Karin Josefsson

Informal caregivers’ experiences and needs when caring for a relative with heart failure: An interview study

Background:Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers’ well-being and cause caregiver burden. Objective:The objective of this study was to explore informal caregivers’ experiences and needs when caring for a relative with heart failure living in their own home. Methods:The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis. Results:Two themes emerged: “living in a changed existence” and “struggling and sharing with healthcare.” The first theme describes informal caregivers’ experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative’s impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative’s understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers’ experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative’s symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative’s healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers’ own initiatives to participate in meetings were positively received by healthcare professionals. Conclusions:Informal caregivers’ daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of “self” and of “us.” Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers’ situation and improve the dyadic congruence in the relation with their relative.

Health and social care management for older adults with multimorbidity: a multiperspective approach.

Multimorbidity, a condition common among older adults, may be regarded as a failure of a complex system. The aim of this study was to describe the core components in health and social care management for older adults with multimorbidity. A cross-sectional design included two methods: individual interviews and group discussions. A total of 105 participants included older adults with multimorbidity and their relatives, care staff and healthcare policymakers. Data were analysed using content analysis. The results show that seven core components comprise a multiperspective view of health and social care management for older adults with multimorbidity: political steering, leadership, cooperation, competence, support for relatives, availability and continuity. Steps should be taken to ensure that every older adult with multimorbidity has a treatment plan according to a multiperspective view to prevent fragmentation of their health care. This study provides relevant evidence developing a multiperspective model of health and social care management for older adults with multimorbidity.

Registered Nurses' Perceptions about the Situation of Family Caregivers to Patients with Heart Failure : A Focus Group Interview Study

Introduction Heart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes. Aims The aims of this study are to explore registered nurses’ perceptions about the situation of family caregivers to patients with heart failure, and registered nurses’ interventions, in order to improve family caregivers’ situation. Methods The study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis. Results Two content areas were identified by the a priori study aims. Four categories and nine sub-categories emerged in the analysis process. The content area “Family caregivers situation” includes two categories: “To be unburdened” and “To comprehend the heart failure condition and its consequences”. The content area “Interventions to improve family caregivers situation” includes two categories: “Individualized support and information” and “Bridging contact”. Conclusions Registered nurses perceive family caregivers situation as burdensome, characterized by worry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent health care contact was considered an important and sustainable intervention to better care for family caregivers worry and uncertainty. In the nurse-led heart failure clinics in hospitals, registered nurses can provide family caregivers with the opportunity of involvement in their relatives health care and address congruence and relationship quality within the family through the use of Shared care and or Family-centred care. Registered nurses consider it necessary to have a coordinated individual care plan as a basis for collaboration between the county council and the municipality.

Nurses’ attitudes toward family importance in heart failure care

Background: Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure. To involve family members in heart failure care is thus valuable for the patients. Registered nurses frequently meet family members of patients with heart failure and the quality of these encounters is likely to be influenced by the attitudes registered nurses hold toward families. Aims: To explore registered nurses’ attitudes toward the importance of families’ involvement in heart failure nursing care and to identify factors that predict the most supportive attitudes. Methods: Cross-sectional, multicentre web-survey study. A sample of 303 registered nurses from 47 hospitals and 30 primary health care centres completed the instrument Families’ Importance in Nursing Care – Nurses’ Attitudes. Results: Overall, registered nurses were supportive of families’ involvement. Nonetheless, attitudes toward inviting families to actively take part in heart failure nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a primary health care centre, a heart failure clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and/or heart failure nursing care, and a competence to work with families. Conclusions: Experienced registered nurses in heart failure nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. Registered nurses who have designated consultation time with patients and families, as in a nurse-led heart failure clinic, may have the most favourable condition for implementing a more supportive approach to families.

Older adults' self-rated health and differences by age and gender : A quantitative study

Background: The older adult population is expected to grow, presenting potential challenges for individuals and society. Maintenance of older adults health will be an important factor for healthy aging. It will also be a challenge for health professionals who work to promote health and care equity. To promote healthy aging and equal care, an overview of older adults self‐rated health is needed. The aim of this study was to describe selfrated health among older adults living at home describe age group and gender‐based health differences. Methods: A descriptive and a comparative cross‐sectional study. The questionnaire study was part of a Swedish national population study. Randomly selected older adults 65‐84 years living in five counties in central Sweden. The response rates were 79% and 75% for those 65‐79 years and 80‐84 years, respectively. Participants (n = 13922) were divided into two age groups: 65‐79 years (n = 5926 male, n = 5755 female) and 80‐84 years (n = 1208 male, n = 1033 female). Results: Older adults generally self‐rated their health as good, especially in the age group aged 65‐79 years. Females self‐rated their health as poorer than males, especially among those aged 65‐79 years. Gender‐based health differences decreased in those aged 80‐84 years. Conclusions: It is important to address these gender‐based health differences; health policies and programmes are needed that promote equitable healthy aging.

Sjuksköterskors syn på svårigheter i telefonrådgivning : En litteraturstudie

Aim: To deepen the knowledge of difficulties in registered nurses telephone advice and identify possibilities to master these. Background: Telephone advice increases the accessibility to health care and the streamlined work at primary health care centres. The goal of telephone advice nursing is to give a correct advice, adapted to the callers situation, in order to reach correct care level. However, nurses telephone advice includes risks for misjudgement and may risk the patient safety. Methods: A systematic and manual literature study was used in CINAHL and Pubmed. A total of 38 studies were identified and 13 articles were screened in full text. Findings: Nurses had difficulties in telephone advice in following areas: computerized decision aids, non-visual communication, third-part communication, limited resources, the nurses vulnerability, genus and ethnicity, and also ethical questions. Conclusion: Nurses perceived difficulties in telephone advice. They should take part in the development of computerized decision support and receive continuous training in communication skills. Nurses telephone advice should be facilitated by the existence of an open climate at the workplace, to discuss and to reflect on difficulties, in order to reach patient safety.

District nurses’ experience of working in home care in Sweden

Background: Home care was previously included in healthcare centers in county councils in Sweden. Today, home care is the responsibility of municipalities. Consequently, the work of district nurses from healthcare centers has changed, and they face a new mission and new challenges. The aim of this study was to explore district nurses experiences of working in home care after the municipalization. Methods: The design was descriptive with an inductive approach. Five district nurses working in different municipalities were interviewed. Qualitative content analysis was used. Results: The district nurses experienced their work through the following themes: organization, local environment and leading the team, and defined the themes in terms of inadequacy, collaboration, control, comfort, continuity and own competence. Their work was free and pleasant with more time for the patients. At the same time they at time had difficulties to carry out their work. Recipients condition in municipality home care experienced as better as a consequence of cross‐border cooperation, compared to earlier organisation of home care. District nurses work involved a great nursing responsibility and required leadership. They experienced losses of competence as well as new competence. Conclusions: District nurses work was at times difficult because of organisational barriers. There is need of improvements and tools for district nurses to carry out their work and to promote their competence development. The organisation is not functioning optimally in municipal home care. Cooperation between municipality, primary care and inpatient care needs improvement.

Sleep duration and sleeping difficulties among adolescents: exploring associations with school stress, self-perception and technology use

Sleeping problems are increasing among adolescents worldwide. This study aimed to describe the prevalence of self-reported sleep duration and sleeping difficulties, as well as to explore their associations with school stress, self-perception, that is how adolescents perceive their appearance and happiness, and technology use among adolescents. Data were collected in 2015 using a questionnaire. A total of 937 ninth grade adolescents, 15-16xa0years, from a city in western Sweden participated, resulting in a response rate of 83%. The result showed that 55% of the adolescents slept less than the recommended 8xa0hours per night and 11% had sleeping difficulties. School stress and technology use were associated with short sleep duration. School stress and self-perception were associated with sleeping difficulties. The girls had worse outcomes for sleeping difficulties, school stress, self-perception and technology use than the boys. Based on the results, there is a need for school nurses to implement preventive measures to improve adolescents sleep.

Family Health Conversations Conducted by Telephone in Heart Failure Nursing Care: A Feasibility Study

Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affects the outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursing care, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. The purpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephone with patients and their family caregivers. A single-group intervention study with a pretest–posttest design was conducted in three regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. Three FamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collected through semistructured interviews and questionnaires. FamHCs improved the nurse–family relationships and relationships within the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone were considered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferred meeting face-to-face with the families as nonverbal communication between the family members could be missed because of lack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to perform illness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages. Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HF nursing care.

Preconditions for district nurses’ telephone counselling during call-time in municipal home care: An observational study

Telephone counselling is a growing and complex task for district nurses in municipal home care, especially during evenings and at weekends. Work at call-time is often handled via telephone from cars, without access to records or other information about patients. There is a lack of research in this subject. The aim of this study was to explore preconditions for district nurses’ telephone counselling at call-time. An observational study with an inductive approach was conducted. A structural protocol was used with a following open question. Seven district nurses who worked in home care in two municipalities in Sweden participated. Data were analysed using content analysis. Five categories were identified: ‘availability’, ‘professionalism’, ‘communicability, ‘secure approach’, and ‘technical approach’. Accessibility appears to be given priority over security. Ethical reflection is required on telephone management policy for district nurses’ telephone counselling while driving and other interventions that require undivided attention.