Anita Kärner

Gastrointestinal Symptoms and Well-Being of Adults Living on a Gluten-Free Diet : A Case for Nursing in Celiac Disease

Women with celiac disease (CD) living on a gluten-free diet (GFD) show a lower health-related quality of life and report a higher rate of gastrointestinal (GI) symptoms than men with CD. Uncertainty exists as to whether GI symptoms may explain the poorer treatment outcome of women with CD. This study was designed to explore relationships of GI symptoms and psychological well-being in men and women with long-standing CD. Patients with CD (n = 108; 59% women), aged 45–64 years, treated with a GFD for at least 8 years were evaluated by the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being index. The results show that women with a high rate of GI symptoms have no lower level of psychological well-being than corresponding men with CD and that women with CD with reduced psychological well-being have no more GI symptoms than corresponding men. Our results fail to support the notion that the reduced subjective health in CD is explained by GI symptoms. They may be secondary to perceived difficulties in managing everyday life, suggesting that launching a nurse-led follow-up may be helpful, as has been proven to be useful in other lifelong disorders.

The effect of problem-based learning in patient education after an event of CORONARY heart disease – a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study

BackgroundEven though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD.Methods/DesignA randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year.DiscussionWe expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to controls. Further, the knowledge obtained from this study may contribute to improving patients’ ability to handle self-care, and furthermore, may reduce the number of patients having subsequent CHD events in Sweden.Trial registrationNCT01462799

Eliciting reflections on caring theory in elderly caring practice

Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory –practice gap is given expression- that theory does not go along with clinical practice in caring. The aim of this study was an investigation into the possible disparity between theory and practice in caring by analysing nurses’ lived experience of the understanding of caring theory in practice in the context of municipal elderly care. Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly. The findings shows that the nurses Impulsively described their experience of detachment to caring theory, but when describing their caring intentions, the relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept. The gap revealed itself on an organisational level, as the nurses’ commission in municipal care did not correspond with their caring intention. We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers. We must make the disparate forces of intention and organisation become one intertwining force.

Problem-based learning used in the context of cardiac rehabilitation: different scenes and different roles

Several studies show that how patients have difficulties in changing lifestyle even though such changes are essential because they are suffering from a life-threatening disease. Coronary artery disease (CAD) patients met 13 times during a year and used problem-based learning (PBL) to improve their empowerment and self-efficacy in making lifestyle changes. District nurses functioned as tutors, helping patients to formulate issues and to state self-care goals. To identify and describe the enactment of PBL, an ethnographic approach was used, including, for example, participant observations and interviews, all derived from six sessions of the education programme. Five different enactments were found, metaphorically expressed as: ‘The study circle’, ‘The classroom’, ‘The expert consultation’, ‘The therapy session’ and ‘The coffee party’. The education programme did not always function as it was supposed to according to the model, but perhaps this should not be seen as a failure of the pedagogical intervention since these enactments as a whole seem to be a way for the patients to be able to make healthy lifestyle changes. The metaphors can broaden the understanding of what can happen when implementing problem-based learning in health care practice.

COR-PRIM: Patient education after coronary disease - Long-term evaluation in primary care

Introduction. It is generally accepted that atheroma with increased intimal-medial thickness (IMT) and plaque formation are the pathological manifestations of coronary atherosclerosis. While lowering LDL-Cholesterol (LDL-C) is associated with atheroma and IMT reduction a similar effect on coronary artery calcifi cation (CAC) remains uncertain. The objective of these meta-analyses is to compare the existing evidence for the effect of lowering LDL-C with statins on both coronary atheroma and CAC. Methods. Literature searches identifi ed fi ve controlled trials suitable for inclusion in the analysis of the effect of statins (high dose versus either low dose or placebo) on coronary artery calcifi cation and six trials suitable for inclusion in the analysis of the effect of statins on coronary atheroma. Results. All trials reported substantial and signifi cant reductions in LDL-C with statins treatment. Similar reductions in LDL-C were achieved in the CAC and atheroma trials of 37mg/dl and 35mg/dl, respectively. Analysis of the CAC trials did not demonstrate any effect of statins on the progression of calcifi cation. In contrast, in the coronary atheroma trials there was a consistent moderation of atheroma progression with statins (p 0.0001). Conclusions. Meta-analysis of the available trials has demonstrated signifi cant moderation of coronary atheroma associated with the statins-induced reduction in LDL-C. In contrast, there was no effect on coronary calcifi cation despite a similar reduction in LDL-C levels. This suggests that the pathogenesis of the two conditions may be different, if not in aetiology, then certainly in their development. It further suggests that statins use to moderate arterial calcifi cation is not effective.

P161 Poster COR-PRIM : Longitudinal Study on PBL in Self-Care after CVD Preliminary Results from a Pilot Study

P161 Poster COR-PRIM : Longitudinal Study on PBL in Self-Care after CVD Preliminary Results from a Pilot Study

A good manuscript review for the European Journal of Cardiovascular Nursing

As noted in a previous editorial, making a journal successful is a team effort with contributions from authors, editors and reviewers.1 Reviewers play an important role in assuring and improving the quality of manuscripts submitted to the European Journal of Cardiovascular Nursing. The function of a peer review process is considered an integral part of scholarly communication helping to ensure validity, increase accuracy and enhance content prior to publication.2 A peer review should evaluate the novelty, quality and value of the manuscript for the scientific community and the readers of the journal. Reviewers are asked to place the manuscript in proper perspective.3 Peer review requires dedicated time and the effort of reviewers, and their reviews help the editors decide which manuscripts to accept or to reject. Peer reviews also often markedly improve a manuscript. We believe it is timely and useful for the editorial team to define what we regard as a constructive peer review for the European Journal of Cardiovascular Nursing. A good and constructive peer review for the journal is based on balanced feedback and comprises several components concerning the overall quality, scientific quality and the relevance for the readers. We encourage our reviewers to state their comments in a clear, concise and structured way. More importantly, we expect reviewers to take a constructive view and formulate their reflections on the manuscript in such a way that they might be used to improve it rather than to be unnecessarily critical and harsh and thus ultimately discourage authors to publish their work. At the same time even if a manuscript is clearly of very good or very poor quality, the editors still require a thorough evaluation and cannot merely base their decision on a simple and vague ‘accept’ or ‘reject’ judgment.

The desire for a good life - patients beliefs of self-care after a coronary event

Introduction: After a first coronary event there is an increased risk for a recurrent event. Despite that risk, 1/5 of the patients continue to smoke, 1/3 is obese and more than half of the patients have elevated blood pressure and total cholesterol. Secondary preventive self-care activities are needed to improve outcomes and the belief of patients plays a vital role in changing behavior. Aim: To examine patients’ beliefs of self-care 6-12 months after a coronary event. Method: The study design was qualitative. Twenty-five patients, including 10 women, mean age 65 years with stable coronary artery disease participated in four focus group interviews. Data were taped, transcribed and analyzed according to the conventional content analysis. Findings: Patients’ belief of self-care is influenced by their desire of a good life even though life seems fragile. Patients try to live up to the standard of health care prescription and advices. However, these achievements require behavior change and conscious boundaries, which are challenged by various obstacles such as fear of, overstrain and stress. Physical activity is considered as both a source to well-being and a necessity, but patients are uncertain and afraid for overstraining. A healthy diet is seen as important but the advices given are sometimes contradictory and create confusion. Medication is found important but not at the cost of all the side-effects. Patients also report that in order to believe in their ability and to be responsible for self-care, support from health care providers is expected. But at the same time the invaluable support and information is often not provided, creating uncertainty. Discussion: The study highlights the patients’ perspective of self-care and what they view as important in self-care after an event of coronary artery disease. The patients’ expectations on health services comprise information, support and continuous follow-up. This is necessary to facilitate the patient’s responsibility for their own care. Conclusion: Patients’ beliefs about the concept of self-care after an event of coronary artery disease are multifaceted and voluminous compared to the health care definition. The findings of the study challenge health care policies approach to self-care. There is a need to reconsider and assess what and how secondary preventive patient education should be performed after an event of coronary artery disease.

1211: Spouses' Views on their Supportive Role in the Rehabilitation Phase of Coronary Heart Disease

diagnosis MI, were invited to participate in a focus group session. Of the 46 invited, 19 returned the informed consent-form and 14 participated in one of the three focusgroup interviews conducted. The main questions were what information, support and follow-up they received and what they wanted, perand post-hospitalisation. The sample comprised two females and 12 males. The age ranged from 42 to 69 years. Data were digitally recorded and transcribed to facilitate content analysis. Most of the informants were satisfied with the information they received at the hospital in relation to acute care and treatment. They reported that the staff was very skilled and talked to them in an empathic way. Few got any follow-up contact except from one compulsory visit at the outpatient clinic. Only a few joined any rehabilitation programme. Areas in which the participants would have liked to have more information about how to cope after discharge, in relation to such matters as physical activity. When asked what kind of support or follow-up they wanted to have but did not receive, most of them thought a contact telephone and telephone follow-up would have been useful ways of receiving counselling, information and support post-discharge MI. Based on a literature review and the results from these focus-group interviews, interventions using an open telephone line and telephone follow-up will be developed and implemented at the hospital, to increase coping and quality of life after MI