Nurse training of a patient-centered information procedure for CABG patients

The preferred IT sources and tools of Iranian people for accessing health information

INTRODUCTION

People need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.

METHODS

This national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.

RESULTS

The participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).

CONCLUSION

The results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

Making knowledge clips with patients: What learning mechanisms are triggered in medical students?

OBJECTIVE

To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course.

METHODS

In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis.

RESULTS

We identified four learning mechanisms: Challenging assumptions about patients' information needs; Becoming aware of the origin of patients' information needs; Taking a patient's perspective; Analyzing language to adapt to patients' needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students.

CONCLUSION

Collaborating with patients helped students to recognize and understand patients' perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients.

PRACTICE IMPLICATION

Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients' perspectives.

Relationship between Psychological Distress and Demographic Characteristics among Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery

Coronary artery bypass graft (CABG) surgery patients often present with anxiety and depression. These symptoms coupled with pain are major concerns and are widely reported among CABG patients. The study aimed to evaluate the relationship between psychological distress and patients’ demographic data. This cross-sectional study in which 178 patients from a surgery ward were selected using the census method. Data were collected using the Hospital Anxiety and Depression Scale and the Brief Pain Inventory (Short Form). The participants’ mean age was 57.49 ± 13.78 years. The majority of participants had a moderate level of anxiety (89.3%) and a moderate level of pain interference (74.7%). Significant differences were noted, with a higher proportion of moderate anxiety level participants aged between 60 and 74 years old, married, and with a tertiary level education (p < 0.05) being found. There were also significant differences between gender (p < 0.05) and pain severity (p < 0.01) across the levels of depression. The levels of anxiety, depression, and pain were significant, especially among older patients. These symptoms should be routinely assessed, and further identification of predictors such as socioeconomic status before the procedure is necessary.

"Walking in the patient's shoes": An innovative training method using storytelling to promote knowledge transfer of patient-centered care in hospital: A quasi-experimental study

OBJECTIVE

To evaluate an onsite patient-centered care (PCC) training program for nurses using a digital patient-storytelling approach.

BACKGROUND

PCC is a dominant model for improving the quality of care. Effective strategies for providing PCC training to nurses can yield numerous benefits.

DESIGN

A pretest-posttest design was used with a nonrandomized control group METHODS: PCC training program involved participants playing a patient role to experience their hospital journey. Nurses' perception of PCC, compassion and knowledge transfer were measured before (pretest) and after (posttest) PCC training (experimental group). Controls received PCC training only after pretest and posttest evaluations.

RESULTS

Changes in PCC perception and compassion were significantly greater in the experimental group (n = 39) than in controls (n = 49; p = .001 and .006, respectively). PCC knowledge transfer was significantly correlated with PCC perception (r = 0.55) and compassion (r = 0.63).

CONCLUSIONS

Through the PCC training program, the perceived improvements of the nurses' views on supporting patient individuality and compassion while providing care were revealed. This program is also potential for promoting PCC knowledge transfer into the daily activities of nurses. Therefore, such PCC training programs could be a good beginning in developing a patient-centered culture in healthcare systems.

Listening to patients' voices: Applying the design-thinking method for teaching person-centered care to nursing students

BACKGROUND

Providing a person-centered care (PCC) education program to nursing students is necessary. This study aims to determine the impact of a design-thinking based education program on how nursing students perceive PCC.

METHODS

Five 2-h lessons were offered to 105 fourth-year nursing students in South Korea. Each randomly assigned group of eight or nine students was instructed to develop a plan to address the problems/dissatisfaction experienced by patients during hospitalization. The Individualized Care Scale-nurse's version was used to measure student's perception of PCC before and after the education program.

RESULTS

After the program the students exhibited significant improvements in how they viewed supporting patient individuality, with that score increasing by 0.44 (from 3.64 to 4.08; p < 0.0001), and maintaining patient individuality while providing care, with that score increasing by 0.34 (from 3.71 to 4.05; p < 0.0001). Among subdomains, the most notable change was in how the students viewed the personal life situation of patients, and its impact on patients' healthcare outcomes.

CONCLUSION

This education program, based on the design-thinking approach, was effective in improving the perceptions of nursing students about PCC. Expanding such PCC education programs for nursing school students should therefore be considered.

Effect of physician prescribed information on hospital readmission and death after discharge among patients with health failure: A randomized controlled trial

In order to understand if a physician prescribed medical information changes, the number of hospital readmission, and death among the heart failure patients. A 12-month randomized controlled trial was conducted (December 2013-2014). Totally, 120 patients were randomly allocated into two groups of intervention (n = 60) and control (n = 60). Accordingly, the control group was given the routine oral information by the nurse or physician, and the intervention group received the Information Prescription (IP) prescribed by the physician as well as the routine oral information. The data was collected via telephone interviews with the follow-up intervals of 6 and 12 months, and also for 1 year after the discharge. The patients with the median age of (IQR) 69.5 years old (19.8) death upon adjusting a Cox survival model, [RR = 0.67, 95%CI: 0.46-0.97]. Few patients died during 1 year in the intervention group compared to the controls (7 vs 15) [RR = 0.47, 95%CI: 0.20-1.06]. During a period of 6-month follow-up there was not statistically significant on death and readmission between two groups. Physician prescribed information was clinically and statistically effective on the reduction of death and hospital readmission rates among the HF patients in long term follow-up.

Patient satisfaction with personal patient care (PPC) in the inpatient treatment of endometriosis

PURPOSE

The aim of this retrospective cohort study was to validate patient's satisfaction and surgical complication rate in patients treated at a certified endometriosis centre with personal patient care (PPC).

METHODS

The implementation of PPC at a gynaecologic treatment centre was retrospectively evaluated by analysing perioperative complications using the Clavien Dindo (CD) classification and patient satisfaction utilizing the Picker Patient Experience Questionnaire (PPE-15) for a total of 219 symptomatic endometriosis patients treated surgically at a certified endometriosis centre (Agaplesion Diakonie Hospital, Kassel, Germany) between November 2018 and April 2019. Data from our sample on complication rates and satisfaction were compared with those from reference samples published by Radosa et al. and Jenkinson et al. RESULTS: An overall complication rate of 10.96% (24 out of 219 patients) was observed. Four endometriosis patients (1.83%) had major complications with complications grade III according to the CD classification system. 155 patients out of 219 chose to answer the PPE-15 (return rate 70.78%). 92 patients (59.35%) reported about problems during their treatment in our hospital in their PPE-15. "Doctors sometimes talked as if I was not here" was the best rated item (1.2%) in our cohort. "Staff gave conflicting information" was the most mentioned item (33.55%) by patients during their hospital stay in relation to patient dissatisfaction.

CONCLUSION

Incorporation of PPC in the surgical inpatient treatment of endometriosis patients resulted in a low postoperative complication rate and a high patient satisfaction in our study cohort. Furthermore, nursing staff of endometriosis patients also needs particular attention.

Person-centred discharge education following coronary artery bypass graft: A critical review

AIMS AND OBJECTIVES

To examine the extent that individualised education helps reduce depression and anxiety and improves self-care for people who have undergone coronary artery bypass graft surgery.

BACKGROUND

Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person-centred care ensure that patients' educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation.

DESIGN

A critical review of published peer-reviewed literature was conducted.

METHODS

Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015.

RESULTS

Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi-experimental with two reviews.

CONCLUSION

A greater understanding of the patients' needs allows tailored education to be provided, which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient-centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft.

RELEVANCE TO CLINICAL PRACTICE

Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals' ability to self-care, health and well-being.

The Motivations of Iranian Patients With Cardiovascular Disease to Seek Health Information: A Qualitative Study

BACKGROUND

Cardiovascular patients need information to preserve and promote their health, but not all of them have the necessary motivation to seek relevant health knowledge.

OBJECTIVES

The present study analyzed experiences of patients, family caregivers, and healthcare providers to explore the motivating factors that cause cardiovascular patients to seek important health information.

PATIENTS AND METHODS

This study was conducted using a qualitative approach and conventional qualitative content analysis method. Thirty-six people, including 18 cardiovascular patients, 7 family caregivers, and 11 healthcare providers (from multidisciplinary backgrounds) participated in the study. The data were collected through semi-structured interviews and purposeful sampling and continued until data saturation. Data collection and analysis proceeded simultaneously and with constant comparison; this study was carried out from May 2012 to May 2013.

RESULTS

During the analysis process, three main themes were extracted that characterized participants' experiences, perceptions, and motivations to seek health information. The themes were "Optimizing quality of life, "Desire for personal rights to be respected," and "Gaining confidence through consultation."

CONCLUSIONS

Our findings showed that, through seeking information, patients try to achieve well-being and realize their personal rights as well as their right to security. They should also be encouraged to enhance their quality of life by using the Knowles' learning theory to formulate their needs and learning priorities.

How can placebo effects best be applied in clinical practice? A narrative review

Placebo effects are documented in a number of clinical and experimental studies. It is possible to benefit from placebo effects in clinical practice by using them as effects additive to those of documented and effective treatments. The purpose of this paper is to discuss how doctors and other health workers may benefit from placebo effects within an ethical framework. A narrative review of the literature relating to placebo effects in clinical practice was performed. We searched PubMed and selected textbooks on placebo effects for articles and book chapters relating to placebo effects in clinical practice. By drawing on placebo effects, doctors may access patients' self-healing potentials. In practice, doctors may best benefit from placebo effects by influencing the patient's expectations through communication. An important principle is to give the patient information stating that a particular treatment is effective, as long as this is based on realistic optimism. A patient-centered style involving elements such as developing trust and respect, exploring the patient's values, speaking positively about treatments, and providing reassurance and encouragement might aid in activating placebo effects. The total effect of a documented treatment will partly depend on how well the placebo effects have been activated. Thus, placebo effects can be understood as a form of supplemental treatment.

Dental anxiety: a comparison of students of dentistry, biology, and psychology

Introduction

Dental anxiety is an important challenge for many patients and clinicians. It is thus of importance to know more about dental students’ own experiences with dental anxiety and their understanding of dental anxiety. The aim was to investigate differences in dental anxiety levels between dental students, psychology students, and biology students at a Norwegian university.

Materials and methods

A total of 510 students of dentistry, psychology, and biology at the University of Tromsø received a questionnaire consisting of the Modified Dental Anxiety Scale, demographic questions, and questions relating to their last visit to the dentist/dental hygienist; 169 students gave complete responses. Nonparametric tests were used to investigate differences between the student groups.

Results

The respondents were 78% female and 22% male; their mean age was 24 years. The dental students showed a significantly lower degree of dental anxiety than the psychology (P<0.001) and biology students (P<0.001). A significant decrease in dental anxiety levels was found between novice and experienced dentistry students (P<0.001).

Discussion

The dental students had less dental anxiety compared to psychology students and biology students. Experienced dental students also had less dental anxiety than novice dental students. This could indicate that the dentistry program structure at the university may influence dental anxiety levels.

Conclusion

Dental anxiety seemed to be less frequent in dentistry students compared to students of biology or clinical psychology. The practice-oriented dentistry education at the university might contribute to the differences in anxiety levels between new and experienced dentistry students.

Barriers to health information seeking in Iranian patients with cardiovascular disease: a qualitative study

OBJECTIVE

Providing patients with health care information is a critical component of the process of cardiovascular disease (CVD) management. The purpose of this study was to explore obstacles to seeking health care information among cardiovascular patients from the perspectives of patients, their family caregivers, and health care providers.

METHODS

This study was conducted with a qualitative approach using conventional qualitative content analysis. The study included 31 Iranian participants including 16 cardiovascular patients, 5 family members, and 10 health care providers (multidisciplinary). Data were collected with semi-structured interviews and continued to the point of data saturation. Analysis of the data was performed continually and concurrently with data collection of using a comparative method.

RESULTS

Five themes emerged including 'poor quality of information provision,' 'mutual ambiguity,' 'beliefs, faith, and expectations,' 'from routine life to obtaining information,' and 'conditions governing information seekers.' Seven sub-themes indicated participants' experiences and understandings of obstacles in health care information seeking.

CONCLUSION

Health care information seeking in cardiovascular patients and their family members occurs as a result of the influence of beliefs, interaction with numerous information sources, and in the context and structure that the care and information are provided. Understanding the nature of obstacles to health information seeking will help health care policy makers to provide evidence-based, reliable, and patient-centered information to encourage cardiovascular patients' involvement in treatment decisions.

Patient-centered care: clarification of its specific elements to facilitate interprofessional care

Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent operationalization and implementation of this approach to care. This integrative review of the literature, guided by the conceptualization of PCC as a complex intervention, aimed to identify the specific elements of PCC. Conceptual, empirical and clinical literature in different health professions (n = 178 articles) was critically analyzed. Comparing and contrasting the definitions and descriptions of PCC revealed three specific elements that were represented in these components: holistic, collaborative and responsive care. Activities that constitute each component were specified. The implementation of PCC components is facilitated by a non-specific element: the therapeutic relationship. The results inform the development of protocols that can be used to promote the fidelity with which PCC is delivered by different professionals in a variety of healthcare settings.

Patient's Perception of Stressors Associated with Coronary Artery Bypass Surgery

INTRODUCTION

Cardiac surgery, due to being associated with stressors, has many physiological, psychological, emotional, growths, and spiritual potential consequences. However, few studies have been conducted about identifying the stressors. Therefore, the objective of the study was to determine patients' perceptions of stressors associated with coronary artery bypass surgery.

METHODS

In this descriptive study during the two-month investigation, qualified patients for participation in the study (68 persons) undergoing coronary artery bypass graft surgery on the third to fifth postoperative day were selected and with using of Revised Cardiac Surgery Stressors Scale (RCSSS), interpersonal, intrapersonal, and extra personal stressors were determined.

RESULTS

The findings showed that intrapersonal stressors are perceived more than interpersonal and extra personal stressors by patients. In the analysis of data, the highest stressors were "pain and discomfort", "the need to have heart surgery", "death due to illness or surgery", "being away from home and work", "having chest tube".

CONCLUSION

In this study the intrapersonal stressors were perceived more than interpersonal and extra personal stressors by patients, which nurses should put emphasis on identification and elimination of intrapersonal stressors based on the needs of patients.

Nurse's Perception of Stressors Associated with Coronary Artery Bypass Surgery

INTRODUCTION

Cardiac surgery has many physiological, psychological, emotional, growth and spiritual potential consequences due to stress. Identifying and understanding the nature of stress can help nurses in controlling and reducing it. However, few studies have been conducted to identify the stressors. Therefore, the objective of this study was to determine nurses' perceptions of patients' stressors associated with coronary artery bypass surgery.

METHODS

During a two month investigation, qualified nurses (n = 68) of patients undergoing coronary artery bypass were selected on the third to fifth day after surgery. With the use of Revised Cardiac Surgery Stressors Scale (RCSSS), interpersonal, intrapersonal and extrapersonal stressors were determined.

RESULTS

The findings showed that the most interpersonal, intrapersonal and extrapersonal stressors were; "the need to have cardiac surgery", "death due to illness or surgery", "needing assistance with various activities", "doctors and nurses discussing about other patients", "having chest tube" and "Payment of hospital and medical bills".

CONCLUSION

Identification of stressors in patients with coronary artery bypass graft helps nurses in taking better care of them. It would make a better ground for the officials and practitioners towards managing the stressors, especially interpersonal and extrapersonal stressors. Thereby patients are helped to cope with stressors.

The use of short message service (SMS) among hospitalized coronary patients

OBJECTIVE

The use of cell phones and short message service (SMS, also called "texting") has become pervasive in Western society and increasingly throughout the world. Despite the importance of this technology in everyday life, little is known about how patients draw on SMS to keep in contact with family and friends during their hospitalization.

METHODS

A questionnaire was distributed to patients with coronary artery disease discharged from a Norwegian university hospital during the period from June 2005 to June 2006. In addition to questions pertaining to demographics, illness and treatment, mental distress, personality traits, perceived control, Internet usage and lifestyle, respondents were asked if they had contact with family and friends by SMS while in the hospital.

RESULTS

Four hundred twelve responded (59%), of which 216 had undergone surgery and 196 had undergone percutaneous coronary interventions. Sixty-three percent had used SMS to keep in touch with family and friends during their stay at the hospital. Use of SMS was positively predicted by Internet usage, gender and the personality trait of Openness, and was negatively predicted by the belief that illness and health were caused by luck or destiny.

CONCLUSIONS

SMS is an important means of communication during hospitalization for a majority of coronary disease inpatients.

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work

OBJECTIVES

Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway.

DESIGN

Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records.

METHODS

Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis.

RESULTS

A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health.

CONCLUSIONS

Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.

How does nursing staff perceive the use of electronic handover reports? A questionnaire-based study

Following the implementation of electronic nursing records in a psychogeriatric ward, we examined nursing staff's attitudes and perceptions to the implementation of an electronic handover routine. A web-based anonymous and secure questionnaire was distributed by e-mail to all nursing staff at a psychogeriatric ward at a university hospital. Most respondents were satisfied with the electronic handover, and they believed they managed to keep informed by the new routine. The simultaneous introduction of a morning meeting, to ensure a forum for oral professional discussion, was a success. A minority of staff did not fully trust the information conveyed in the electronic handover, and a significant proportion expressed a need for guidance in using the system. Staff that had a high level of trust in written reports believed these saved time, had little trouble finding time and a place to read the reports, and were more positive to the new handover routine.

A preliminary study to evaluate a patient-centred asthma education programme on parental control of home environment and asthma signs and symptoms in children with moderate-to-severe asthma

AIMS AND OBJECTIVES

To evaluate the effectiveness of a nurse-led patient-centred asthma education programme on home environmental control behaviours of parents of children with moderate or severe asthma.

BACKGROUND

Reducing allergic triggers is important self-management behaviour for preventing asthma attacks and patient-centred asthma education has been shown to effectively manage chronic disease.

DESIGN

A preliminary quasi-experimental, non-equivalent control group design was used.

METHOD

Dyads (n = 75) of parents and their children with moderate or severe asthma (ages 6-14 years) were purposively recruited from the asthma clinics of two hospitals in central Taiwan. The experimental group of 38 children/parents from one hospital received patient-centred asthma education. The comparison group of 37 children/parents from the other hospital received routine individual education. At pretest and at the end of the three-month patient-centred asthma education programme, we measured parents' control of home environmental triggers, children's asthma signs/symptoms and children's pulmonary function. Data were analysed by the general linear model for repeat measures.

RESULTS

The level of improvement in dust and cleaning methods was significantly greater among parents in the experimental group than among those in the comparison group (p < 0.05). Children with moderate or severe asthma in the experimental group had fewer signs/symptoms of asthma and better lung function than children in the comparison group.

CONCLUSIONS

Our patient-centred asthma education programme improved parents' home environmental control and children's asthma sign/symptoms and lung function.

RELEVANCE TO CLINICAL PRACTICE

Nurses can play primary roles as patient educators in asthma clinics. Well-trained patient educators can continuously monitor self-management behaviours to improve patients' compliance with home environmental control, thus leading to better physical outcomes in children with asthma than routine individual asthma education alone.

The relation between patient-centeredness and patient empowerment: a discussion on concepts

OBJECTIVE

The concepts of patient-centeredness and patient empowerment offer opportunities for patients to increase their autonomy and involvement in their care and treatment. However, these concepts appear to be understood in different ways by professional groups involved in healthcare and research. To optimize understanding there is a need to create a common language. To explore and compare the concepts of patient-centeredness and patient empowerment, and clarify a possible relationship between the two from the perspective of the encounter between patients and their healthcare providers.

METHODS

Concept analysis approach in which the concepts are compared based on literature review.

RESULTS

Patient-centeredness can be the goal of an encounter between patient and caregiver. As a process, it is of great value in the process of patient empowerment. Patient empowerment appears to be broader than patient-centeredness, and may place greater demands on caregivers and the organisation of healthcare.

CONCLUSION

Patient-centeredness and patient empowerment are complementary concepts which do not oppose one-another. Patient empowerment can be achieved by patient-centeredness, but patients can also empower themselves.

PRACTICE IMPLICATIONS

Clarification of patient-centeredness and patient empowerment can facilitate their use by those involved in healthcare, improve the quality of healthcare, and aid future research.

Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients

The combination of negative affectivity (NA) and social inhibition (SI) - the Type D Personality - is associated with poor outcomes in coronary artery disease (CAD) patients. A Norwegian translation of the standard instrument measuring Type D (DS14) was tested on 432 CAD patients receiving coronary revascularization treatment. Factor analysis produced two factors with high inter-item reliability, indicating that the Norwegian DS14 has acceptable psychometric properties. Eighteen percent were classified as Type D, lower than has been reported elsewhere. Type D was associated with anxiety, depression, and passive coping. NA correlated positively with depression, anxiety, and passive coping. SI correlated positively with depression and anxiety, and negatively with active coping. The prevalence of Type D was higher among women, and negatively correlated with time since treatment. The variation in Type D prevalence among studies needs further elucidation as does the predictive power of continuous scoring of the Type D trait.

Therapists' Perceptions of how Teamwork Influences Client-Centred Practice

This qualitative study adds to the client-centred literature by focusing on occupational therapists' experience of working on teams that support clients with a severe and persistent mental illness from a client-centred perspective. The paper reports on the second category of data relating to a previously published paper, which replicated the work of Sumsion (2004).

Interviews were conducted with 12 therapists to capture their experience and interpretation of this approach to practice. The multiphased analysis included template analysis and open coding. It resulted in the creation of the category of meaningful goals, which addressed the work done to ensure that the goals towards which everyone was working were meaningful for the client. The facilitators related to these goals included team cohesion, the structure of the system and family collaboration and support. The challenges were differing perspectives and paradigms, competitive frameworks and time.

This study identified the unique contribution that families provided to a client-centred approach. Overall, the study makes a significant contribution to the literature and to therapists' understanding of the factors that influence the therapist's ability to facilitate client-centred practice.