Marianne Svedlund

Patients´and their partners´experiences of returning home after hospital discharge following acute myocardial infarction

Background: Returning home from hospital after an acute myocardial infarction [AMI] can be a period of vulnerability both for the patient and his/her partner. This study focuses on the time immediately after discharge. Aims: The aim of this study was to describe the patients and his/her partners experiences after hospital discharge following AMI. Methods: 15 couples took part in individual interviews, 4–8 weeks after discharge. Data were analysed using qualitative content analysis. Results: The results are presented by means of three themes, ‘at home in ones own home’, ‘at home within oneself’ and ‘having normality in sight’, comprising ten categories that describe the experiences of both the patient and his/her partner. Conclusions: The patients as well as partners described the period after discharge from hospital comprising ambitions of feeling safety in their home, an inner sense of security and seeking normalisation. The results of this study could be useful for nurses when planning for patient discharge. During hospitalization nurses can prepare both the patient and their partner for what to expect when the patient returns home.

Reliability of a Swedish pre-hospital dispatch system in prioritizing patients.

The need of emergency help often begins with a call to a dispatch center. The operator uses a medical index to prioritize dispatches. Since the resources of ambulances are limited, it is important that the priority grading decided by the operator at the dispatch center is as adequate as possible. In the county of Jamtland in Sweden, a system for triage named METTS-A (Medical Emergency Triage and Treatment System-A) has been in use since 2009, when the patient is coded according to priority level. The aim of this study was to analyse the sensitivity and specificity of the priority grading made by the dispatch center in comparison with the METTS-A priority assessed by the ambulance nurse. Statistics from a data-base in northern Sweden were analyzed. The material covered every ambulance that was dispatched, 6986 times during the period of data collecting. The results show a high sensitivity but low specificity in the dispatch system. The results also indicate that over prioritization exists since most of the patients with a high acute need of an ambulance are correctly identified, while many patients without that need are also given a high priority ambulance service. Therefore the conclusions were that both over- and under prioritizations were made.

Impact of environmental factors in home rehabilitation – a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers

Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors. Implications for Rehabilitation Environmental factors can be considered as obstacles or facilitators depending on each unique individual’s need. In a relatively small sample, this study shows the importance of the impact of the social environment on activities and participation among older people receiving home rehabilitation. Using ICF “linking rules” to link environmental factors as facilitators or barriers reported by older people can identify potentially important areas in home rehabilitation service described in the ICF categories. This can facilitate to improve rehabilitation service for older people. Reveals health care professionals as one central environmental factor for older people’s rehabilitation.

Changes in hope and health-related quality of life in couples following acute myocardial infarction: a quantitative longitudinal study.

BACKGROUND Acute myocardial infarction (AMI) is a life-changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period. AIMS To compare self-rated scores of hope and health-related quality of life (HRQoL) 1, 7, 13 and 25 months, after an AMI with regard to (i) differences across time, and (ii) differences between patients and their partners. DESIGN Explorative and longitudinal study. METHODS In this nonrandomized study, Short Form 36 Health Questionnaire (SF-36) and Herth Hope Index-Swedish (HHI-S) questionnaires were completed by thirteen post-AMI patients and their partners. Data were collected on four occasions. RESULTS In general, hope as well as HRQoL scores increased over time. A 2 (groups) × 4 (times) anova for mixed design showed significant changes in mental as well as in physical health over time but no significant effect of group on mental or physical health. Calculation of the minimum detectable change (MDC-index) for HHI-S and SF-36 revealed that scores between data collection points were not stable. conclusion: Our results show that although hope and HRQoL scores increased, only a few of the changes were statistically significant. Neither HHI-S nor SF-36 seems to measure stable states. Changes in hope and HRQoL levels may be due to participants striving to adapt to the current situation. RELEVANCE TO CLINICAL PRACTICE These results can be used in the training of nursing staff to enhance their understanding of the significance of a family-centred approach after an AMI.

Perceptions of illness, lifestyle and support after an acute myocardial infarction

After an acute myocardial infarction (AMI), people are encouraged to adopt a healthy lifestyle. But they are not always motivated to maintain the necessary lifestyle changes and need the right support to do it. In sparsely populated areas, people afflicted by an AMI have difficulty in finding standard rehabilitation programmes near their homes during the recovery, so they need alternative forms of support. The aim was to describe individual perceptions of their lifestyle and support, 1 year after an AMI, with or without mentorship. This study has a qualitative, descriptive design with data collected in individual interviews. Twenty men and women were interviewed 1 year after their first AMI, and 11 had been offered contact with mentors who had had an AMI. Content analysis was used to analyse the data. Those with and without mentors had similarities and tendencies to variation in their perceptions, with both a positive and negative view of life. The participants were aware of the necessity of living a healthy lifestyle but some resisted doing so. They wished to live as before, and all saw the future positively. Having a mentor with the same experience could be valuable for some people, but more research is needed to understand the lack of motivation to make beneficial lifestyle changes after a serious health event as AMI.

Aktivitetsutförandeproblem i samband med höftledsoperation : en intervjustudie av kvinnor och män.

The information patients receive prior to a hip arthroplasty influences considerably how they feel before surgery and affects their rehabilitation and recovery afterwards. The aim of this study was to illuminate everyday activities that were experienced as being a problem before the operation, the patients expectations prior to a total hip arthroplasty, describe the post surgical result, as well as focusing on how women respectively men describe their situations. Patient interviews were carried out (n=8) about one week before and five months after the operation. A qualitative content analysis was used to interpret the text. The result shows that the informants had considerable problems in carrying out everyday activities prior to the operation, i.e. they described feelings of frustration and being unable to carry out everyday activities independently had a negative mental impact. It appeared that they had high expectations of full recovery after the operation. After surgery the informants were more satisfied and had recovered the capacity to carry out some everyday activities. A few, however still had problems with pain. It also emerged that some patients were of the opinion that they had not been given adequate information pre and post surgery. The result shows that there is a definite need for information material to be provided, in order to make it easier to prepare the patients adequately both pre and post surgery, as well as to shorten the period of time needed for care and treatment.