than somatic. We examine three views on this issue—namely, the internal cause view, the symptom view, and the pluralist view—and assess to what extent these accounts are plausible. In connection with this, three strategies that have been used to pinpoint the mental in psychiatry are identified, namely negative characterizations (the mental as the nonsomatic), exemplification of paradigmatic mental features, and an appeal to intentional content. We also examine different versions of nihilism, the view that the distinction between mental and somatic disorder is ill founded. Finally, it is observed that the discussion of what makes a mental disorder mental has largely been unaffected by conceptions of the mental in the philosophy of mind.