Glenys Hamilton

Measuring adherence in a hypertension clinical trial

BACKGROUND: Non-adherence in hypertension is a global problem and promoting adherence is necessary to decrease cardiovascular mortality. AIMS: The purpose of this paper is to examine the measurement of adherence to medication taking in hypertensive patients. Adherence was evaluated primarily by means of MEMS (Medication Event Monitoring System, Aprex Corporation, Fremont, California) an electronic system that records the date and time of opening of the study medication container. Additional measurements such as change in urinary potassium level, capsule count, client self report and physician estimate of adherence were recorded. METHODS: A randomised clinical trial was used to assign patients to receive the study medication (potassium) or placebo. Descriptive statistics were used to answer the research questions. Frequency and percentage of responses to different measures of adherence were carried out as well as correlation between the measures. RESULTS: One hundred and seven subjects between the ages of 26 and 80 participated in the clinical trial. The results showed that adherence measures varied with lowest adherence from two items of self-report related to forgetfulness (46 and 55%) and stringent electronic monitoring with the MEMS (58%) to percentages in the 80–90 range for other self-report items and the general adherence scale. Electronic monitoring correlated best with capsule count at visit 5. Implications for health care providers are discussed.

The Complexity of Symptoms and Problems Experienced in Children with Cancer: A Review of the Literature

To adequately help children with cancer, care providers need to understand the complexity of symptoms and problems associated with the illness that children are experiencing, which can enable them to better tailor patient care individually to each child. In this integrative literature review, we identified the types of symptoms and problems that children with cancer can experience during treatment and rehabilitation; the terms/expressions they use to describe their symptoms and problems; how childrens symptoms and problems vary during the course of their illness; and how they vary and co-vary with age, gender or race. Of the 1175 titles identified, 110 articles met the inclusion criteria and were included in the review. Seventy-eight were research-based. A total of 219 distinct symptoms or problems were identified in the literature either as the main problem or a symptom of the main problem. There is significant evidence that children and adolescents experience numerous and complex symptoms, and problems during and after treatment for cancer. Children use many different expressions to talk about their symptom experiences. However, few articles looked at how childrens symptoms and problems varied during the course of their illness or the variations in symptom severity and degree of bother, or examined the relationship between childrens symptom experience and age, gender, or race. Most instruments that were used to measure symptoms were interviewer-administered questionnaires, often adaptations from adult versions, and in younger children, symptoms were often obtained from adult informants. The insights gained from this review can be helpful to researchers and clinicians who wish to better understand how symptoms and problems are experienced from the childrens own perspective. However, more research is needed: to better understand differences in symptom experiences among different age groups; to identify differences among children from distinct cultural, ethnic, or socio-economic backgrounds; to clarify how symptoms and problems interfere with daily life; and to refine assessment methods that allow even younger children to communicate their symptom experiences in an age-adjusted manner.

Patients’ experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting

Background: The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients’ detailed experiences, and give direction for future clinical practice. Aim: To explore the CABG patients’ symptoms and needs in the early rehabilitation phase. Methods: A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. Results: Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgerythe patients’ symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. Conclusion: CABG patients’ experiences indicate a need to extend the hospital’s discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.

Changes in health status, psychological distress, and quality of life in implantable cardioverter defibrillator recipients between 6 months and 1 year after implantation.

Background: Living with an implantable cardioverter defibrillator (ICD) has positive health benefits but the impact on well-being and quality of life over a period of time has not been studied in depth. Aim: To follow patients prospectively over the first year and to compare the changes from time of ICD implantation, to 6 months and 1 year. Methods: Generalized linear models were used to assess changes through examination of health status (SF-36), psychological distress (POMS), and quality of life (QLI) scores. Results: There were 19 females (27%) and 51 males (73%) in the sample with a mean age of 64 years. There were significant improvements over time in 3 of the 8 sub-concepts of health status: role physical (P<0.001), vitality (P<0.013) and social functioning (P<0.001). The Profile of Mood States revealed significantly less total psychological distress at 6 months with a non-significant leveling off or increase at 1 year. The quality of life index revealed no significant changes over time. Conclusions: The effects of living with an ICD are not well understood. Research should continue to identify the impact over time in this population and sub-groups so that health care providers can address the social and psychological needs of this population.

Preparing patients for urological surgery

There is consensus among health care professionals that patients need and use written and oral patient education to prepare for hospitalisation. The purpose of this study was to re-design information for patients preparing for transurethral surgery (TUR P-B) and describe the effect of this change. A quasi-experimental design was used to answer the research questions. The findings showed that patients did benefit in some areas. The patients found a correspondence between what they were told to expect and what actually happened in the hospital. Nurses need to evaluate written materials to see that they are current and reflect best practice.

Morbid obese adults increased their sense of coherence 1 year after a patient education course: a longitudinal study

Background Personal factors are key elements to understand peoples’ health behavior. Studies of such factors are important to develop targeted interventions to improve health. The main purpose of this study is to explore sense of coherence (SOC) in a sample of persons with morbid obesity before and after attending a patient education course and to explore the association between SOC and sociodemographic and other personal factors. Methods In this longitudinal purposely sampled study, the participants completed questionnaires on the first day of the course and 12 months after course completion. Sixty-eight participants had valid scores on the selected variables at follow-up: SOC, self-esteem, and self-efficacy. Relationships were assessed with correlation analyses and paired and independent samples t-tests and predictors with linear regression analyses. Results From baseline to follow-up, the total SOC score and the subdimension scores comprehensibility, manageability, and meaningfulness all increased significantly. At both time points, the SOC scores were low compared to the general population but similar to scores in other chronically ill. At baseline, a multivariate analysis showed that older age, having paid work, and higher self-esteem were directly related to higher total SOC score after controlling for other sociodemographic factors and the participants’ level of self-efficacy. Multivariate analyses of the relationship between baseline predictors of SOC at 12-month follow-up, controlling for baseline SOC scores or sociodemographic or personal factors, revealed that none of these variables independently predicted SOC scores at follow-up. Conclusion The total SOC score and its subdimensions increased significantly at follow-up. SOC may be a useful outcome measure for lifestyle interventions in people with morbid obesity and possibly other health care problems. Subdimension scores may give an indication of what is poorly developed and needs strengthening. This might guide choices for targeted cognitive and psychosocial interventions. Further studies are needed to explore this issue with larger samples.

Partners in Change: Action Research in Action in Clinical Practice

The purpose of this article is to illustrate significant aspects of action research and challenges encountered when this design is applied in a clinical setting. To improve information for TUR-patients, nurses on a clinical ward and university professors in nursing joined forces. Action research was adopted since the project had a dual aim, namely to develop new patient information and to measure the results of the new practices. Permanent changes are in place while various factors impinging on the research process may affect the evaluation of the changes.

A strategy for establishing hospital based nursing research in Norway

The purpose of this article is to describe the strategies used to develop and implement nursing research at a large university hospital in Norway. The use of the literature and evidence from previous experiences are explored and form the framework for the program of nursing research. One of the main strategies was to create a centre for nursing research at the hospital where employees would have access to all the resources necessary to conduct nursing research. The progress of the project over several years is described.