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Östman M, Bäck-Pettersson S, Sundler AJ, Sandvik AH. Nurses' experiences of continuity of care for patients with heart failure: A thematic analysis. J Clin Nurs 2020; 30:276-286. [PMID: 33141466 DOI: 10.1111/jocn.15547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/06/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to describe nurses' experiences of continuity of care for patients with heart failure. BACKGROUND Heart failure is a life-influencing condition that causes varying care needs over time with risks of fragmentation. Nurses play an important role in caring for patients with heart failure. However, nurses' experiences of continuity of care seem to be less explored in this context. DESIGN A qualitative study with a descriptive design. METHODS Four focus groups were chosen to collect the data, and the analysis was made by using a method for thematic analysis. A purposeful sampling of nurses (n = 14) with experiences from hospital-connected heart failure clinics, primary healthcare centres and municipal home healthcare settings was recruited. The COREQ checklist was used in this study. RESULTS The nurses' experiences of continuity of care for patients with heart failure were described in four themes: access and flexibility, responsibility and transparency, trustful and caring relationships and communication and collaboration. CONCLUSIONS The results indicate that nurses have an excellent position to act as the "hub" in caring for patients with heart failure, but they need to have the possibility of networking and establishing trusting relationships with their colleagues. From the nurses' point of view, mutual trust between the nurse, the patient and the patient's next of kin is crucial for promoting and maintaining continuity of care in patients with heart failure. RELEVANCE TO CLINICAL PRACTICE To promote continuity of care for patients with heart failure, nurses expressed the necessity of establishing trusting relationships in a continuity-promoting organisation with seamless coordination. Nurses can be the "hub" supporting a person-centred care approach based on the patients' needs. There seems to be a need for better collaboration with common guidelines across and within primary healthcare centres, hospital-connected heart failure clinics and municipal home healthcare settings.
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Affiliation(s)
- Malin Östman
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Region Västra Götaland, Närhälsan Källstorp Health Centre, Trollhättan, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, R, D&E Centre Fyrbodal, Västra Götaland, Sweden
| | - Siv Bäck-Pettersson
- Region Västra Götaland, Research and Development Primary Health Care, R, D&E Centre Fyrbodal, Västra Götaland, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ann-Helén Sandvik
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Aamodt IT, Lycholip E, Celutkiene J, von Lueder T, Atar D, Falk RS, Hellesø R, Jaarsma T, Strömberg A, Lie I. Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study. J Med Internet Res 2020; 22:e15445. [PMID: 31909717 PMCID: PMC6996721 DOI: 10.2196/15445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/22/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals—one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.
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Affiliation(s)
- Ina Thon Aamodt
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Edita Lycholip
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine of the Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Thomas von Lueder
- Department of Cardiology B, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Research Support Services, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tiny Jaarsma
- Division of Nursing, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Anna Strömberg
- Division of Nursing, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Irene Lie
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
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Structured multi-disciplinary psychosocial care for cancer patients and the perceived quality of care from the patient perspective: a cluster-randomized trial. J Cancer Res Clin Oncol 2019; 145:2845-2854. [DOI: 10.1007/s00432-019-03018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
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