Elin Thygesen

Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people?

Background: The objective of this study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important. Methods: A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years). Results: Subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH. Conclusion: Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.

Psychological distress and its correlates in older care-dependent persons living at home

Objectives: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. Method: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale. Results: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis. Conclusion: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.

Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study

BackgroundDemographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice.MethodsA Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed.ResultsNineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change.ConclusionsThis study identified several important challenges for coordination and it supports previous research. IMC in health care services deals with challenges other than coordination, and these must be addressed specifically. Our study contributes to extended knowledge of theoretical and practical implications in the field of coordination and IMC in health care sector.

Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: Patients' experiences.

Introduction The way in which telemedicine contributes to promote coping and independence might be undervalued in the development of telemedicine solutions and the implementation of telemedicine interventions. This study explored how home-living patients diagnosed with chronic obstructive pulmonary disease (COPD) experienced follow-up using telemedicine, and the extent to which the implemented technology was able to support and improve the patients’ coping resources and independence. Methods A qualitative approach with individual semi-structured interviews was used. Ten patients diagnosed with COPD participated. The data were transcribed verbatim and a qualitative content analysis method was used, including analyses of the manifest and latent content of the texts. Results The participants’ positive attitude to handling and understanding the technology and the positive and negative feelings related to use the technology derived the theme: “The telemedicine solution is experienced as comprehensible and manageable and provides meaning in daily life”. The importance of telemedicine services that provided trust and confidence, the intervention’s impact on independence and self-management and the intervention’s ability to support integrity and meaning in life, derived the theme: “The telemedicine intervention contributes to stress reduction caused by illness burden and facilitates living as normally as possible”. Discussion The impact of a telemedicine intervention might be influenced by the experience of a technological solution that requires little effort to deal with, while it must also provide meaning in life. Furthermore, the telenurses’ expertise and the intervention’s flexibility, i.e. possibilities for individual adaption, might promote coping to facilitate living as normally as possible despite illness.

The Subjective Health Complaints Inventory: a useful instrument to identify various aspects of health and ability to cope in older people?

Aims: The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. Methods: Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. Results: The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. Conclusions: This study supports the stability of the SHC’s factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.

User-centred Design of the User Interface of a Collaborative Information System for Inter-municipal Dementia Team

In the Norwegian Health sector there are currently undergoing changes at local, regional and national level triggered by recent health reforms. Municipalities are facing for first time the duty of implementing new primary health services. Inter-municipal coordination (IMC) health care teams have been created to operate across borders to share costs, extend geographical range of operation and optimise resources. This study focuses on the development and evaluation of the user interface (UI) functional prototype of a collaborative information system for IMC dementia team in Norway. Employing a user-centred design approach, the interface prototype was built based on the information gathered on two workshops where the end-users described their current clinical workflow of dementia assessment and how the UI would best fit into their daily work. The outcome of the workshops creatively informed the design of a working prototype that was qualitatively usability tested. Results showed that the UI effectively and efficiently supported the work of the IMC dementia team, with a sufficient level of satisfaction among the end-users. The resulting prototype established the foundation for the system implemented in the FP7 EU project United4Health.

Pasientopplevelser og kronisk sykdom — en fenomenologisk studie av leddgiktpasienters livssituasjon:

There are often big differences between the patients and the healthcare workers view of what happen to the body when we get chronically ill. By listening to the patients needs, it may be possible to reduce the gap between these two different views of reality. The purpose of this study was to gain increased knowledge of how it is to live with a chronic disease like rheumatoid arthritis, and what consequences it has for activities of daily living — and the need for health care. The main aim of the study was to enhance the patients own experience. Based on a phenomenological philosophy and method, six patients with server rheumatoid arthritis where interviewed. The analysis of the material was based on Giorgi (13), who has developed a method of analysis inspired by Husserl and Merlau-Ponty, who are central philosophers within the phenomenological tradition. The respondents tells that having a disease like rheumatoid arthritis leads to changes in the body. These changes gives limits to their lives. They do not regard these limitations as isolated phenomena, but are concerned about the consequences they have for the person itself, and the people close to them. The respondents often expressed that their meeting with the healthcare-service made them feel incapable. In their view the healthcare-service has had a paternalistic attitude dominated by lack of information and empathy. In this study I have argued that the paternalistic attitude should be replaced by a “softer” maternalistic attitude. This will enable the patient to be included in their treatment to a greater extent, thus increasing the possibility for better control of their own lives and illness.

Critical issues for employees in inter-municipal health care services: a multiple case study

BackgroundTraditional, hierarchical government structures have recently been challenged by increased complexity, fragmented services and heavy public demand. When healthcare services become fragmented and decentralised, they require redesign. Inter-municipal cooperation is a strategy to deal with current challenges and future demographic changes. Few studies exist that can help us conceptualize challenges regarding employment in this context and inform managers in the involved municipalities. This study aims to identify critical issues for employees in inter-municipal health care services and to elaborate on how and why these issues are experienced.MethodsA multiple qualitative case study was conducted with data from interviews, observation studies, a participant workshop and inter-municipal healthcare service project documents and reports. The study involved two districts in Norway and six cases including 17 informants. First, a within-case analysis was conducted for all cases; second, a cross-case analysis was conducted in each district to examine replication, contrasts and extension to emergent findings; and, eventually, replicated findings in Districts 1 and 2 were analysed across districts.ResultsThree critical issues were identified: support, differences, and geographical distances. Employees working in teams experienced fewer challenges than did those working as isolated individuals.ConclusionsCritical issues for employees represent an important aspect of inter-municipal cooperation, and additional research should be undertaken to inform future policy and practice.

Advancing beyond the system: telemedicine nurses’ clinical reasoning using a computerised decision support system for patients with COPD – an ethnographic study

BackgroundTelemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses’ reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses’ clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated.MethodsIn this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis.ResultsWhen telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: “the process of telemedicine nurses’ reasoning to assess health change” and “the influence of the telemedicine setting on nurses’ reasoning and decision-making processes”. An overall theme, termed “advancing beyond the system”, represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses’ clinical reasoning process.ConclusionIn the telemedicine setting, when supported by a computerised decision support system, nurses’ reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses’ reasoning process. Nurses’ reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses’ reasoning process.