Mid Sweden University

Bakgrund: Sjuksköterskans roll är viktig vid överflyttning av patienter från en vårdgivare till en annan. Äldre personer med komplexa vårdbehov löper stor risk vid vårdövergångar och sköra äldre tenderar känna oro i samband med dessa processer. Återinskrivningsrisken är högre vid utskrivning till ordinärt boende än till särskilt boende, vilket även skiljer sig mellan glesbygds- och tätortsbosatta, till nackdel för de glesbygdsbosatta. Få tidigare studier förklarar sjuksköterskans perspektiv på vårdövergångar från sjukhusvård till hemsjukvård i ordinärt boende i gles landsbygd.

Syfte: Att ge en djupare förståelse för sjuksköterskors uppfattningar av vårdkvalitet vid vårdövergångar från sjukhusvård till hemsjukvård i gles landsbygd.

Frågeställningar: Vad uppfattar sjuksköterskor vara det huvudsakliga bekymret i vårdövergångar från sjukhusvård till hemsjukvård i gles landsbygd och hur hanteras detta?

Metod: En konstruktivistisk grundad teori-Metod: baserad på individuella intervjuer med 21 legitimerade sjuksköterskor med erfarenhet av vårdövergångar från sjukhus till hemsjukvård i glesbygd.

Resultat: Det huvudsakliga bekymret vid vårdövergångar var "Vårdkoordination i en komplex process". Komplexiteten härrörde från flera miljömässiga och organisatoriska faktorer, vilket skapade en rörig och fragmenterad kontext för sjuksköterskorna att navigera inom. Kärnkategorin ”Att aktivt kommunicera för att reducera patientsäkerhetsrisker” förklarades närmre av de tre kategorierna – ”Samarbeta kring förväntade vårdbehov”, ” Förutse hinder” och ”Tajma avgången”. Underlåtenhet att utföra dessa aktiviteter förknippades med ökad risk för vårdskador i flera avseenden.

Diskussion: Fynden visar hur kommunikation och samarbete är nyckelfaktorer för vårdkvaliteten i övergångsprocessen. Ett proaktivt arbetssätt underlättar i gles landsbygd där långa avstånd medför längre tid från beslut till genomförande. Den konstanta interaktionen mellan kategorierna sammanknöts av den teoretiska koden ”Att konstant prioritera”. Beslutsfattare måste ha i åtanke vilka risker kopplat till organisation och vårdövergångar som kan uppstå i glesbygdsmiljö, för att möta behoven hos sköra äldre personer och deras anhöriga.

Slutsats: Studien visar en mycket komplex och stressad process som omfattar flera organisationer och aktörer. Riskreducering kan underlättas av tydliga riktlinjer, verktyg för kommunikation och tillräcklig bemanning.

Purpose: Although previous research indicates that care transitions differ between rural andurban areas, the knowledge of challenges related to care transitions in rural areas appearslimited. This study aimed to provide a deeper understanding of what registered nurses’perceive as the main concerns in care transitions from hospital care to home healthcare inrural areas, and how they handle these during the care transition process.

Methods: A Constructivist Grounded Theory method based on individual interviews with 21registered nurses.

Results: The main concern in the transition process was “Care coordination in a complexcontext”. The complexity stemmed from several environmental and organizational factors,creating a messy and fragmented context for registered nurses to navigate. The core category“Actively communicating to reduce patient safety risks” was explained by the three categories–“Collaborating on expected care needs”, “Anticipating obstacles” and “Timing the departure”.

Conclusions: The study shows a very complex and stressed process that includes severalorganizations and actors. Reducing risks during the transition process can be facilitated byclear guidelines, tools for communication across organizations and sufficient staffing.

Aims

To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003–2013.

Design

An integrative literature review.

Methods

PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003–2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).

Results

Meleis' four typologies were found in all studied disciplines, except development in oral health. The health‐illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.

Objective: Evaluate the effects of a psycho-educational model for follow-up in adults with congenitally malformed hearts.

Methods: The study had a randomized controlled design. Usual care was compared with computer-based and individualized care by face-to-face psycho-education by a multidisciplinary team. Knowledge and perceived control regarding the heart condition, symptoms of anxiety and depression was analysed at baseline, 3 and 12-months.

Results: The 114 participants (control group n=58, intervention group n=56) had an average age of 34 years, SD 13.5. The intervention group had significantly higher general knowledge after 3 (effect size (ES) 0.63, p= <0.01), and 12-months (ES 0.53, p= 0.02). Knowledge regarding endocarditis was significantly increased at 3 (ES 1.43, p=<0.001), and 12-months (ES 0.58, p= 0.02) compared to baseline. There were no changes in knowledge regarding medical treatment, contraceptives and pregnancy, perceived control or anxiety and depression in any of the groups.

Conclusion: The model for follow-up was effective to improve and maintain knowledge about self-management.

Practice implication: Future evaluation of how the improved knowledge will affect health behaviours over-time is needed. Clinical Trials NCT01234753

Objectives: The aim of this study was to identify the challenges, strategies and needs of dyads who are dealing with postoperative heart failure.

Background: An increasing number of patients with postoperative heart failure are living with their partner as primary caregiver. Heart failure is known to reduce quality of life but little is known about the strategies dyads use to cope with postoperative heart failure or what kind of support they need.

Methods: Data were collected through semi-structured dialogue guides. Content analysis was performed to derive the main themes and categories of the data.

Results: Three main themes were derived from the data; Everyday challenges, Strategies to deal with everyday challenges and Factors facilitating everyday life.

Conclusions: Dyads living with postoperative heart failure find the change in everyday life challenging, but have strategies to handle the situation and know what kind of help they need. With the right help from health care, quality of life and self-care can be improved.

The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children's experiences of social support in relation to a parent's heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals' approaches, family and friends' approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery).

BACKGROUND: The well-being of relatives of patients having chronic heart diseases (CHD) has been found to be negatively affected by the patient's condition. Studies examining relatives of patients with atrial fibrillation (AF) indicate that their well-being may be affected in a similar manner, but further research is needed.

AIM: To explore and describe critical incidents in which relatives of patients experience how AF affects their well-being and what actions they take to handle these situations.

DESIGN AND METHOD: An explorative, descriptive design based on the critical incident technique (CIT) was used. Interviews were conducted with 19 relatives (14 women and five men) of patients hospitalised in southern Sweden due to acute symptoms of the AF.

RESULTS: The well-being of relatives was found to be affected by their worries (patient-related health), as well as the sacri-ficing of their own needs (self-related health). In handling their own well-being, these relatives adjusted to and supported the patient (practical involvement), along with adjusting their own feelings and responding to the mood of the patients (emotional involvement).

CONCLUSION: The well-being of relatives of patients with AF was affected depending on the patients' well-being. In their attempt to handle their own well-being, the relatives adjusted to and supported the patients. Further research is needed in order to evaluate the effects of support to relatives and patients respectively and together.