Lena Nordgren

Symptoms Experienced in the Last Six Months of Life in Patients with End-Stage Heart Failure

Background: Despite todays modern therapy, the advancement of chronic heart failure (CHF) has not been curbed (Dying from heart failure: lessons from palliative care, BMJ, 317, 1998, 961–962, Editorial). Consequently, the suffering in patients with end-stage CHF is still present. The knowledge on the frequency of symptoms in these patients is scarce. Aims: The aim of this study was to achieve a deeper understanding of patients with end-stage CHF and to describe symptoms in these patients during the last 6 months of life by examining documentation in medical records. Methods: The study adopted a descriptive, retrospective design using record reviews to collect data, in which 80 medical records of patients hospitalised for CHF in 1995 were reviewed. Descriptive statistics and Students t-tests were performed. Results: Breathlessness was the most common symptom (men 90%, women 86%). The largest gender difference was on limitation in physical activity (men=77%, women=37%, total=49%, P=0.001). Conclusion: (1) Twenty-one symptoms were observed, implicating that, patients with CHF in later stages of the disease experience a wide range of symptoms. (2) Despite the fact that several symptoms were documented by both nurses and physicians, it is quite remarkable that symptom-controlling measures were only provided sparingly. (3) A palliative care approach may benefit patients suffering from end-stage CHF.

Animal-Assisted Intervention in Dementia Effects on Quality of Life

There is a need to develop nonpharmacological treatments and methods which can serve as alternatives or complements to medications in dementia care. Previous research indicates that animal-assisted intervention (AAI) can be beneficial. The purpose of the present pilot project was to evaluate effects of AAI on quality of life (QoL) in people with dementia in four Swedish nursing homes. A pretest/posttest research design was used. Twenty people (12 women, 8 men; aged 58 to 88) were included. Nine people completed the intervention which comprised 10 training sessions with a certified therapy dog team. QoL improved in the expected direction after the intervention (p = .035). Even though the effects of AAI may not be discernible over longer periods of time, there are still immediate effects which can promote better QoL for people living with dementia diseases.

Effects of Animal-Assisted Therapy on Behavioral and/or Psychological Symptoms in Dementia A Case Report

Background: Recently, interest in nonpharmaceutical interventions in dementia care has increased. Animal-assisted therapy has been shown to be one promising intervention but more knowledge is needed. The present article reports on a pilot study involving an 84-year-old woman with vascular dementia who was systematically trained with a therapy dog team for 8 weeks. Methods: A quasi-experimental longitudinal interventional design with pre-post measures was used. Data were collected on 3 occasions. Descriptive statistics were used for data analysis. Results: Some effects on the woman’s ability to walk and move were identified. In addition, some effects in the woman’s cognitive state were observed. Conclusions: Physical, psychological, and/or social training with certified therapy dog teams can have effects on behavioral and psychological symptoms in people living with dementia. Further research is needed.

Safety and understanding : Support as experienced by women living with heart failure in middle age

To reformulate and adjust to their life-situation, women living with heart failure (HF) need help and support. However, the actual meaning of the phenomenon of support is not yet well described. The aim of the study was to uncover the meaning of the phenomenon of support as experienced by women living with HF in middle age. A reflective lifeworld approach within the perspective of caring science was used. Six women (aged 33–61 years) were interviewed. The findings show that the essence of support can be understood as safety, depicted by understanding. However, there is tension between what is supportive and what is not, meaning that even though intentions are good, intended support may involve limitations, uncertainties or insecurity. The meaning of support is further illuminated in the following constituents: “knowledge and understanding”, “finding balance”, “ambiguity of relationships” and “support and formal care—a matter of trust and mistrust”. Findings demonstrate the need for carers to find an approach that ensures both good quality medical care and, at the same time, acknowledges the uniqueness of each individual.

Being on sick leave due to heart failure: Encounters with social insurance officers and associations with sociodemographic factors and self-estimated ability to return to work

Background: Little is known about sick leave and the ability to return to work (RTW) for people with heart failure (HF). Previous research findings raise questions about the significance of encounters with social insurance officers (SIOs) and sociodemographics in people sick-listed due to HF. Aims: To investigate how people on sick leave due to HF experience encounters with SIOs and associations between sociodemographic factors, experiences of positive/negative encounters with SIOs, and self-estimated ability to RTW. Methods: This was a population-based study with a cross-sectional design. The sample consisted of 590 sick-listed people with HF in Sweden. A register-based investigation supplemented with a postal survey questionnaire was conducted. Bivariate correlations and logistic regression analysis was used to test associations between sociodemographic factors, positive and negative encounters, and self-estimated ability to RTW. Results: People with low income were more likely to receive sickness compensation. A majority of the responders experienced encounters with SIOs as positive. Being married was significantly associated with positive encounters. Having a low income was related to negative encounters. More than a third of the responders agreed that positive encounters with SIOs facilitated self-estimated ability to RTW. High income was strongly associated with the impact of positive encounters on self-estimated ability to RTW. Conclusion: Encounters between SIOs and people on sick leave due to HF need to be characterized by a person-centred approach including confidence and trust. People with low income need special attention.

Patient complaints about health care in a Swedish County: characteristics and satisfaction after handling

To describe patient complaints and to examine possible associations between healthcare providers’ statements and reports of satisfaction/dissatisfaction.

Being on sick leave due to heart failure: self-rated health, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work

Younger people with heart failure often experience poor self-rated health. Furthermore, poor self-rated health is associated with long-term sick leave and disability pension. Socio-demographic factors affect the ability to return to work. However, little is known about people on sick leave due to heart failure. The aim of this study was to investigate associations between self-rated health, mood, socio-demographic factors, sick leave compensation, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work, for people on sick leave due to heart failure. This population-based investigation had a cross-sectional design. Data were collected in Sweden in 2012 from two official registries and from a postal questionnaire. In total, 590 subjects, aged 23–67, responded (response rate 45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and logistic regression analyses were used to investigate associations. Poor self-rated health was strongly associated with full sick leave compensation (OR  =  4.1, p < .001). Compared self-rated health was moderately associated with low income (OR  =  2.6, p  =  .003). Good self-rated health was strongly associated with positive encounters with healthcare professionals (OR  =  3.0, p  =  .022) and to the impact of positive encounters with healthcare professionals on self-estimated ability to return to work (OR  =  3.3, p  < .001). People with heart failure are sicklisted for long periods of time and to a great extent receive disability pension. Not being able to work imposes reduced quality of life. Positive encounters with healthcare professionals and social insurance officers can be supportive when people with heart failure struggle to remain in working life.

The use of qualitative evidence in clinical care

The article discusses the importance of applying the results of qualitative research to clinical care. It explains the approaches to evaluating the generalisation of such research. It cites the nee ...

To be on sick-leave due to heart failure: a qualitative perspective

Abstract Purpose: The aim of the present study was to explore and describe meanings of being on sick leave due to heart failure. Methods: The study was conducted in Sweden during 2011–2012. Five men and one woman, aged 46 to 62, were interviewed. A reflective life-world research approach based on phenomenological philosophy was used. The result of the analysis is presented in three themes. Results: To be on sick leave due to heart failure implies a life situation characterized by anxiety, insecurity and uncertainty. When rehabilitation professionals do not take on their professional responsibility, sick listed people with heart failure perceive they are dismissed and abandoned. If rehabilitation professionals take on their professional responsibility it can be experienced as supportive. Conclusions: People who are on sick leave due to heart failure are abandoned by rehabilitation professionals and they lack opportunities to participate in their own sick leave/rehabilitation processes. Rehabilitation professionals need to take more responsibility and allow the patients to participate by connecting and recognizing patients as equal human beings. The present results can be used by rehabilitation professionals to reflect on and discuss the needs of people on sick leave due to heart failure. Implications for Rehabilitation Heart failure is a chronic condition implying a complicated life-situation. People with heart failure experience abandonment by rehabilitation professionals and lack participation in their own rehabilitation process. In order to support people on sick leave due to heart failure collaboration and coordination between rehabilitation professionals are needed.

Heart failure clients' encounters with professionals and self-rated ability to return to work.

Abstract Background People with heart failure are sick listed for long periods and disability pension is common. Healthcare professionals need knowledge about factors that can enhance their return to work processes. Aims This study focus on people on sick leave due to heart failure and their encounters with healthcare professionals/social insurance officers. Specifically, it aimed to investigate associations between: (1) encounters and socio-demographic factors and, (2) encounters and self-rated ability to return to work. Material and methods A cross-sectional study based on registry data and a postal questionnaire to people on sick leave due to heart failure (n = 590). Bivariate correlation analyses and logistic regression analyses were used. Results Gender, income, and age were strongly associated with encounters with both social insurance officers and healthcare professionals. Self-rated ability to return to work was associated with the encounters ‘Made reasonable demands’, ‘Gave clear and adequate information/advice’ and ‘Did not keep our agreements’. Conclusion and significance To enhance clients’ abilities to return to work demands should be reasonable, information and advice need to be clear, and agreements should be kept. These results can be used by healthcare professionals as occupational therapists involved in vocational rehabilitation for people on sick leave due to heart failure.