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  • 51.
    Koinberg, Inga Lill
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Holmberg, Lars H.
    Department of Surgical Sciences, Division of Surgery, Uppsala University, Uppsala, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Breast cancer patients' satisfaction with a spontaneous system of check-up visits to a specialist nurse2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 3, p. 209-215Article in journal (Refereed)
    Abstract [en]

    Aim: To describe breast cancer patients' satisfaction with a spontaneous system of check-up visits to a specialist nurse. Background: There is little evidence that routine follow-up visits after breast cancer surgery influence survival or patient satisfaction. Consequently, there is a need to evaluate alternative follow-up programmes. Sample: A strategic sample of 19 breast cancer patients, who were not involved in a routine follow-up system but who had the possibility of contacting a specialist nurse when necessary, were interviewed. Method: A qualitative descriptive design inspired by the method of phenomenographic analysis was used. Findings: Five description categories and 606 statements showing similarities and differences in conceptions were obtained. The patients satisfaction with the knowledgeable and professional skills of the nurses was high. Confirmation and trust were important and necessary in order for the women with breast cancer to feel secure. Patients had a need for information and self-care education. Accessibility and early assessment by professional personnel or an oncology nurse were essential in a system without routine follow-ups. Discussion: This study identifies key issues in a specialist nurse-led check-up system. The findings can be used for developing an education programme for women who have undergone breast cancer surgery. Additionally, the findings emphasize the need to introduce more flexible solutions to the follow-up programmes, one alternative being specialist nurse-led check-ups.

  • 52.
    Koinberg, Inga-Lill
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Surgery, Varberg Hospital, Varberg, Sweden & Division of Nursing, Department of Medicine and Care, Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Nursing, Lund University, Lund, Sweden.
    Engholm, G.-B
    Department of Oncology, Örebro, University Hospital, Örebro, Sweden.
    Holmberg, L.
    Division of Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Nurse-led follow-up on demand or by a physician after breast cancer surgery: A randomised study2004In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 8, no 2, p. 109-117Article in journal (Refereed)
    Abstract [en]

    The value of routine follow-up with frequent visits to a breast cancer specialist - both in terms of detection of recurrence and patient satisfaction - has been questioned. The aim of this study was to compare nurse-ted follow-up on demand versus physician follow-up after breast cancer treatment with regards to patients’ well-being, satisfaction, access to medical care and medical safety. Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer, classified as UICC stage I or stage II, were randomised to follow-up at two hospitals in Sweden, either by routine medical follow-up, the physician group (PG, n = 131), or on demand by a specialist nurse, the nurse group (NG, n = 133). Measures were done at baseline and twice a year over a period of 5 years by means of a questionnaire containing the Hospital Anxiety and Depression Scale (HAD), and the Satisfaction and Accessibility (SaaC) scale. Number of contacts with the health care services, number of diagnostic procedures, and time to recurrence or death were monitored. The ratings of HAD and SaaC did not show any statistically significant differences between the groups. The levels of anxiety and depression were generally low and levels of patient satisfaction high. There were no differences between the groups concerning time to recurrence or death. This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety. © 2004 Published by Elsevier Ltd.

  • 53.
    Kristofferzon, Marja-Leena
    et al.
    Department of Caring Science and Sociology, University of Gävle.
    Johansson, Ingela
    Department of Medical and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping, Sweden.
    Brännström, Margareta
    Department of Nursing, Umeå University, Umeå, Sweden.
    Arenhall, Eva
    Department of Cardiology, Örebro University Hospital and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Baigi, Amir
    General Practice and Public Health, Halland County Council, Falkenberg, Sweden.
    Brunt, David
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Fridlund, Bengt
    Shool of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Nilsson, Ulrica
    Department of Anaesthesia and Intensive Care and Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Persson, Sylvi
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Rask, Mikael
    School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Wieslander, Inger
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Ivarsson, Bodil
    Department of Cardiothoracic Surgery, Lund University Hospital and Lund University, Lund, Sweden.
    Evaluation of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) in persons with heart disease: a pilot study2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, no 3, p. 168-174Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As part of preparation for a Swedish multicentre study, exploring sexual and married life in patients with myocardial infarction and their partners, a Swedish validated instrument was required.

    AIMS: The aim of this pilot study was to evaluate the validity and reliability of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) among persons with a heart disease.

    METHODS: A convenience sample of 79 persons (47 men and 32 women) living with a heart disease was recruited from the members of the National Association of Heart and Lung Patients. They completed a Swedish version of the WSFQ on two occasions.

    RESULTS: Two separate factor analyses each revealed a two-factor structure on both occasions: "Sexual appetite" and "Sexual expectations" with gender-neutral questions and "Sexual sensitiveness" and "Sexual ability" with gender-specific questions. Cronbach's alpha coefficients ranged from 0.48 to 0.86 and test-retest values for all but one question exceeded 0.70.

    CONCLUSIONS: The Swedish version of the WSFQ showed good validity and stability and acceptable internal homogeneity. Extended evaluations of the questionnaire are recommended.

  • 54.
    Kristén, Lars
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Sport Health and Physical activity.
    Patriksson, Göran
    Göteborgs Universitet: Idrottshögskolan: Institutionen för pedagogik och didaktik.
    Fridlund, Bengt
    Linnéuniversitetet: Institutionen för vårdvetenskap och socialt arbete.
    Benefits of sport activities for disabled children and youth. / Die Bedeutung des Sports fuer behinderte Kinder und Jugendliche2003In: Towards a society for all through adapted physical activity: Proceedings. Kongressbericht Wien 3-7 juli 2001 / [ed] Maria Dinold ... et.al., Wien: Institut für Sportwissenschaft , 2003, p. 394-398Conference paper (Refereed)
    Abstract [en]

    Describes a phenomenography-based study that attempted to show how children and adolescents with disabilities felt about the consequences of taking part in sports activities. Provides information about the sports program involved, informants, interviews, and results.

  • 55.
    Kristén, Lars
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Luleå, University of Technology, Luleå, Sweden.
    Patriksson, Göran
    Göteborg University, Göteborg, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Conceptions of Children and Adolescents with Physical Disabilities about Their Participation in a Sports Programme2002In: European Physical Education Review, ISSN 1356-336X, E-ISSN 1741-2749, Vol. 8, no 2, p. 139-156Article in journal (Refereed)
    Abstract [en]

    Sport and leisure can be of significant importance for the well-being and social support of children and adolescents with physical disabilities. However, it has been established that organized sport sometimes has a social construction, in that those without disabilities are favoured at the expense of others. The aim of this study was, therefore, to describe conceptions of children and adolescents with physical disabilities about their participation in a sports programme. Using questions based on a holistic view of the human being, 20 children and adolescents were interviewed. The method of analysis used was inspired by phenomenography. Six categories emerged: Getting new friends, learning, strengthening one’s physique, becoming someone, experiencing nature and having a good time. The findings show the great diversity of sports participation. Further, the conceptions mirror the difficulty of dividing people into groups and of delimiting important areas. The findings highlight the importance of programmes where actors from different sections of society cooperate. Even if the findings cannot be generalized, they nevertheless demonstrate that physical activity involves many positive factors both at the individual and at the society level. © 2002, North West Counties Physical Education Association and SAGE Publications. All rights reserved.

  • 56.
    Kristén, Lars
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Luleå University of Technology, Luleå, Sweden.
    Patriksson, Göran
    Göteborg University, Göteborg, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Parents' conceptions of the influences of participation in a sports programme on their children and adolescents with physical disabilities2003In: European Physical Education Review, ISSN 1356-336X, E-ISSN 1741-2749, Vol. 9, no 1, p. 23-41Article in journal (Refereed)
    Abstract [en]

    Parents of children and adolescents with physical disabilities have an important role in strengthening and supporting their children in everyday life. Children and adolescents with physical disabilities do not ordinarily have natural access to club activities, nor do they receive the same support for physical activities as their peers without disabilities. The aim of this Swedish study was to describe parents' conceptions of the influences of participation in a sports programme on their children and adolescents with physical disabilities. The data were collected from 20 parents of children and adolescents with disabilities in the 9-15 year age group through interviews based on a holistic view. The method of analysis used was inspired by phenomenography. Three descriptive categories emerged: achieving good health, being part of a social group and learning a sporting activity. The findings show that the parents regarded sport as a form of health education and as a means for their children to achieve increased participation in society. The findings also show that the learning process was important for empowering the children to influence their life situation.

  • 57.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Fridlund, Bengt
    Hälsohögskolan Jönköping.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients’ experiences of nurse-led follow-up in biological therapy – a qualitative study2011In: / [ed] The European Leage Against Rheumatism, London: BMJ , 2011, p. 755-755Conference paper (Refereed)
    Abstract [en]

    Background: Pain, stiffness and functional restrictions of the joints are the main problems for patients with inflammatory rheumatic diseases. When conventional drugs fail to delay the development of the disease the patients may require biological therapy. These patients usually have rheumatologist follow-up twice a year. Nurse-led clinics have been proposed for patients treated with biological therapy that are in low disease activity or remission (Disease Activity Score, DAS <3.2). In an ongoing study at a Swedish rheumatology clinic every other rheumatologist follow-up has been replaced by a rheumatology nurse-led follow-up. At the nurse-led follow-up the patients' disease activity is assessed by examining tender or swollen joints and laboratory tests.Objectives: The purpose of this study was to describe patients' experiences of nurse-led follow-up in biological therapy.Methods: The study had a descriptive design with a qualitative content analysis approach. In qualitative content analysis the interpretations vary in depth and level of abstraction: the manifest content describes the visible, what the text says and creating categories, the latent content involves an interpretation of the underlying meaning of the text, what the text talks about and creating a theme. Seventeen interviews were conducted based on a strategic sampling in order to achieve variation in experiences of nurse-led follow-up in terms of sex, age, civil status, education, duration of disease and therapy and ways of administration.Results: The content analysis of the interviews resulted in the theme "The rheumatology nurse promotes patients with added value" which was based on four categories: familiarity, security, availability and participatory: Familiarity meant that it was easier to ask the rheumatology nurse about disease, treatment and how to live with a chronic disease than the rheumatologist. Patients experienced security in the rheumatology nurse's knowledge and skill. Availability meant that it was easy to contact the rheumatology nurse who spent time to patients' needs. Patients experienced being participatory in their biological therapy and in the rheumatology nurse's examination of the disease activity.Conclusions: The rheumatology nurse follow-up resulted in that patients experienced familiarity, security, availability and being participatory in their biological therapy. The rheumatology nurse promoted patients from another perspective, than the rheumatologist, in the rheumatology care. By replacing every other rheumatologist follow-up with a rheumatology nurse-led follow-up for patients with biological therapy, who are in low disease activity or remission, the rheumatology care will be more complete. A rheumatology nurse and a rheumatologist have different perspectives and complement each other. When patients are given the opportunity to meet both professions regularly they are able to receive optimal rheumatology care.

    Disclosure of Interest: None Declared

    Citation: Ann Rheum Dis 2011;70(Suppl3):755

  • 58.
    Larsson, Ingrid
    et al.
    School of Health Sciences, Jönköping University.
    Bergman, Stefan
    Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patients' independence of a nurse for the administration of subcutaneous anti-TNF therapy: a phenomenographic study2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, p. 5146-1-5146-10Article in journal (Refereed)
    Abstract [en]

    Rheumatology nursing supports patients to manage their lives and live as independently as possible without pain, stiffness and functional restrictions. When conventional drugs fail to delay the development of the rheumatic disease, the patient may require biological treatment such as self-administered subcutaneous anti-tumour necrosis factor (TNF) therapy. It is therefore important that the patient perspective focuses on the life-changing situation caused by the administration of regular subcutaneous injections. The aim of this study was to describe variations in how patients with rheumatic diseases experience their independence of a nurse for administration of subcutaneous anti-TNF therapy. The study had a descriptive, qualitative design with a phenomenographic approach and was carried out by means of 20 interviews. Four ways of understanding the patients' experience of their subcutaneous anti-TNF therapy and independence of a nurse emerged: the struggling patient; the learning patient; the participating patient; the independent patient. Achieving independence of a nurse for subcutaneous anti-TNF injections can be understood by the patients in different ways. In their strive for independence, patients progress by learning about and participating in drug treatment, after which they experience that the injections make them independent.

  • 59.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult, Oskarström, Sweden.
    Biological therapy could be monitored by a rheumatology nurse-led clinic without any differences in outcome – a randomised controlled study2012Conference paper (Refereed)
    Abstract [en]

    Background: Patients with rheumatic diseases treated with biological therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients who are in low disease activity or remission.

    Objectives: To compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients treated with biological therapy with low disease activity or in remission.

    Methods: In a prospective controlled study 107 patients were randomised into two groups with six months follow up to a rheumatology nurse (intervention group; n=53) or to a rheumatologist (control group; n=54). Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. In the nurse-led rheumatology clinic the patients´ disease activity was assessed by examination of tender or swollen joints and laboratory tests. The rheumatology nurse also had a dialogue concerning the patient’s needs with regard to drug therapy, smoking habits and psychosocial aspects. After 12 months 97 patients completed the study. Main outcome was disease activity measured by DAS28.

    Results: Patients had mean age of 55.4 years and disease duration of 16.7 years. DAS28 was 2.1. At inclusion there were no significant differences in DAS28 between the groups. There were no differences (p=0.67) in change of DAS28 between the intervention group (0.14) or control group (0.20) from inclusion to 12 months.

    Conclusions: In patients with low disease activity biological therapy could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.

  • 60.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Hälsohögskolan Jönköping, Jönköping, Sverige.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult, Oskarström, Sverige.
    Sjuksköterskemottagning för patienter med en reumatisk sjukdom behandlade med biologiska läkemedel – ett randomiserat, kontrollerat försök jämförande sjuksköterskemottagning med läkarmottagning2012Conference paper (Refereed)
    Abstract [sv]

    Bakgrund Målet med behandling av reumatiska sjukdomar är att ta kontroll över ledsmärta och svullnad, reducera ledskador samt förebygga funktionsnedsättningar. För patienter med otillräcklig respons på traditionella läkemedel har forskningen inom reumatologin varit av stor betydelse och medfört utveckling av biologiska läkemedel. Behandling med biologiska läkemedel för patienter med reumatisk sjukdom följs vanligtvis upp av en reumatolog. För patienter som är lågaktiva i sin sjukdom eller i remission har uppföljning via en sjuksköterskemottagning föreslagits. Syfte var att jämföra sjuksköterskemottagning med läkarmottagning avseende behandlingsresultat för patienter behandlade med biologiska läkemedel med låg eller ingen sjukdomsaktivitet.

    Metod Ett randomiserat kontrollerat öppet försök med 12 månaders uppföljning genomfördes mellan oktober 2009 och augusti 2011. Avsikten var att ersätta ett av de två årliga läkarbesöken med ett sjuksköterskebesök. En sjuksköterskemottagning utformades utifrån en personcentrerad vård med patientens behov i fokus. Inklussionskriterier var patienter med en reumatisk sjukdom behandlade med biologiskt läkemedel och en sjukdomsaktivitet, Disease Active Score 28 (DAS28) ≤3.2. Av 107 patienter randomiserades 53 patienter till uppföljning av sjuksköterska och 54 patienter till uppföljning av läkare. Hypotesen var att behandlingsresultatet på en sjuksköterskemottagning inte skulle vara sämre än på en läkarmottagning vid 12 månaders uppföljning. Huvudutfallsmått var DAS28.

    Resultat Efter 12 månader hade 47 patienter i sjuksköterskegruppen och 50 patienter i läkargruppen fullföljt studien. Patienterna hade en medelålder på 55.4 år, sjukdomsduration på 16.7 år och DAS28 var 2.1. Det fanns ingen statistiskt signifikant skillnad mellan grupperna. Efter 12 månader var det inte någon statistisk signifikant skillnad (p=0.66) i förändring av DAS28 mellan sjuksköterskegruppen (0.14) eller läkargruppen (0.20). I utfallsmåtten sänka, svullna och ömma leder, global hälsa och smärta (VAS) eller Health Assessment Questionnaire (HAQ) var det inte heller någon statistisk signifikant skillnad i förändring efter 12 månader mellan grupperna. Båda grupperna var lika nöjda med vården och säkra på att få hjälp från reumatologmottagningen vid problem med lederna.

    Sammanfattning Patienter med en stabil reumatisk sjukdom behandlade med biologiskt läkemedel kan följas upp vid en sjuksköterskemottagning utan någon skillnad i behandlingsresultat med avseende på DAS28.

  • 61.
    Larsson, Ingrid
    et al.
    Jönköping University, Jönköping, Sweden.
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Bergman, Stefan
    Spenshult Hospital, R&D Center, Spenshult Hospital, Oskarström, Sweden.
    Treatment Outcomes From a Nurse-Led Rheumatology Clinic in Monitoring of anti-TNF Therapy – a Randomised Controlled Trial2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10, p. S667-S667, article id 1559Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic inflammatory arthritis (CIA) treated with anti-TNF therapy are usually followed up by rheumatologists. Nurse-led rheumatology clinics have been proposed for patients with low disease activity or in remission. The purpose of this trial was to compare treatment outcomes from a nurse-led rheumatology clinic and a rheumatologist clinic for patients undergoing anti-TNF therapy with low disease activity or in remission.

    Methods: A randomized controlled trial (RCT) with a 12-month follow-up was conducted with 107 patients randomised into two groups with a 6-month follow up to a nurse-led rheumatology clinic based on a person-centred care (intervention group; n=53) or to a rheumatologist-led clinic (control group; n=54). The intention of the interventional trial was to replace one of the two annual rheumatologist monitoring visits by a nurse-led rheumatology monitoring visit for patients undergoing anti-TNF therapy. Inclusion criteria were patients undergoing anti-TNF therapy and Disease Activity Score 28 (DAS28) ≤3.2. The hypothesis was that the outcomes from nurse-led clinic will not be inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. Primary outcome was disease activity measured by DAS28.

    Results: After 12 months 47 patients in the intervention group and 50 patients in the control group completed the trial and there were no differences (p=0.66) in mean change of DAS28 between the intervention or control group. There were no differences (p>0.05) in mean change in Visual Analogue Scales (VAS) for pain, Health Assessment Questionnaire (HAQ), satisfaction or security with the rheumatology care  between the two groups, see table.

    Conclusion: In monitoring of anti-TNF therapy treatment outcomes for patients at a nurse-led rheumatology clinic are not inferior to those obtained by rheumatologist-led clinic at 12-month follow-up. The follow-up care of anti-TNF therapy may advantageously be performed by a nurse-led clinic based on a person-centred care. The results from this trial demonstrated that patients with CIA undergoing anti-TNF therapy, with low disease activity or in remission, could be monitored by a nurse-led rheumatology clinic without any differences in outcome as measured by DAS28.

  • 62.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Teleman, Annika
    R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
    Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, Suppl. 3, p. 139-140Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic inflammatory arthritis (CIA) treated with biological therapy are usually monitored by rheumatologists. Research shows that a nurse-led rheumatology clinic is safe and effective in monitoring biological therapy (1) and contributed added value in patients within rheumatology care, because the encounter with the nurse led to a sense of security, familiarity and participation (2).

    Objectives: To compare the cost of monitoring biological therapy in a nurse-led rheumatology clinic with those of a rheumatologist-led clinic in patients with low disease activity or in remission.

    Methods: Cost comparison was based on data from a 12 month randomised controlled trial (1). A total of 107 patients were randomly assigned to either a rheumatologist-led clinic or to a nurse-led rheumatology clinic. The purpose of the intervention was to replace one of two annual monitoring visits at the rheumatologist-led clinic (control group; n=54) by a visit to a nurse-led rheumatology clinic (intervention group; n=53), based on person-centred care. Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. All outpatient visits, team rehabilitation and all the telephone advice at the Rheumatology Clinic were registered for the patients who participated in the trial. Main outcome measures were direct costs related to rheumatology care during the 12 month follow-up period.

    Results: After 12 months 97 patients completed the study. At the inclusion the patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. There was no mean difference in changes in clinical outcome between the two groups (DAS28 -0.06; p=0.66). The total annual cost of team rehabilitation in rheumatology care, per patient monitored by the nurse-led rheumatology clinic was €580 compared with €1278 for monitoring by a rheumatologist-led clinic, translating in a €698 (55%) lower annual cost. The annual cost of just the outpatient rheumatology care provided by rheumatologist and rheumatology nurse, per patient was €457 for monitoring by the nurse-led rheumatology clinic compared with €598 for monitoring by a rheumatologist-led clinic, translating in a €141 (24%) lower annual cost.

    Conclusions: Patients with stable CIA undergoing biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic compared to a rheumatologist-led clinic, with no difference in clinical outcome as measured by DAS28.

    References

    1. Larsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.
    2. Larsson et al. (2012). Patients’ experiences of a nurse-led rheumatology clinic in Sweden – a qualitative study in patients undergoing biological therapy. Nurs Health Sci, 14(4): 501-507.
  • 63.
    Larsson, Ingrid
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Centre, Halmstad, Sweden.
    Fridlund, Bengt
    School of Health and Welfare, Jönköping University, Jönköping, Sweden .
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Teleman, Annika
    Capio Movement Hospital, Halmstad, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Bergman, Stefan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Spenshult Research and Development Centre, Halmstad, Sweden & University of Gothenburg, Gothenburg, Sweden.
    A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial2015In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 16, article id 354Article in journal (Refereed)
    Abstract [en]

    Background: Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients’ disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.

    Methods: Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.

    Results: A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated €14107.7 per patient in the NLC compared with €16274.9 in the RCL (p = 0.004), giving a €2167.2 (13 %) lower annual cost for the NLC.

    Conclusions: Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.

    Trial registration: The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.

    © 2015 Larsson et al.

  • 64.
    Lidell, Evy
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Axelsson, Åsa
    Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet.
    Fridlund, Bengt
    School of Health Sciences, Jönköping University, Jönköping.
    Mårtensson, Jan
    School of Health Sciences, Jönköping University, Jönköping.
    Hildingh, Cathrine
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    A masters programme in cardiovascular nursing: a two-year-follow-up2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, no 2, p. 48-49Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate professional development and promotion as well as whether the new competence was requested after completion of a one-year master programme (MP) in Cardiovascular (CV) nursing. In Sweden the first one-year MP within the CV area took place between 2003 and 2005 at Halmstad University with a follow-up in 2007. The sample consisted of seventeen former students who had completed the MP. A questionnaire was developed comprising twenty items grouped into three main sections. Most of the nurses stated that their knowledge was requested and that they had developed their professional attitude, skills and knowledge. Seven of the nurses had a new position and five of them had advanced in terms of leadership. In three cases, the master exam was critical for the employers’ decision. Six of the nurses who had a new post had obtained an increase in salary. In conclusion, the MP led to increased competence as well as improved career prospects. Information about the MP should be available at clinics, and collaboration between clinical practice and education is necessary in order to ensure relevant use of master educated nurses’ competence.

  • 65.
    Lidell, Evy
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Long-term effects of a comprehensive rehabilitation programme after myocardial infarction1996In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 10, no 2, p. 67-74Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the long-term effects on myocardial infarction (MI) patients of a six-month comprehensive rehabilitation programme (CRP) conducted by an interdisciplinary team regarding cardiac events, physical and psychological conditions, life habits, and cardiac health knowledge. The results of a multivariate analysis carried out five years after the MI showed that cardiac events and psychological condition were not significantly influenced by the CRP. However, it was found that the physical condition of the patients benefited from the CRP; self-reported physical fitness (p < 0.002) and physical exercise test (p < 0.007). CRP participation was linked to significant modifications of life habits (diet change; p < 0.04, sexual activity; p < 0.000). The cardiac health knowledge was significantly improved by participation in the CRP (basic cardiac knowledge; p < 0.005; knowledge about misconceptions; p < 0.04). In conclusion, CRPs have had positive long-term effects on physical condition, life habits and cardiac health knowledge. No such effects, however, were found regarding either cardiac events or psychological condition.

  • 66.
    Lindgren, Eva-Carin
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Influencing Exercise Adherence in Physically Non-active Young Women: Suggestion for a Model1999In: Women in Sport & Physical Activity Journal, ISSN 1063-6161, E-ISSN 1938-1581, Vol. 8, no 2, p. 17-44Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to develop a theoretical understanding of what could influence exercise adherence in physically non-active young women. Interviews with twelve physically non-active young women werw strategically selected and analyzed by grounded theory. The results were that several factors could influence exercise adherence in physically non-active young women, and that these factors can be regarded as a number of interrelated dimensions. The influence was coming either from the exercise or from the environment connected to the exercise. The participants wanted to feel enjoyment and to learn something during the exercise (recreation/learning influence). They also wanted to feel belongingness during the exercise (social influence). An influence that promotes health or builds skills (investment influence) could be a trigger to start exercising among the participants, but not to maintain exercise adherence. Influence coming from the environment (enabling influence) was both important and stimulating for physically non-active young women in establishing regular exercise. It is important to present the model developed in this study to communities, sport federations and other authorities working with health promotion activities so that they can explore innovative ways to promote exercise adherence among physically non-active young women. Good examples could be to offer non-cometitive sports as well as to develop well-designed exercise programs for physically non-active young women.

  • 67.
    Lindgren, Eva-Carin
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Motives for participation in sport and exercise among young women2000In: Sport Psychology Conference in the New Millennium -A dynamic research-practice perspective, proceedings / [ed] Björn A. Carlsson, Urban Johnson, Fredrik Wetterstrand, Halmstad: Centre for Sport Science [Centrum för idrottsvetenskap] , 2000, p. 254-258Conference paper (Refereed)
  • 68.
    Lindgren, Eva-Carin
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Patriksson, Göran
    University of Gothenburg, Gothenburg, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Empowering young female athletes through a self-strengthening programme: A qualitative analysis2002In: European Physical Education Review, ISSN 1356-336X, E-ISSN 1741-2749, Vol. 8, no 3, p. 230-248Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe how young female athletes perceived the influences of a self-strengthening programme. The self-strengthening programme for young female athletes was run by the Swedish Sport Confederation. The programme was designed to empower young female athletes. The study methodology was based on a phenomenographic approach and entailed interviews with a strategically selected group of 14 participants in the programme. The informants were between 13 and 20 years of age and came from individual and team sports. The findings show that perceived influences of the programme were: a feeling of self-confidence; a feeling of being seen and confirmed; awareness of women’s issues; a feeling of belongingness; and an improvement in coaching skills. The self-strengthening programme empowered young female athletes due to increased self-efficacy and an increased awareness of women’s issues.

  • 69.
    Lindgren, Eva-Carin
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Tebelius, Ulla
    Halmstad University, School of Education, Humanities and Social Science, Center for Social Analysis (CESAM).
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    The impact of sport on young women’s attitude to physical activity in adult life2000In: Women in Sport & Physical Activity Journal, ISSN 1063-6161, E-ISSN 1938-1581, Vol. 9, no 1, p. 65-86Article in journal (Refereed)
    Abstract [en]

    Sport participation or regular physical activity is often seen as a factor, which leads to better health and well being. Sport also has a social function, as most of the activities are performed together with other people. However, while club sports in Sweden have a stimulating effect on young men, there is a risk that they do not provide enough scope for young women. In particular, early specialization and a high level of seriousness do not suit all young sportswomen. The purpose of this study was to develop a theoretical understanding of the ways in which sport has influenced young women’s lifestyles in terms of their attitudes to physical activity in adult life. The data were collected using strategic interviews and analyzed using the grounded theory method. Based upon the results, young women’s physically active lifestyles varied depending on how they valued their sport in combination with how they handled their sport. Sport was regarded as having a positive effect on health and well-being. This led to the young women studied intending to pursue a physically active lifestyle also in adult life. They enjoyed participating in sport, but not particularly sport with a high level of seriousness or a high level of vigor, which is what characterizes most club sports today.

  • 70.
    Lundén, Karin
    et al.
    Gothenburg University, Sweden.
    Baigi, Amir
    Dept. of Primary Health Care, Gothenburg University, Sweden.
    Lidell, Evy
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Hildingh, Cathrine
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    School of Health Sciences and Social Work, Växjö University, Sweden.
    Coronary care unit nurses' outlook on death - their own thoughts as well as those of their patients: a pilot study2007In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 27, no 3, p. 9-12Article in journal (Refereed)
    Abstract [en]

    No studies have examined the  level of preparedness of CCU  nurses to deal with cardiac patients’  death issues. Accordingly,  the aim of this pilot study was to  explore and describe CCU nurses’  outlook on their own as well  as their patients’ thoughts about  death. A pilot study was conducted  in 2005 at a University Hospital  in southern Sweden. The 63  (93%) nurses answered a newly  established 18-item questionnaire  regarding their own and their  patients’ thoughts about death.  Descriptive statistics revealed  that 90% of nurses believed that  patients often thought about  death. Regarding their outlook on  death issues, 41% were aware of  their personal standpoint, 63%  were clear about their plan of  action, 34% showed openness  towards their patients and 26%  expressed educational adequacy.  These low figures pertaining to  both personal and professional  awareness indicate a lack of  knowledge and competence. Clinical  implications are the provision  of various forums at CCUs  on this subject and the creation of  awareness at all levels of nursing  education. Research implications  are to further develop the instrument  and implement an intervention  at the CCU of how to care  for dying cardiac patients in a  professional manner.

  • 71.
    Marklund, Bertil
    et al.
    Primary Health Care Research and Development Unit, County Council Mailand, Falkenberg, Sweden.
    Almroth, Birgitta
    Primary Health Care Research and Development Unit, County Council Mailand, Falkenberg, Sweden.
    Schaffrath, Ann Marie
    Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    Gunnarsson, Birgitta
    Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    Höijer, Barbro
    Atomen Pharmacy, Göteborg, Sweden.
    Fridlund, Bengt
    Primary Health Care Research and Development Unit, County Council Mailand, Falkenberg, Sweden.
    Promoting medical self-care: evaluation of a family intervention implemented in the primary health care by pharmacies1999In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 16, no 5, p. 522-527Article in journal (Refereed)
    Abstract [en]

    Background: Medical self-care is the range of behaviours undertaken by people to promote or restore health when dealing with a medical problem.

    Objectives: The aim of the study was to evaluate medical self-care effects of a family intervention implemented in primary health care by pharmacies, in terms of non-professional and professional involvement.

    Methods: The intervention was implemented in one of two primary health care areas during a 4-month period and involved consecutive families acting as an intervention (IG, n = 94) or a control (CG, n = 93) group. Eight telephone interviews were conducted with each family. The families were asked about complaints of illness, how long they prevailed and how they were treated.

    Results: The results showed (P < 0.05–0.0001) that the IG had more medical problems (931 versus 621) compared with the CG, were less hospitalized (4 versus 10), stayed at home more to take care of sick children (84 versus 40), read more medical brochures (121 versus 31), tried more non-medical treatments (228 versus 116), and had fewer visits to the department of paediatrics but more visits to primary health care (69 and 98 versus 90 and 68).

    Conclusions: Due to the non-randomization procedure, some caution with regard to generalization of the results must be taken, but they are in concordance with established knowledge of the usefulness of medical self-care. The results indicate that a brief intervention for families can change the use of health authorities. It therefore seems meaningful to implement the intervention in a more comprehensive way in the primary health care setting, while at the same time trying to implement it as a large-scale randomized experimental study, comprising aspects such as the individual's need for care, the use of the right organization level and the assessment of economic costs and savings.

  • 72.
    Marklund, Bertil
    et al.
    Primary Health Care Research and Development Unit, County Council Halland.
    Wallin, I.
    Medical Group Mölndals-Bro, Mölndal.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    A primary preventive coronary health survey among a finnish immigrant population in Sweden1999In: Coronary Health Care, ISSN 1362-3265, E-ISSN 1532-2025, Vol. 3, no 1, p. 32-37Article in journal (Refereed)
    Abstract [en]

    Primary prevention strategies aimed at immigrants are insufficiently documented in primary health care services and, in Sweden, this is especially true regarding coronary health care with a gender perspective. The aim of this study was to examine the coronary health condition among a Finnish immigrant population in Sweden in terms of gender differences. Immigrated Finns (256 men and women aged 25-64) belonging to one primary health care centre were invited to participate in a coronary health survey. The instruments used, comprising a well-established self-rated questionnaire as well as tests forming a coronary heart disease (CHD) risk index, were analysed using descriptive and inferential statistics. The findings show that 23% were at high risk; more men than women (P<0.015). Men indicated more problems in food (e.g. fibre intake P<0.012) and drink (e.g. alcohol use P<0.000) habits while women indicated more psychosocial problems (e.g. psychosocial strain P<0.020). Furthermore, male and female Finnish immigrants are at least at an equal risk of CHD compared to their Swedish and Finnish counterparts, due to a high smoking rate (42% and 43%). Both genders show higher body mass index and waist-hip ratio figures compared to Swedish people on average. Establishing permanent connections with immigrant organizations and finding key persons anchored both among the immigrants and in the primary health care are important tasks in order to reach compliance in coronary health care. An important research implication would be to implement a primary prevention clinical trial based partly on the general findings of risk indicators and partly on gender differences among the risk indicators with regard to language obstacles.

  • 73.
    Morténius, Helena
    et al.
    FoUU Region Halland, Halmstad, Sweden & Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hildingh, Cathrine
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Fridlund, Bengt
    University of Gothenburg, Gothenburg, Sweden & School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Strategic Communication Intervention to Stimulate Interest in Research and Evidence-Based Practice: A 12-Year Follow-Up Study With Registered Nurses2016In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    Background

    Bridging the research–practice gap is a challenge for health care. Fostering awareness of and interest in research and development (R & D) can serve as a platform to help nurses and others bridge this gap. Strategic communication is an interdisciplinary field that has been used to achieve long-term interest in adopting and applying R & D in primary care.

    Aim

    The aim of the study was to evaluate the impact of a strategic communication intervention on long-term interest in R & D among primary care staff members (PCSMs) in general and registered nurses (RNs) in particular.

    Methods

    This prospective intervention study included all members of the PCSMs, including RNs, in a Swedish primary care area. The interest of PCSMs in R & D was measured on two occasions, at 7 and 12 years, using both bivariate and multivariate tests.

    Results

    A total of 99.5% of RNs gained awareness of R & D after the first 7 years of intervention versus 95% of the remaining PCSMs (p = .004). A comparison of the two measurements ascertained stability and improvement of interest in R & D among RNs, compared with all other PCSMs (odds ratio 1.81; confidence interval 1.08–3.06). Moreover, the RNs who did become interested in R & D also demonstrated increased intention to adopt innovative thinking in their work over time (p = .005).

    Linking Evidence to Action

    RNs play an important role in reducing the gap between theory and practice. Strategic communication was a significant tool for inspiring interest in R & D. Application of this platform to generate interest in R & D is a unique intervention and should be recognized for future interventions in primary care. Positive attitudes toward R & D may reinforce the use of evidence-based practice in health care, thereby making a long-term contribution to the patient benefit. © 2015 The Authors

  • 74.
    Månsson, J.
    et al.
    Research and Development Unit, Prim. Hlth. Care, Co. Cncl. H., Falkenberg, Sweden.
    Marklund, Bertil
    Prim. Hlth. Care R. and D. Unit, County Council Halland, Falkenberg, Sweden.
    Bengtsson, C.
    Department of Primary Health Care, Göteborg Univ., Vasa Hospital, Gothenburg, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Evaluation of an educational programme for the early detection of cancer1999In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 37, no 3, p. 231-242Article in journal (Refereed)
    Abstract [en]

    Avoiding patient's and doctor's delay is important for the detection of cancer. In order to study the possibilities for shortening the delay, without causing anxiety, an educational programme for early detection of cancer (EPEDC) was worked out, aimed to be evaluated at the community level. A community with 77 100 inhabitants, was informed about cancer symptoms in a letter. Participants who observed the cancer symptoms, described in the letter, were invited to visit the health centres, where they were interviewed and examined according to a specially designed schedule. Guidelines for taking care of these participants were also worked out. Fifteen previously unknown cancers were detected. By means of a telephone interview and a questionnaire the reactions to the EPEDC were studied. The results indicate that it is possible to inform and educate the population about cancer symptoms without causing anxiety on condition that there is an organisation which can be contacted without delay by subjects with potential cancer symptoms. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.

  • 75.
    Mårtensson, Irene E.
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Factors influencing the patient during weaning from mechanical ventilation: a national survey2002In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 18, no 4, p. 219-29Article in journal (Refereed)
    Abstract [en]

    Successful weaning depends on the application of skilled judgement and decision making to nursing and medical interventions. The intensive care nurse is in an unique position for adopting a holistic approach to weaning. Such an approach needs teamwork and consideration of all the factors that could influence the outcome of the weaning phase. The aim of this study was to conduct a survey, to establish the factors taken into consideration and documented during weaning at the intensive care units (ICUs) in Sweden. A questionnaire was developed and sent to all 92 ICUs. The results identified that nutrition, communication, analgesics and sedatives, psychological and metabolic factors, as well as weaning methods and measurable parameters were taken into consideration. Written instructions for weaning were used by only three ICUs and weaning protocols were not common. A holistic approach to the discontinuation of mechanical ventilation is a valuable means of improving the quality of care and merits further research.

  • 76.
    Mårtensson, J.
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Karlsson, J.E.
    Department of Cardiology, Ryhov County Hospital, Jönköping, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Female patients with congestive heart failure: how they conceive their life situation1998In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 28, no 6, p. 1216-1224Article in journal (Refereed)
    Abstract [en]

    Congestive heart failure (CHF) is a significant health problem for women, particularly elderly women. The risk factors for heart failure appear to be different in women than in men, with hypertension and diabetes playing a greater role in women and ischaemic heart disease a greater role in men. The aim of this study was to describe, from a nurse's perspective, how female patients with CHF conceive their life situation, interview questions were designed with a focus on five dimensions: biophysical, socio-cultural, emotional, intellectual and spiritual-existential. A qualitative method was used with a phenomenographic approach, as this approach examines aspects of the surroundings as they are conceived. Five categories emerged in the results: feeling content, feeling a sense of support, feeling a sense of limitation, feeling anxiety and feeling powerless. A sense of limitation regarding working capacity and being able to support those in their surroundings causes patients with CHF to experience anxiety due to feeling insecure about themselves and in relation to their surroundings. This may result in feelings of worthlessness in women with CHF, both concerning their own capacity and the fact that they feel they are a burden to those around them. Through nursing intervention, these patients can receive help to break this vicious circle of feeling limited and powerless. This can be done by encouraging them to verbalize their feelings and set realistic goals and expectations, and by increasing their knowledge and that of their families concerning CHF and its symptoms, with a focus on self-care and existing possibilities. These measures will make it easier for woman with CHF to maintain a hopeful perspective and a sense of control, competence, and self-esteem.

  • 77.
    Mårtensson, Jan
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Dracup, Kathleen
    School of Nursing, University of California, San Francisco.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Decisive situations influencing spouses' support of patients with heart failure: A critical incident technique analysis2001In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 30, no 5, p. 341-350Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The aim of this study was to describe decisive situations experienced by spouses of patients with heart failure that could potentially affect their ability to provide social support to the patient.

    METHODS:

    A qualitative descriptive design with a critical incident technique was used. Twenty-three informants, 15 women and 8 men, who were spouses of patients with severe heart failure were strategically chosen to ensure maximal variation in sociodemographic data and experiences as a spouse.

    RESULTS:

    Decisive situations influenced the experience of spouses of patients with heart failure in a manner that was either positive (involvement with others) or negative (feeling like an outsider). When spouses were given attention and treated like persons of value, they experienced involvement with others. In these cases, spouses had someone to turn to and were included in the physical care. In contrast, when spouses were kept at a distance by the patient, were socially isolated, and received insufficient support from children, friends, and health care professionals, they experienced feeling like an outsider.

    CONCLUSIONS:

    By identifying spouses' experiences, health care professionals can assess which kind of specific interventions should be used to improve the life situation of the patient with heart failure and his or her spouse.

  • 78.
    Mårtensson, Lena I.
    et al.
    Veddige Health Care Centre, Veddige, Sweden.
    Pettersson, Lisbeth
    Varberg Health Care Centre, Varberg, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    Patients with fibromyalgia and their conception of health after an intervention programme1995In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 2, no 3-4, p. 113-120Article in journal (Refereed)
    Abstract [en]

    Fibromyalgia is a well-known syndrome interpreted as general muscular pain in the whole body and as pressure soreness in the so-called tender points. The cause of the syndrome is not yet clear and it has therefore been difficult to find proper treatment. The aim of this study was to describe how patients with fibromyalgia conceived their health after having taken part in an intervention programme based on ego-strengthening psychotherapy and the salutogenetic model. The intervention was performed by an occupational therapist and a physiotherapist. In this study, 10 patients were interviewed and data were analysed by the phenomenographic method. Four different catagories of health conceptions became evident as a result of the intervention; receiving confirmation, creating distance to things, gaining insight, and gaining control. The results showed that the patients had increased their sense of meaningfulness, comprehensibility and manageability of the pain syndrome, which led to improved health. Due to the fact that this kind of intervention requires comparatively small resources in terms of staff and financial expenditure it is suitable in small clinics, e.g. health care centres. Further research should be aimed at finding out whether this intervention also suits patients with other diagnoses or whether treatment in larger groups might produce equally favourable results. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

  • 79.
    Nederfors, T.
    et al.
    Cent Hosp, Dept Hosp Dent, Halmstad, Sweden.
    Isaksson, R.
    Cent Hosp, Dept Hosp Dent, Halmstad, Sweden.
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Attitudes to the importance of preserving own teeth in an adult Swedish population1998In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 77, no 5, p. 1335-1335Article in journal (Other academic)
  • 80.
    Nederfors, T.
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Isaksson, R.
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Ability to estimate oral health status and treatment need in elderly receiving home nursing - a comparison between a dental hygienist and a dentist2000In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 79, no 5, p. 1291-1291Article in journal (Other academic)
  • 81.
    Nederfors, Tommy
    et al.
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Paulsson, Gun
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Isaksson, Rita
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Ability to estimate oral health status and treatment need in elderly receiving home nursing: a comparison between a dental hygienist and a dentist2000In: Swedish Dental Journal, ISSN 0347-9994, Vol. 24, no 3, p. 105-116Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare the estimation ability of a dental hygienist to that of a dentist when, independently, recording the oral health status and treatment need in a population of elderly, receiving home nursing. Seventy-three persons, enrolled in a home nursing long-time care programme, were recruited. For the oral examination a newly developed protocol with comparatively blunt measurement variables was used. The oral examination protocol was tested for construct validity and for internal consistency reliability. Statistical analyses were performed using Wilcoxon matched pairs signed rank sum test for testing differences, while inter-examiner agreement was estimated by calculating the kappa-values. Comparing the two examiners, good agreement was demonstrated for all mucosal recordings, colour, form, wounds, blisters, mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental hygienist recorded significantly more changes. The dental hygienist also recorded significantly higher plaque index values. Also regarding treatment intention and treatment need, the dental hygienist's estimation was somewhat higher. In conclusion, when comparing the dental hygienist's and the dentist's ability to estimate oral health status, treatment intention, and treatment need, some differences were observed, the dental hygienist tending to register "on the safe side", calling attention to the importance of inter-examiner calibration. However, for practical purpose the inter-examiner agreement was acceptable, constituting a promising basis for future out-reach activities.

  • 82.
    Nilsson, Ulrica
    et al.
    Umeå University, Umeå, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Alm-Roijer, Carin
    Malmö University, Malmö, Sweden.
    Thylen, Ingela
    Linköping University, Linköping, Sweden.
    Sex knowledge in males and females recovering from a myocardial infarction: a brief communication2012In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 21, no 4, p. 486-494Article in journal (Refereed)
    Abstract [en]

    The purpose of this article was to explore sexual knowledge in persons who had suffered from myocardial infarction (MI). Seventy-six Swedish persons completed the "Sex after MI Knowledge Test" questionnaire. Overall, 53% of the men and 45% of the women scored maximum in the test. In a comparison between sexes, the men scored significantly more often a correct answer compared to the women for two out of the 25 items. The levels of correct answers were less then 50% for 14 out of the 25 items in both sexes. In conclusion we found that people who had suffered MI had poor levels of knowledge about sex and that there were some differences concerning lesser knowledge among the females in comparison to males. In regard to application, using a validated instrument facilitates an interactive communication between the patient and health care professionals, and opens up for a tailored education in line with the patient's and his or her partner's needs. © The Author(s) 2012.

  • 83.
    Paulsson, Gun
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nederfors, T.
    Cent Hosp, Dept Hosp Dent, Halmstad, Sweden.
    Attitudes to oral hygiene procedures among nursing personnel in special housing facilities for the elderly.1998In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 77, no 5, p. 1335-1335Article in journal (Other academic)
  • 84.
    Paulsson, Gun
    et al.
    Oral and Dental Health Centre, Central Hospital, Halmstad, Sweden.
    Nederfors, T.
    Oral and Dental Health Centre, Central Hospital, Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    Nurse managers' conception of oral health. A qualitative analysis.2000In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 79, no 5, p. 1291-1291Article in journal (Other academic)
    Abstract [en]

    Aim: The aim of this study was to describe how nurse managers perceive oral health in general and the oral health of the care-receiver in particular. Background: Oralhealth and general health are independent and influence each other through biological, psychological, emotional and developmental factors. To most adults, oral health is anatural daily routine of hygiene, whereas to people who are dependent on other people's assistance, it is a procedure carried out by nursing personnel. Methods: Data were collected through interviews and analysed according to the phenomenographical method. Findings: Five categories emerged describing how nurse managers perceive oralhealth: maintaining patients' well-being, having knowledge about oral health, behaviour towards the patient, feeling of being insufficient and creating the necessary conditions. Conclusion: The nurses considered oral health an important and obvious, but neglected, part of nursing. They expressed the wish to be updated in the knowledge area concerned, both for themselves and for their personnel. A majority called for standards for oral care, including documentation, which was considered necessary for the successful implementation. Implications: A suggestion for further research is to study whether the creation of national standards may increase its status and quality.

  • 85.
    Paulsson, Gun
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nederfors, Tommy
    Oral Health Centre, Central Hospital, Halmstad, Sweden; King Faisal Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
    Söderfeldt, Björn
    Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    The effect of an oral health education program after three years2003In: Special Care in Dentistry: managing special patients, settings, and situations, ISSN 0275-1879, E-ISSN 1754-4505, Vol. 23, no 2, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Three years after providing an oral health education program (OHEP) to nursing personnel, the authors analyzed the effect of the program on knowledge of the importance of oral health and on perception among the nurses of the possibility to implement oral care in patient care. The study was based on a cross-sectional survey of all nursing personnel (N = 2,901) in five municipalities in the Southwestern Sweden, of whom 950 had attended four one-hour lessons during an OHEP in 1996. The response rate to the survey questionnaire was 67% (1,930 subjects). Statistical analysis was performed by means of descriptive and analytical statistics. The program was shown to have an independent effect on the dependent variables "knowledge of oral health" and "assessment of implementation possibilities," This study has given further evidence of the feasibility of an educational program to improve both knowledge and implementation of oral health care. through interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the transcribed interviews showed that there were four strategies, related to staff education, hospital resources, and leadership motivation. The strategies were grounded in data and emerged from the interaction between the two main categories: 'the valuation of the importance of oral health' and 'the behavior towards oral health maintenance'. They were characterized as the routine, theoretical, practical, and flexible strategies, with the latter considered ideal. As increased knowledge is one important part in enhancing the nursing personnel's ability to perform oral hygiene procedures, there is a need for education among nursing personnel, primarily among those using a routine strategy.

  • 86.
    Paulsson, Gun
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Söderfeldt, Björn
    Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Nederfors, Tommy
    Oral Health Centre, Central Hospital, Halmstad, Sweden.
    Recall of an oral health education programme by nursing personnel in special housing facilities for the elderly2001In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 18, no 1, p. 7-14Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the recall of oral health knowledge and confidence by nursing personnel in special housing facilities for the elderly, three years after an education programme.

    Design: A cross sectional design using a questionnaire.

    Sample: All nursing personnel, a total of 2,901 subjects, in five municipalities in south-western Sweden; of whom 950 had attended the programme. The response rate was 67% (1930 subjects).

    Intervention: An oral health education programme consisting of four one-hour lessons.

    Results: The oral health education programme still had an effect on the participants' attitudes towards oral health three years later. When comparing the trained group (OHEP+) which attended the programme with those who did not have training (OHEP-), the perceived ability, opportunity and the knowledge of oral health were significantly better in the former group, p<0.01 Eurther, within the OHEP- group who did not attend the programme there was a significant difference in the perceived ability, opportunity and the knowledge of oral health between those with a higher level of health care education, p<0.01.

    Conclusions: The effect of an oral health education programme on the participants' attitudes towards oral health persists at least for three years. The data indicate that trainees with a low level of health care education benefit most.

  • 87.
    Paulsson, Gun
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Söderfeldt, Björn
    Cent Hosp Halmstad, Oral Hlth Ctr, Halmstad, Sweden .
    Nederfors, Tommy
    King Faisal Specialist Hospital and Research Centre, Department of Dentistry, Riyadh, Saudi Arabia.
    Fridlund, Bengt
    School of Health Sciences Jönköping, School of Health Sciences, Jönköping, Sweden.
    Nursing personnel's views on oral health from a health promotion perspective: a grounded theory analysis2002In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 60, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to develop a model for how nursing personnel view oral health in general and the oral health of the care receivers in particular, applying a health promotion perspective and using grounded theory analysis. Data were collected through interviews with 17 nursing personnel, selected by strategic sampling. Analysis of the transcribed interviews showed that there were four strategies, related to staff education, hospital resources, and leadership motivation. The strategies were grounded in data and emerged from the interaction between the two main categories: 'the valuation of the importance of oral health' and 'the behavior towards oral health maintenance'. They were characterized as the routine, theoretical, practical, and flexible strategies, with the latter considered ideal. As increased knowledge is one important part in enhancing the nursing personnel's ability to perform oral hygiene procedures, there is a need for education among nursing personnel, primarily among those using a routine strategy.

  • 88.
    Pihl, Emma
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Cider, Åsa
    Physiotherapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Strömberg, Anna
    Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Mårtensson, Jan
    Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Exercise in elderly patients with chronic heart failure in primary care: Effects on physical capacity and health-related quality of life2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, p. 150-158Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: 

    Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL). 

    AIM: 

    The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care.

    METHODS: 

    An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12 months.

    RESULTS: 

    Exercise significantly improved muscle endurance in the intervention group (n=29, mean age 76.2years) compared to the control group (n=31, mean age 74.4years) at all follow-ups except for shoulder flexion right at 12months (shoulder abduction p=0.006, p=0.048, p=0.029; shoulder flexion right p=0.002, p=0.032, p=0.585; shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3months (p=0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12months (p=0.016 and p=0.034) and SF-36, general health (p=0.048) and physical component scale (p=0.026) significantly improved at 3months compared to the control group. 

    CONCLUSION: 

    This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population. ©Sage Publications

  • 89.
    Pihl, Emma
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Jacobsson, Anna
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Strömberg, Anna
    Linköping University.
    Mårtensson, Jan
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study2005In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 7, no 4, p. 583-589Article in journal (Refereed)
    Abstract [en]

    Background:

    Little is known about the factors that influence the health outcome of elderly patients suffering from heart failure or the health of their spouses. The aim of this comparative study was to determine if older patients suffering from heart failure and their spouses experience similar levels of health-related quality of life (HRQOL) and depression. The aim was also to identify those factors that contribute to HRQOL and depression in patient-spouse pairs.

    Methods:

    Data were collected from 47 couples, using the Short Form 36 (SF-36) and Zung Self-rating Depression Scale (SDS) questionnaires.

    Results:

    Patients suffering from heart failure and their spouses differed significantly in their experience of the physical, but not the mental, health-related quality of life, with patients experiencing significantly worse physical functioning. Physical symptoms of heart failure seemed to dominate the experience of the patient and was positively related to mental health and inversely related to the New York Heart Association classification (NYHA class) and patients' depression. Depressive symptoms as reflected in SDS showed no significant difference between patients and spouses. Patients' depression was positively related to high NYHA class, while spouse depression was positively related with higher age of the patient.

    Conclusion:

    Physical symptoms seem to dominate the experience of heart failure.

  • 90.
    Rask, Mikael
    et al.
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Malm, Dan
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Kristofferzon, Marja Leena
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Roxberg, Åsa
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Group for Research on health promotion and disease prevention.
    Arenhall, Eva
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Baigi, Amir
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Brunt, David
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Fridlund, Bengt
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Ivarsson, Bodil
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Nilsson, Ulrica
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Sjöström-Strand, Annica
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Wieslander, Inger
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Benzein, Eva Gunilla
    Växjö University, School of Health Sciences and Social Work, Växjö, Sweden.
    Validity and reliability of a Swedish version of the Relationship Assessment Scale (RAS): a pilot study2010In: Canadian journal of cardiovascular nursing, ISSN 0843-6096, Vol. 20, no 1, p. 16-21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need for a short and easily administered scale, in the Swedish language, for assessing partner relationships in the health care of persons with cardiac disease. PURPOSE: To establish the reliability and validity of the Swedish version of the Relationship Assessment Scale (RAS). DESIGN: The present pilot study has a methodological design. FINDINGS: Content validity has been tested for relevance, clarity and readability. The scale was tested for construct validity with explorative factor analysis. The reliability was tested by internal consistency and test-retest analysis. The result showed a two-factor solution, which does not correspond to the original proposed one-factor solution. The factor analyses revealed two quite distinct factors of RAS, labelled "Relationship built on expectations and satisfaction of needs" and "Relationship built on love and devotion". CONCLUSIONS: The scale has satisfactory psychometric properties in terms of content validity, construct validity, homogeneity and stability in a population of persons with cardiac disease. Wider evaluations of the RAS for other populations and settings are recommended.

  • 91.
    Roxberg, Åsa
    et al.
    Växjö University, Växjö, Sweden & University College of Haraldsplass, Bergen, Norway.
    Burman, Marianne
    Växjö University, Växjö, Sweden.
    Guldbrand, Mona
    Växjö University, Växjö, Sweden.
    Fridlund, Bengt
    Växjö University, Växjö, Sweden & Jönköping University, Jönköping, Sweden.
    Barbosa da Silva, António
    Ansgar College and Theological Seminary, Kristiansand, Norway & Stavanger University, Stavanger, Norway.
    Out of the wave: the meaning of suffering and relieved suffering for survivors of the tsunami catastrophe. An hermeneutic-phenomenological study of TV-interviews one year after the tsunami catastrophe, 20042010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 4, p. 707-715Article in journal (Refereed)
    Abstract [en]

    The tsunami catastrophe, 26th December 2004, is one of a number of catastrophes that has stricken mankind. Climate reports forecast that natural disasters will increase in number in the future. Research on human suffering after a major catastrophe, using a caring science perspective, is scarce. The aim of the study was to explore the meaning of suffering and relieved suffering of survivors of the tsunami catastrophe, 26th December 2004. An explorative study design, inspired by the French philosopher Paul Ricoeur’s hermeneutic-phenomenology, was used. Interviews made by the Swedish Television (SVT) in connection with the 1 year anniversary were carried out on site in the disaster area and in Sweden. The text analysis revealed four main themes: ‘An incomprehensible event’, ‘A heavy burden’, ‘Help that helps’, and to ‘Being changed in a changed life situation’. The findings were mainly interpreted in light of Paul Ricoeur’s thinking on suffering, quilt, forgiveness, time and narrative. The first year after the loss of loved ones in the tsunami catastrophe, 2004, was like starting an inner as well as an outer journey. This journey was experienced as living with the heavy burden of an incomprehensible event. Help that helped was mediated by consolers who endured the suffering of the other. An ‘enduring courage’ is a key moral virtue to encounter the alienation of the sufferer and how it in turn alienates from the sufferer. It is also important to recognize that the complexity of the world of those who have lost loved ones in major catastrophes includes possibilities for reconciliation with the loss. The reconciliation creates hope that opens up for being changed in a changed life situation.© 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

  • 92.
    Roxberg, Åsa
    et al.
    Växjö University, Växjö , Sweden.
    Dahlberg, Karin
    Växjö University, Växjö , Sweden.
    Stolt, Carl-Magnus
    Medical Humanities, Karolinska Institute, Stockholm, Sweden.
    Fridlund, Bengt
    Växjö University, Växjö, Sweden & Jönköping University, Jönköping, Sweden.
    In the midst of the unthinkable. A phenomenological life-world approach to the experiences of suffering and relieved suffering during the tsunami catastrophe, 2004.2009In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 1, p. 17-27Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to highlight the instantaneous experience of suffering and relieved suffering that was presented on the Swedish Television (SVT) by those who experienced the tsunami wave in Thailand, 26 December 2004. The selected TV-interviews were watched, transcribed and conducted with an empirical phenomenological analysis. A phenomenological lifeworld approach, inspired by the French philosopher Maurice Merleau-Ponty, was chosen for the theoretical framework. The findings showed three main features: the motion, the stillness and the shift in perspective. The motion comprised both the motion of the wave and the motion it caused the victims in terms of external as well as internal disorder. When the tsunami waves withdrew, it was followed by stillness. The feeling of being unreal was prominent, triggered by lack of information and endless waiting. Another prominent feature was the victims’ incapacity to answer ‘‘how long’’ they had suffered before being rescued. The tsunami catastrophe seemed to be a timeless event. Caring for other victims meant a shift in perspective in one’s own devastated world to that of another person. The shift between focus and comprehension, contributed to the making of life-saving decisions, for the victims themselves and for other victims. The findings were mainly reflected on from the perspective of the French philosopher Maurice Merleau-Ponty, for example the experience of time as an embedded and lived now. It was also reflected on from the perspective of the German philosopher Karl Jaspers as a limit-experience and as a fulfilment of love. A suggestion for further research is to investigate how suffering and relieved suffering is experienced and encountered when further time has passed.

  • 93.
    Roxberg, Åsa
    et al.
    Växjö University, Växjö, Sweden.
    Eriksson, Katie
    Åbo Academy, Vasa, Finland & Helsinki University Central Hospital, Helsinki, Finland.
    Rehnsfeldt, Arne
    Linköping University, Linköping, Sweden.
    Fridlund, Bengt
    Växjö University, Växjö, Sweden.
    The meaning of consolation as experienced by nurses in a home-care setting2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 8, p. 1079-1087Article in journal (Refereed)
    Abstract [en]

    Aims and objective. The aim of this study was to illuminate nurses’ experiences of consolation and how these experiences relate to suffering and care.

    Background. Consolation is commonly associated with the relief of suffering. The question of consolation in terms of its definition and relevance for care has, however, been a matter of discussion among nurse researchers. The question raised concerns about the nature of consolation, its place and its role in relation to care and the caring sciences.

    Design. An explorative qualitative interview study with 12 participants, six registered and six enrolled nurses, was carried out in a home-care context.

    Methods. A phenomenological-hermeneutic method inspired by the French philosopher Paul Ricoeur was used for the text analysis.

    Results. Two main aspects of consolation appeared: ‘the present consolation’, which is flexible, sustaining and opening and ‘the absent consolation’, which conceals the suffering and is incapable of consoling. The result was interpreted from a philosophical-ethical perspective, based on the works of Levinas and Lögstrup.

    Conclusions. Consolation appears as a complex phenomenon, both in terms of its existence and its absence consolation, constituting a caring and non-caring consolation. A caring consolation entails meeting the other as different and being present in a way that gives the other space to be the one he or she really is. It requires acceptance, accepting the sufferer and his/her way of suffering as unique.

    Relevance to clinical practice. The clinical nurse is involved in complex care situations, which entails both reflecting upon and using intuition when consoling. A caring consolation is a contradictory phenomenon that requires a nurse to be capable of both reflecting upon and acting intuitively on the unique suffering of the other. © 2008 Blackwell Publishing Ltd.

  • 94.
    Roxberg, Åsa
    et al.
    Linnaeus University, Växjö, Sweden & University College of Haraldsplass, Bergen, Norway.
    Sameby, Jessica
    Linnaeus University, Växjö, Sweden.
    Brodin, Sandra
    Linnaeus University, Växjö, Sweden.
    Fridlund, Bengt
    Linnaeus University, Växjö, Sweden & Jönköping University, Jönköping, Sweden.
    Barbosa da Silva, António
    Psykisk helsearbeid, Kristiansand, Norway.
    Out of the wave: The meaning of suffering and relief from suffering as described in autobiographies by survivors of the 2004 Indian Ocean tsunami2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 3, article id 5323Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the meaning of suffering and relief from suffering as described in autobiographies by tourists who experienced the tsunami on 26 December 2004 and lost loved ones. A lifeworld approach, inspired by the French philosopher Merleau-Ponty's phenomenology of perception, was chosen for the theoretical framework. This catastrophe totally changed the survivors' world within a moment. In this new world, there were three main phases: the power of remaining focused, a life of despair, and the unbearable becoming bearable. Life turns into a matter of making the unbearable bearable. Such challenging experiences are discussed in terms of the philosophy of Weil, Jaspers, and Merleau-Ponty. The survivors of the tsunami catastrophe were facing a boundary situation and "le malheur," the unthinkable misfortune. Even at this lowest level of misfortune, joy is possible to experience. This is part of the survivors' ambivalent experiences of their lifeworld. In this world of the uttermost despair there are also rays of hope, joy, and new life possibilities. © 2010 Å. Roxberg et al.

  • 95.
    Samarashinge, Kerstin
    et al.
    Kristianstad University.
    Arvidsson, Barbro
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Abrahamsson, Anita
    FoUrum, County of Jönköping.
    Fridlund, Bengt
    Jönköping University.
    The promotion of family wellness for refugee families in cultural transition- A phenomenographic study2012In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 2, no 4, p. 92-104Article in journal (Refereed)
    Abstract [en]

    Objective: To illustrate how nurses can promote family wellness and facilitate acculturation for involuntary migrant families as conceptualized by bilingual interpreters and cultural mediators with own past refugee experience.  Due to the nature of involuntary migration and accompanying acculturation, refugee families face a complex transition, exposing them to vulnerability in cohesion and family function. Involuntary migrant health needs are largely managed within the Primary Health Care sector where Primary Health Care Nurses (PHCN) play an important role. Additionally, bilingual interpreters and cultural mediators with personal experience of being refugees and subsequent acculturation play a critical role in bridging the language and cultural gap between migrant families and PHCNs.

    Methods: The study is descriptive and explorative in design with a phenomenographic approach. Data was collected in Southern Sweden utilizing in-depth interviews with ten bilingual interpreters and cultural mediators originating from the Balkans, Kurdistan, Eritrea and Somalia. A contextual analysis with reference to phenomenography was used in interpreting the data material.

    Results: Three separate themes illustrated the meaning of family wellness: a sense of belonging to the new homeland, the maintenance of self-esteem and stable family interrelationships. The analysis demonstrated that the way ex-refugee bilingual interpreters and cultural mediators perceived of how to promote family wellness, fell into three qualitative different conceptions: (1) Promotion of family wellness is the responsibility of the family itself, manifested in its attitude in wanting to adjust to change, (2) Promotion of family wellness is the consideration of those outside the family and is marked by understanding and respectful attitudes, (3) Promotion of family wellness is a societal responsibility to which successful integration is a prerequisite.

    Conclusions: The promotion of health of involuntary migrant families in cultural transition is complex due to families, other members of the society and society at large all contributing to family wellness in the process of acculturation. For nurses to facilitate a healthy transition for involuntary migrant families, a holistic approach working with the entire family in a psychosocial way and cooperating with other health care professionals, community authorities and ethnic organizations maybe a future direction in encounters with involuntary migrant families with health problems. Adopting a family system approach will enable nurses to provide culturally and transition-competent quality care by enabling stabilizing interfamily relationships through supportive conversations about changes and its subsequent reactions and possible coping of the family as a unit. Further research in order to enhance health promotion would preferable take on a participatory approach. © Sciedu Press

  • 96.
    Skärsäter, Ingela
    et al.
    Göteborg University, Fac. of Health and Caring Sciences, Institute of Nursing, Göteborg, Sweden.
    Dencker, Karina
    Göteborg University, Fac. of Health and Caring Sciences, Institute of Nursing, Göteborg, Sweden.
    Häggström, Lars
    Department of Psychiatry, Central Hospital, S-301 85 Halmstad, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    A salutogenetic perspective on how men cope with major depression in daily life, with the help of professional and lay support2003In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 40, no 2, p. 153-162Article in journal (Refereed)
    Abstract [en]

    Worldwide, major depression is one of the main causes of premature death and lowered functional capacity, and its importance will increase in the coming years. At the same time, there is a gap in service provision, and the needs of depressed patients are often not met. Therefore, the aim of this study was to describe how men (N = 12) with major depression (DSM-IV) cope with daily life with the help of professional and lay support. The men were selected by strategic sampling and analysed with an approach inspired by phenomenography. Four descriptive categories emerged: being unburdened, restoring one's health, feeling involved, and finding a meaning. A man receives help and support from health care in,restoring his health but his own path to getting well is to resume his place in the public domain. To help him do so, lay support is vital, and an important task for the nurse is, therefore, to support him in maintaining his existing social network or in building a new one. (C) 2002 Elsevier Science Ltd. All rights reserved.

  • 97.
    Strömberg, A.
    et al.
    Dept Cardiol, Linkoping, Sweden .
    Mårtensson, J.
    Country Hosp Ryhov, Dept Cardiol, Jonkoping, Sweden .
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Dahlström, U.
    Univ Hosp, Dept Cardiol, Linkoping, Sweden.
    Factors causing hospitalisation due to heart failure2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, p. 472-472Article in journal (Other academic)
  • 98. Strömberg, A.
    et al.
    Mårtensson, J.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Karlsson, J.E.
    Levin, L.A.
    Dahlström, U.
    Effects of follow-up after hospitalisation at a nurse-led heart failure clinic: a randomiced trial2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, p. 242-242Article in journal (Other academic)
  • 99.
    Strömberg, Anna
    et al.
    Department of Cardiology, University Hospital, Linköping, Sweden.
    Dahlström, Ulf
    Department of Cardiology, University Hospital, Linköping, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Computer-based education for patients with chronic heart failure: A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life2006In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 64, no 1-3, p. 128-135Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences.

    METHODS: One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n = 72) or standard education and additional computer-based education (n = 82).

    RESULTS: Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P = 0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P = 0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P = 0.0001).

    CONCLUSION: Computer-based education gave increased knowledge about heart failure. PRACTICE IMPLICATIONS: Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated.

  • 100.
    Strömberg, Anna
    et al.
    Department of Cardiology, Heart Centre, Linköping University Hospital, Linköping, Sweden.
    Mårtensson, Jan
    Department of Medicine, Faculty of Health Sciences, Linkdping University, Linköping, Sweden.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Dahlström, Ulf
    Department of Cardiology, Heart Centre, Linköping University Hospital, Linköping, Sweden.
    Delay time and factors causing hospitalization due to heart failure2002In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 106, no 19, p. 599-600Article in journal (Other academic)
123 51 - 100 of 118
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