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A qualitative study: Perceptions of the psychosocial consequences and access to support after an acute myocardial infarction
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.ORCID iD: 0000-0002-9014-060X
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
2014 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 1, 22-30 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to describe individuals' perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event. Methods: The study included 20 participants (14 men and six women) who lived in rural areas and had experienced their first AMI. Eleven were offered contact with a mentor. The participants were interviewed one year after their AMI. Results: The findings are presented in three themes: having a different life, having to manage the situation and having access to support, with 11 subthemes. During their recovery, the participants experienced psychosocial consequences, consisting of anxiety and the fear of being afflicted again. Most mentees appreciated their mentor and some of those without mentors wished they had received organised support. Participants were often more dissatisfied than satisfied with the follow-up provided during recovery. Conclusions: After an AMI, follow-up is important during recovery, but the standardised information provided is inadequate. During recovery, people need help dealing with existential crises. After discharge, receiving peer support from lay people with similar experiences could be valuable. The knowledge gleaned from this study could be used in education at coronary care units and in health care outside the hospital setting. © 2013 Elsevier Ltd.

Place, publisher, year, edition, pages
2014. Vol. 30, no 1, 22-30 p.
Keyword [en]
Emotional distress, Existential crises, Mentor, Peer support, Qualitative content analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:miun:diva-20993DOI: 10.1016/j.iccn.2013.07.002ISI: 000349929400004Scopus ID: 2-s2.0-84888428249OAI: oai:DiVA.org:miun-20993DiVA: diva2:687556
Note

Source: Scopus

Available from: 2014-01-14 Created: 2014-01-09 Last updated: 2016-12-16Bibliographically approved
In thesis
1. Peer mentoring - A complementary support to persons after an acute myocardial infarction
Open this publication in new window or tab >>Peer mentoring - A complementary support to persons after an acute myocardial infarction
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to investigate the experience of having an acute myocardial infarction in newly afflicted persons living in sparsely populated counties, and whether an intervention with peer mentors would provide support by affecting the perception of illness, health related quality of life and everyday life. The aim was also to describe the support of peer mentors from their perspective and what the mentoring meant to them. The thesis was based on four empirical studies (I-IV) and had a prospective, longitudinal, quasi-experimental, comparative design. A suitable sample was recruited, comprising 72 individuals who were newly afflicted with an acute myocardial infarction (AMI) for the first time; 34 of them were offered contact with a peer mentor, while 38 were not. Furthermore, 34 peer mentors participated in the project. The results were based on data collected from 28 individuals with mentors, 33 individuals without and 22 peer mentors. In studies I and III, qualitative approaches were used based on individual interviews with 20 newly afflicted individuals with (n=11) and without (n=9) mentors one year after AMI. The aims were to describe individuals’ perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event (I) and to describe individual perceptions of their lifestyle and support, 1 year after an AMI with or without mentorship (III). Study II was quantitative, consisting of data from questionnaires IPQ-R and SF-36 answered by 61 newly afflicted individuals with (n=28) and without (n=33) mentors. It aimed to investigate whether changes in illness perception and health-related quality of life occur over time after an intervention with peer mentors 1, 6 and 12 months after an AMI. Study IV had a mixed design and included peer mentors with the purpose to describing the personal meaning of being a peer mentor, for a person recovering from an acute myocardial infarction. Data consisted of individual interviews (n=15) and some data from IPQ-R and SF-36 that were provided on two occasions (n=22). All of the interviews (I, III, IV) were digitally recorded and analysed by qualitative content analysis, while the quantitative studies included descriptive data and were further compared using analysis of variance (ANOVA) (II) and the paired-sample t-test (IV).

 

The results from all four studies are interpreted and presented together, and they show differences and similarities between the newly afflicted with or without peer mentors and the peer mentors. The results comprise six main areas; the meaning of becoming a person with an AMI (I, II, III) pointed toward an awareness of the situation expressed both in positive and negative terms, as being thankful or of being afraid of having a second AMI. View at health care (I) indicated that follow-up after discharge was sometimes a positive experience but more often resulted in dissatisfaction with this part of the health-care system. Consequences (II) showed significant effects between groups in the dimensions ‘consequences’ and ‘timeline acute/chronic’ (IPQ-R), with higher mean values for those without mentors and a significant effect of time in both dimensions. There were also physical consequences for many of the participants (I, II, III, IV) as well as psychological consequences (I, II, IV). Everyday life (I, III) was affected by AMI that sometimes limited activities. There were demands to change areas of life-style that were perceived as both positive and negative. Health (II, III, IV) showed that health increased for most individuals during the year, as confirmed by significant values for time for those newly afflicted. The peer mentors showed a decrease in mean values but expressed that they felt healthier after compared with before their commitment. Meaning of support (I, IV) indicated that families and relatives had an important, supportive role for newly afflicted participants. The mentorship showed that the relationship was, in some cases and for different reasons, unsuccessful. However, most of them were satisfied, and new friendships arose. More of the mentors felt pride and were thankful because their experience was shown to be valuable to others in addition to themselves.

 The results were synthesised using the Human Becoming nursing theory, which confirmed that recovery after an AMI is a process that occurs over time in which that those afflicted must accept and be comfortable being a person who is afflicted by an AMI. Some tendencies indicated an advantage for the newly afflicted participants who had received contact with a peer mentor. Conclusion: Because the mentor had experienced the same event, the relationship contributed to the security of the mentee. The peer mentors matured with the task because they felt that their experience was valuable and they felt unique.

Abstract [sv]

Övergripande syfte i avhandlingen var att studera erfarenheter av att drabbas av en akut hjärtinfarkt (AHI) för nyinsjuknade personer, boende i glesbygdslän, och om en intervention med kamratstöd i form av mentorer skulle kunna innebära ett stöd, genom att påverka deras sjukdomsuppfattning, hälsorelaterade livskvalitet och deras vardagsliv. Syftet var även att beskriva mentorernas stöd utifrån deras perspektiv, och vad mentorskapet har betytt för dem.

 

Avhandlingen är baserad på fyra studier (I-IV) och har en prospektiv, longitudinell och kvasiexperimentell, jämförande design. Ett lämpligt urval utgjordes av 72 personer som nyligen hade drabbats av AHI första gången. Av dessa erbjöds 34 att få kontakt med en mentor medan 38 inte erbjöds detta. Dessutom deltog 34 mentorer. Det slutgiltiga resultatet i avhandlingen baserades på data som samlats från 28 personer med mentor, 33 utan mentor samt av 22 mentorer. Studie I och III utgick från kvalitativ metod, baserat på individuella intervjuer med 20 av de nyinsjuknade med mentor (n11), och utan mentor (n9) ett år efter deras AHI. Syftet var att beskriva individuella erfarenheter av psykosociala konsekvenser i samband med en AHI, och deras tillgång till stöd ett år efter händelsen (I), samt att beskriva individuella uppfattningar om deras livsstil och stöd ett år efter AHI, med eller utan mentorskap (III). Studie II var kvantitativ och utgjordes av data från enkäter; IPQ-R och SF-36, som besvarades av 61 nyinsjuknade, varav 28 med mentor och 33 utan mentor, i syfte att undersöka om förändringar i sjukdomsuppfattning och hälsorelaterad livskvalitet förekommer över tid, efter en intervention med mentorer 1, 6 och 12 månader efter AHI. Studie IV hade en mixad design och inkluderade mentorer med syfte att beskriva den personliga betydelsen av att vara mentor, under loppet av ett år, för en person under återhämtningen efter AHI. Data bestod av individuella intervjuer (n15) samt en del data från IPQ-R och SF-36, besvarat vid två tillfällen. Samtliga intervjuer (I, III, IV) spelades in digitalt och analyserades med kvalitativ innehållsanalys, medan de kvantitativa studierna innefattade beskrivande data, samt dessutom analyserades med variansanalys (ANOVA) (II) samt parvisa t-test (IV).

 

Resultat från samtliga fyra studier är tolkade och presenterade gemensamt, och visar på skillnader och likheter mellan de nyinsjuknade med eller utan mentor, samt mentorerna. Resultaten utgörs av sex huvudområden: Innebörden av att bli en person med en AHI (I, II, III) tyder på en medvetenhet om sin situation, och som uttrycks i både positiva och negativa ordalag, som att vara tacksam eller att vara rädd för att få en ny AHI. Syn på sjukvården (I) antyder att uppföljningen efter utskrivning i vissa fall var en positiv upplevelse, men flera av dem var missnöjda med den delen av vården. Konsekvenser (II) visade  signifikant effekt mellan grupperna för dimensionerna ’konsekvenser’ och ’tidslinje akut/kronisk’ (IPQ-R) med högre medelvärden för dem utan mentor. Dessutom var det signifikant effekt för tid i båda dimensionerna. Det förekom även fysiska konsekvenser för flera av deltagarna (I, II, III, IV) liksom psykologiska konsekvenser (I, II, IV). Vardagslivet (I, III) påverkades av AHI genom att den i vissa fall hindrade dem från fysiska aktiviteter.  Det fanns krav på dem att förändra delar i deras livsstil, vilket kunde uppfattas som både positivt och negativt.  Hälsa (II, III, IV) visade att de flestas hälsa hade förbättrats under året, vilket bekräftades med signifikanta värden för tid hos de nyinsjuknade. Mentorerna hade däremot sjunkande medelvärden men uttryckte att de mådde bättre efter sitt uppdrag, än innan. Betydelsen av stöd (I, IV) visade att familjer och närstående hade en betydelsefull roll för de nyinsjuknade. Mentorskapet för dem med mentor samt mentorerna visade att relationen i vissa inte hade fungerat, av olika anledningar. Trots allt var ändå de flesta tillfreds, och nya vänskapsförhållanden hade uppstått. Flera mentorer kände sig stolta och var tacksamma för att deras erfarenheter hade visat sig värdefulla för andra, men även för dem själva.

 

Resultaten syntetiserades med omvårdnadsteorin Human Becoming, som bekräftade att återhämtningen efter en AHI är en process som förekommer över tid, och innebär att acceptera och känna sig bekväm med att vara en person som drabbats av AHI. Det fanns vissa tendenser till att det var en fördel för de nyinsjuknade att ha kontakt med en mentor. Slutsatsen var att eftersom mentorerna hade genomgått samma händelse, bidrog det till trygghet. Mentorerna hade växt med uppgiften, eftersom de kände att deras erfarenheter var värdefulla, och att de var unika.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet, 2014. 62 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 205
Keyword
Illness perception, Intervention, Longitudinal, Quality of life, Quasi-experimental, Recovery, Rural, Social support, Intervention, Kvasi-experimentell, Glesbygd, Livskvalitet, Longitudinell, Sjukdomsuppfattning, Social support, Återhämtning
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-23277 (URN)978-91-87557-89-7 (ISBN)
Public defence
2014-11-14, F234, Östersund, 10:15 (Swedish)
Opponent
Supervisors
Note

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 2 inskickat, delarbete 4 inskickat.

At the time of the doctoral defence the following papers were unpublished: paper 2 submitted, paper 4 submitted.

Available from: 2014-10-23 Created: 2014-10-22 Last updated: 2017-03-17Bibliographically approved

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