Pia Alsén

General self-efficacy and health-related quality of life after myocardial infarction

Fatigue after myocardial infarction (MI) has been found to be distressing. A persons self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

Validation of the Revised Illness Perception Questionnaire (IPQ-R) in a sample of persons recovering from myocardial infarction--the Swedish version.

When peoples health is threatened, they generally develop illness perceptions to make sense of their illness. The Illness Perception Questionnaire (IPQ-R), developed by Moss-Morris et al (2002), has been widely used in many countries to measure such representations. However, since studies in this crucial research area are lacking in Sweden a Swedish version of IPQ-R was validated with a focus on the seven subscales: timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representations. Using confirmatory factor analysis, the aim of the present study was to validate the internal structure of the Swedish version in a sample of 202 persons (144 men and 58 women) who had been diagnosed with myocardial infarction four months earlier. Additionally, inter-correlations among the seven subscales and external concurrent validity were also investigated. The results of confirmatory factor analysis revealed that, in line with the English version of the IPQ-R, the specified seven-factor model had a satisfactory fit. One item was however not considered reliable and was therefore excluded from the instrument. The internal consistency (Cronbachs alpha coefficients) and the inter-factor correlations were relatively similar to those reported in the validation study of the original English IPQ-R. In tests of concurrent validity, the seven IPQ-R subscales were, as hypothesized, mainly associated with external variables. To conclude, the Swedish version of the IPQ-Rs seven dimensions, with one item removed, (total 37 items) was found to be a reliable and valid measure of illness perception.

Fatigue two months after myocardial infarction and its relationships with other concurrent symptoms, sleep quality and coping strategies.

Aims and objectives To explore fatigue levels two months after myocardial infarction and examine the associations with other concurrent symptoms, sleep quality and coping strategies. Background Fatigue has been found to be the most frequent and bothersome symptom after myocardial infarction, influencing health‐related quality of life negatively. Design The present study was explorative and cross‐sectional. The focus was on fatigue two months postmyocardial infarction, complemented with a comparative analysis of fatigue dimension levels. Methods The sample included 142 persons (mean age 63 years), treated for myocardial infarction, who responded to a questionnaire package measuring fatigue, depression, health complaints (symptoms), sleep quality and coping strategies. Results The main results showed that a global fatigue score two months postmyocardial infarction was associated with concurrent symptoms, such as breathlessness and stress, and coping strategies such as change in values, intrusion and isolation. In comparisons of present fatigue dimension levels (general fatigue, physical fatigue, reduced activity and mental fatigue) two months postmyocardial infarction with baseline measurements (first week in hospital), the results showed that levels of fatigue dimensions had decreased. In comparisons with levels of fatigue four months postmyocardial infarction in a reference group, we found lower levels of fatigue two months postmyocardial infarction. Conclusion The present findings indicated that postmyocardial infarction fatigue is lowest two months postmyocardial infarction. This may thus be the right time to identify persons experiencing postmyocardial infarction fatigue, as timely fatigue relief support may prevent progression into a state of higher levels of fatigue. Relevance to clinic practice Measuring fatigue two months postmyocardial infarction would enable healthcare professionals to identify persons experiencing fatigue and to introduce fatigue relief support. Tailored rehabilitation support should include stress management and breathlessness relief support. If maladaptive use of the coping strategies isolation and intrusion is observed, these strategies could be discussed together with the patient.

Psychometric analysis of the Multidimensional Fatigue Inventory in a sample of persons treated for myocardial infarction.

Background and Purpose: Fatigue after myocardial infarction is a frequent and distressing symptom in the early recovery phase. The purpose of this study is to psychometrically evaluate the Multidimensional Fatigue Inventory (MFI-20). Methods: The MFI-20 was evaluated using Rasch analysis. Results: The result showed that the MFI-20 can be used to obtain a global score reflecting an underlying unidimensional trait of fatigue; a transformation of the summarized raw scale scores into interval scale scores could be made. Also, 4 of the 5 original dimensions separately fitted the Rasch model. Conclusions: Calculation of a global score increases the possibility of identifying persons experiencing fatigue after myocardial infarction, and using the MFI-20 dimension scores increases the possibility of determining each person’s specific fatigue profile.

Flawed communications: Health professionals’ experience of collaboration in the care of frail elderly patients

Aims: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals’ experience of obstacles and opportunities for collaboration. Methods: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories. Results: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities. Conclusions : Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees’ own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.

Difficulties experienced by men during the first year after their myocardial infarction and fatigue

Difficulties experienced by men during the first year after their myocardial infarction and fatigue

Associations between fatigue, symptom experiences and sleep quality after myocardial infarction

Associations between fatigue, symptom experiences and sleep quality after myocardial infarction

Measuring fatigue with the multidimensional fatigue inventory (MFI-20) in persons treated for myocardial infarction

Measuring fatigue with the multidimensional fatigue inventory (MFI-20) in persons treated for myocardial infarctionThe 12th Annual Spring Meeting on Cardiovascular Nursing Copenhagen, Denmark, 16-17 March 2012Background: The intensive care unit (ICU) is not only a place to survive from accidents and serious illness. For S32 European Journal of Cardiovascular Nursing many people it is also a place to die. Nursing care does not stop when the patient die, but continue with care of the dead body and family support. The aims of this study were to i) explore experiences and attitudes of nurses towards use of music during after death care and ii) describe the feedback nurses received from relatives when music was used as part of the appearance. Method: A qualitative design using focus groups interviews was applied. Three focus group interviews with 15 nurses were undertaken. All the interviews were audio taped, transcribed verbatim, and analyzed using qualitative content analysis. Findings: Six main themes emerged from the analysis: (1) Different attitudes among nurses towards use of music; (2) Music affects the atmosphere; (3) Music affects emotions; (4) Use of music was situational; (5) Choice of music; (6) Positive feedback from the bereaved. Conclusion: This study demonstrates that music can prove helpful for nurses during after death care as well as in the care of the relatives. Relevance to clinical practice: Including music in an after death programme can be helpful for nurses in order to show respect for the dead person under preparation of the body. Music during the appearance may be a way to help the relatives in the time of grieving. It may ease the situation by giving them a special and memorable moment. It is not appropriate to standardize this intervention. It depended on the particular situation, and how the nurses and relatives are affected by using music. It has to be up to the individual nurse and the family to decide whether music is to be used in the particular situation.