Anne-Cathrine Mattiasson

The Experiences of Elderly People in Geriatric Care with Special Reference to Integrity

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions.

Implantable Cardioverter-Defibrillator Therapy Before Death High Risk for Painful Shocks at End of Life

Background— Several trials have demonstrated improved survival with implantable cardioverter-defibrillator (ICD) therapy. The cause and nature of death in the ICD population have been insufficiently investigated. The objective of this study was to analyze ICDs from deceased patients to assess the incidence of ventricular tachyarrhythmias, the occurrence of shocks, and possible device malfunction. Methods and Results— We prospectively analyzed intracardiac electrograms in 125 explanted ICDs. The incidence of ventricular tachyarrhythmia, including ventricular fibrillation, and shock treatment was assessed. Ventricular tachyarrhythmia occurred in 35% of the patients in the last hour of their lives; 24% had an arrhythmic storm, and 31% received shock treatment during the last 24 hours. Arrhythmic death was the primary cause of death in 13% of the patients, and the most common cause of death was congestive heart failure (37%). More than half of the patients (52%) had a do-not-resuscitate order, and 65% of them still had the ICD shock therapies activated 24 hours before death. Possible malfunctions of the ICD were found in 3% of all patients. Conclusions— More than one third of the patients had a ventricular tachyarrhythmia within the last hour of life. Cardiac death was the primary cause and heart failure the specific cause of death in the majority of the cases. Devices remained active in more than half of the patients with a do-not-resuscitate order; almost one fourth of these patients received at least 1 shock in the last 24 hours of life.

Implantable Defibrillator Therapy Before Death: High Risk for Painful Shocks at End of Life

Background— Several trials have demonstrated improved survival with implantable cardioverter-defibrillator (ICD) therapy. The cause and nature of death in the ICD population have been insufficiently investigated. The objective of this study was to analyze ICDs from deceased patients to assess the incidence of ventricular tachyarrhythmias, the occurrence of shocks, and possible device malfunction. Methods and Results— We prospectively analyzed intracardiac electrograms in 125 explanted ICDs. The incidence of ventricular tachyarrhythmia, including ventricular fibrillation, and shock treatment was assessed. Ventricular tachyarrhythmia occurred in 35% of the patients in the last hour of their lives; 24% had an arrhythmic storm, and 31% received shock treatment during the last 24 hours. Arrhythmic death was the primary cause of death in 13% of the patients, and the most common cause of death was congestive heart failure (37%). More than half of the patients (52%) had a do-not-resuscitate order, and 65% of them still had the ICD shock therapies activated 24 hours before death. Possible malfunctions of the ICD were found in 3% of all patients. Conclusions— More than one third of the patients had a ventricular tachyarrhythmia within the last hour of life. Cardiac death was the primary cause and heart failure the specific cause of death in the majority of the cases. Devices remained active in more than half of the patients with a do-not-resuscitate order; almost one fourth of these patients received at least 1 shock in the last 24 hours of life.

Intimacy - Meeting Needs and Respecting Privacy in the Care of Elderly People: what is a good moral attitude on the part of the nurse/carer?

This article explores notions of intimacy in the caring context. The aspects discussed are: privacy and intimacy; intimacy as emotional and/or physical closeness; intimacy as touch; sexual intimacy and normal ageing; sexual intimacy and patients suffering from dementia; and intimacy as trust. Examples are given and problems are identified, with reflection on the attitude and behaviour of the carer. It is suggested that when trying to make moral decisions in concrete situations it is imperative that the carer is aware of the values upon which his or her own thinking is based. It is argued that the guiding principle should be the moral assumption that the carer’s responsibility can never be interpreted as a right to disregard the wishes of the patient. Hence, the key word in daily care is ‘respect’.

Perceived loneliness and social support in patients with chronic heart failure

Self-reported conditions have become increasingly important in patient care, and perceived loneliness and social relationships in patients with chronic heart failure (CHF) are not sufficiently investigated. Aim: The aim was to investigate perceived loneliness and social support in patients with CHF. Further, to investigate whether loneliness and social support might be associated with gender, age, healthcare utilization and mortality. Methods: One hundred and forty nine patients with CHF, hospitalised at least once during a 4-month period in 2006, completed a self-reported questionnaire including measurements about loneliness and social support. Healthcare utilization was assessed prospectively by frequency of readmissions and number of days hospitalised during 1 year. Results: Loneliness was reported by 29 (20%) participants. They were more often women (p < 0.001) and younger (p = 0.024). Patients who perceived loneliness had fewer social contacts (p = 0.033), reported lower occurrence of emotional contacts (p = 0.004), were less satisfied with social contacts and close relationships (p < 0.001). Those reporting loneliness had more days hospitalised (p = 0.044), and more readmissions to hospital (p = 0.027), despite not having more severe CHF. Conclusion: Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF.

Cross-cultural adaptation of the Swedish version of Readiness for Interprofessional Learning Scale (RIPLS)

Context  Interprofessional learning activities in health care are being gradually introduced on an international basis and therefore cross‐cultural and internationally collaborative research into the outcomes of these activities is needed. Hence, it is necessary not only to translate research instruments into the language of the culture in which they are to be used, but also to adapt them culturally if they are to fulfil the testing purposes for which they are intended. It is also necessary to test a translated instrument in order to ensure that it retains its intended psychometric properties.

Confirming Older Adult Patients’ Views of Who They Are and Would Like To Be

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be.

Evaluation of an educational programme for family members of patients living with heart failure : a randomised controlled trial

AIMS AND OBJECTIVES To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. BACKGROUND When a person is diagnosed with heart failure, the daily life of the family members is also affected. DESIGN Randomised controlled trial. METHODS A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used. RESULTS There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R(2) = 0·35) and depression (p = 0·021, R(2) = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). CONCLUSION Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. RELEVANCE TO CLINICAL PRACTICE Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

Emotions delay care-seeking in patients with an acute myocardial infarction

Background: In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients’ pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care. Aim: To add a deeper understanding of patients’ thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction. Methods: Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis. Results: Four themes were conceptualized: ‘being incapacitated by fear, anguish and powerlessness’, ‘being ashamed of oneself’, ‘fear of losing a healthy identity’ and ‘striving to avoid fear by not interacting with others’. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care. Conclusions: The present study indicates that emotional reactions are important and influence patients’ pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.

After axillary surgery for breast cancer : is it safe to take blood samples or give intravenous infusions?

AIM To investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer. BACKGROUND After axillary lymph node clearance in patients with breast cancer, some women experience lymphoedema and recurrent infections. To reduce the risk of these postoperative complications, most women are advised to not have intravenous infusions in, or blood samples taken from, the arm in the operated side. Very little published data are available regarding the incidence of lymphoedema after intravenous procedures under clean conditions in the hospital setting. This study set out to investigate the occurrence of complications after a needle puncture or intravenous injection in the ipsilateral arm of women who have undergone axillary lymph node clearance for breast cancer is therefore important. DESIGN Descriptive. METHODS Self-reported questionnaire. RESULTS Most of the reported complications were minor, including itching, bruises and vomiting at the time of the intravenous procedure. The most serious complication was infection in one patient needing antibiotic treatment and subsequent arm swelling. CONCLUSIONS This study indicates that if a blood sample is taken or intravenous injection is given according to the current Swedish guidelines for health care professionals, there should be a very low risk of complications. RELEVANCE TO CLINICAL PRACTICE If intravenous procedures are performed without any disadvantage in the arm of the operated side in women who have undergone axillary surgery, the clinical problem of finding a proper vein and the psychological concern of the women can be reduced.