10 research outputs found
Immigrants with heart failure- A descriptive comparative study of symptoms, self care, social support, care and treatment
No full textBackground: The current demographic profile in Sweden demonstrates blended ethnicities and cultures evolving through mass migration and resettlement. While it is acknowledged that cultural background affects, illness experience, participation in the care or self-management of illness, little is presently known about the treatment patterns, symptoms, health care seeking and health outcomes among immigrants with heart failure (HF) in Sweden or other Scandinavian countries – despite the fact that worsening of chronic heart failure is the most common cause of hospitalisation in patients over 65 years of age. Aim: This comparative, explorative thesis describes immigrants with HF regarding symptoms, self-care, social support, care and treatment, physical limitation and emotional state, as well as health outcomes, e.g., readmissions and mortality, in comparison to Swedes. Method: The thesis has a descriptive and comparative design. The first study is an interview study exploring symptom recognition and health care strategies related to worsening of HF. The second and third studies of the thesis are retrospective record audits of patient records describing care and treatment of immigrant and Swedish patients with HF in a medical ward and at a nurse-led HF clinic. The fourth study is a descriptive study with group comparisons of changes from baseline to four month follow up, in symptoms, functional limitations, emotional status, social support and self-care measures over a four month period, from baseline to four-month follow-up. The study setting was a university hospital serving a large and diverse immigrant population. Results: A majority of the immigrant and Swedish patients sought health care for symptoms and signs, such as breathing difficulties, fatigue and swelling. In addition, equal numbers of patients in both groups were aware of their reluctance to seek care when symptoms and signs occurred, and gave diverse explanations for delays. However, twice as many immigrants as Swedes were unaware of the underlying reason for their illness and its connection with HF (I). Reviewed patient records revealed no significant differences between the groups regarding symptoms, diagnostic investigations, medical treatment, hospital stay and health outcomes, such as readmissions and mortality. Furthermore, records from both patient groups showed that functional status using the New York Heart Association classification was infrequently assessed and that documentation of provided HF information was lacking. The only significant between-group differences were that more immigrants were referred to the nurse-led HF clinic for a follow-up visit at discharge (II); fewer routine clinical parameters were assessed in immigrants; and fewer immigrants were scheduled for follow-up visits (III). No differences were seen between immigrants and Swedes regarding 4-month changes in symptoms and signs, physical functioning, social support, emotional status, or in health care seeking in response to certain symptoms. However, adherence to prescribed medications was significantly higher among immigrants, whereas significantly fewer immigrants reported that they had access to emotional support if needed (IV). Conclusion and implication: Although immigrant and Swedish patients with chronic heart failure were provided largely the same care and treatment, fewer immigrants were able to relate their symptoms to their condition when seeking acute care. Immigrants also reported higher adherence to prescribed medication and were more often referred to the nurse-led HF clinic by physicians at discharge from hospital, possibly with the expectation that the patients would receive more individualised care and follow up. Information about how and if patient education and counselling had been carried out was rarely documented in the patient records. More precise and comprehensive notations of the patients’ own perceptions of their care may enhance the quality of this documentation. Patient records should also document performed assessments and interventions, which may improve communication between caregivers in different health care settings and consequently improve the efficiency of future care plans
Immigrants with heart failure- A descriptive comparative study of symptoms, self care, social support, care and treatment
No full textBackground: The current demographic profile in Sweden demonstrates blended ethnicities and cultures evolving through mass migration and resettlement. While it is acknowledged that cultural background affects, illness experience, participation in the care or self-management of illness, little is presently known about the treatment patterns, symptoms, health care seeking and health outcomes among immigrants with heart failure (HF) in Sweden or other Scandinavian countries ? despite the fact that worsening of chronic heart failure is the most common cause of hospitalisation in patients over 65 years of age. Aim: This comparative, explorative thesis describes immigrants with HF regarding symptoms, self-care, social support, care and treatment, physical limitation and emotional state, as well as health outcomes, e.g., readmissions and mortality, in comparison to Swedes. Method: The thesis has a descriptive and comparative design. The first study is an interview study exploring symptom recognition and health care strategies related to worsening of HF. The second and third studies of the thesis are retrospective record audits of patient records describing care and treatment of immigrant and Swedish patients with HF in a medical ward and at a nurse-led HF clinic. The fourth study is a descriptive study with group comparisons of changes from baseline to four month follow up, in symptoms, functional limitations, emotional status, social support and self-care measures over a four month period, from baseline to four-month follow-up. The study setting was a university hospital serving a large and diverse immigrant population. Results: A majority of the immigrant and Swedish patients sought health care for symptoms and signs, such as breathing difficulties, fatigue and swelling. In addition, equal numbers of patients in both groups were aware of their reluctance to seek care when symptoms and signs occurred, and gave diverse explanations for delays. However, twice as many immigrants as Swedes were unaware of the underlying reason for their illness and its connection with HF (I). Reviewed patient records revealed no significant differences between the groups regarding symptoms, diagnostic investigations, medical treatment, hospital stay and health outcomes, such as readmissions and mortality. Furthermore, records from both patient groups showed that functional status using the New York Heart Association classification was infrequently assessed and that documentation of provided HF information was lacking. The only significant between-group differences were that more immigrants were referred to the nurse-led HF clinic for a follow-up visit at discharge (II); fewer routine clinical parameters were assessed in immigrants; and fewer immigrants were scheduled for follow-up visits (III). No differences were seen between immigrants and Swedes regarding 4-month changes in symptoms and signs, physical functioning, social support, emotional status, or in health care seeking in response to certain symptoms. However, adherence to prescribed medications was significantly higher among immigrants, whereas significantly fewer immigrants reported that they had access to emotional support if needed (IV). Conclusion and implication: Although immigrant and Swedish patients with chronic heart failure were provided largely the same care and treatment, fewer immigrants were able to relate their symptoms to their condition when seeking acute care. Immigrants also reported higher adherence to prescribed medication and were more often referred to the nurse-led HF clinic by physicians at discharge from hospital, possibly with the expectation that the patients would receive more individualised care and follow up. Information about how and if patient education and counselling had been carried out was rarely documented in the patient records. More precise and comprehensive notations of the patients? own perceptions of their care may enhance the quality of this documentation. Patient records should also document performed assessments and interventions, which may improve communication between caregivers in different health care settings and consequently improve the efficiency of future care plans
Symptom recognition and health care seeking among immigrants and native Swedish patients with heart failure
No full textAbstract Background It is not known what patient perceptions or beliefs lead to beneficial decisions or response patterns in symptom interpretation among heart failure (HF) patients, especially immigrants. The aim of this study was to explore and compare symptom recognition and health care seeking patterns among immigrants and native Swedes with HF. Methods The study used a qualitative design. Semi-structured interviews were conducted with 42 patients with HF, of whom 21 were consecutively selected immigrants and 21 were randomly selected Swedish patients. The interviews were analysed using content analysis. Results A majority of the immigrant patients sought health care for symptoms and signs, such as breathing difficulties, fatigue and swelling. Twice as many immigrants as Swedes were unaware of "what the illness experience entailed" and which symptoms indicated worsening of HF. Conclusion The symptoms that patients sought care for, were similar among immigrants and Swedes. However, when interpreting symptoms more immigrants were unaware of the connection between the symptoms/signs and their HF condition. More tailored educational interventions might improve recognition of worsening symptoms in immigrant patients with chronic heart failure.</p
Assessment and decision-making of Swedish primary care nurses in relation to the use of interpreters
No full text Communicating with immigrants in primary care can be a challenge for nurses who must assess language proficiency and decide whether to use an interpreter. The aim of this study was to examine primary care nurses' experiences of assessment and decision-making in relation to the use of interpreters. A qualitative inductive research design was chosen and nurses with experience of professional interpreters were recruited for focus group interviews. The study results showed that primary care nurses respected immigrants as human beings and recognised their right to decline an interpreter in sensitive situations. The purpose of primary care nurses' experiences of assessment and decision-making in relation to the use of interpreters was ensuring patient safety, the importance of reciprocal information and respect for patient autonomy. </jats:p
A review of records from follow-up visits for immigrant and Swedish patients at a heart failure clinic
No full textToday, nearly 20% of the Swedish population originates from multiethnic backgrounds. Patients' symptom expressions, adherence to health regimens, and communication with health-care professionals have been shown to be related to their ethnic and cultural backgrounds. PURPOSE: To describe documented care of immigrant patients and matched Swedish patients at a heart failure clinic. METHOD: Journal audit of records of 25 immigrant and 25 matched Swedish patients with HF included from the patient registration database at the hospital where they were cared for. RESULTS: In the immigrant group, significantly fewer clinical parameters were assessed during their visits and fewer patients were scheduled for follow-up visits. Analyses revealed that some of the items recommended in the European Society of Cardiology guidelines for non-pharmacological HF care were overlooked for both of the groups. CONCLUSIONS: We found that medication adjustments and information about the condition and treatment were fairly similarly documented between Swedish and immigrant patients while significantly fewer clinical measurements and follow-up visits were documented for the immigrant group
Evaluation of the case method in nursing education
No full textThe case based learning (CBL) is a problem-based learning which engaging students and presenting them with learning-related and cognitive challenges. The purpose of the study was to elucidate nursing students experiences of the CBL as an educational tool in order to find out if it supports their learning. Qualitative content analysis was used and performed on the statements from nursing students’ course evaluations. Students perceived the CBL as an approach combining theory with practice which provides an overview of upcoming profession. Students gain adequate knowledge about patient care in reality and thereby enabling them to obtain a holistic understanding of patients health problems. Reflections related to case seminars widen students perspectives, improve their capacity for cooperation and help them to achieve long-lasting knowledge. This learning method offers nursing students an opportunity to enhance their judgment and critical thinking skills by applying theory in practice. Students gain adequate knowledge about patient care which may benefit patient care due to students acting professionally in their future role.</p
Equality in the care and treatment of immigrants and native Swedes--a comparative study of patients hospitalised for heart failure
No full textThe aim of this study was to compare immigrant and Swedish patients with heart failure (HF) regarding symptoms, diagnosis, medical treatment, discharge planning, readmission and mortality. The method was descriptive and retrospective using an audit protocol to review data from 214 medical records of 107 immigrants and 107 Swedish patients hospitalised for HF or chronic heart failure during 1994-2003. Descriptive statistics and significance testing were performed. Few differences between the patient groups were observed. Significantly larger number of immigrants were referred to the nurse-led HF clinic follow-up visits (P=0.026). Significantly more immigrants had ischemic heart disease on admission (P=0.025) and were prescribed short-acting nitrates at discharge (P=0.026). More Swedes were prescribed medications for insomnia (P=0.029). More immigrants than Swedes are referred to HF clinic after discharge, suggesting that physicians rely on specialised nurses to provide follow-ups, tailored to the needs of immigrant patients. The study indicates that the Swedish health care system has achieved its aim of equality in the care and treatment of this patient group. Further studies are needed to determine if this also applies to the quality of the provided care and treatment
En studie om allmänna reklamationsnämndens avtalstolkning
No full textAllmänt känt hos många jurister – om inte alla – är att allmän domstol använder sig av vissa utarbetade modeller eller metoder då den har att utföra en tolkningsoperation på ett avtal. Dessa metoder underlättar för tolkaren att uppvisa enhetlighet i bedömningen så att lika avtal tolkas lika. Detta är även önskvärt då det leder till ett visst mått av förutsägbarhet. Allmänna reklamationsnämnden är en svensk statlig myndighet som, enligt dess förordning (Förordning 2007:1041 med instruktion för allmänna reklamationsnämnden), har till huvuduppgift att pröva tvister mellan konsumenter och näringsidkare. Nämnden kan alltså liknas vid en allmän domstol. En viktig skillnad är dock att nämnden endast kan lämna rekommendationer om hur en tvist bör lösas. Parterna har med andra ord själva att välja huruvida de vill rätta sig efter beslutet eller ej. Författaren har valt att i det här arbetet undersöka vilka metoder som nämnden använder sig av då den tolkar avtal mellan konsumenter och näringsidkare; använder den sig av samma metoder som allmän domstol och som finns behandlade i juridisk doktrin, eller har den egna metoder som den arbetar efter? Det är främst den frågeställningen som det här arbetet har till syfte att besvara. Med den frågan besvarad vill författaren dock även försöka få klarhet i vilka ärenden som i praktiken uppkommer hos nämnden i anslutning till avtalstolkning och hur utgången blir. Nämnden anger t.ex. att konsument får rätt i knappt hälften av ärendena som inkommer till myndigheten, dvs. nästan 50 %, stämmer det även när man ser till avtalstolkningsfrågor isolerat, och om så inte skulle vara fallet vad kan det tänkas bero på? Slutligen kommer författaren även, i diskussionen, försöka dra vissa allmänna slutsatser runt för- och nackdelar med Allmänna reklamationsnämnden kontra allmän domstol ur ett rättssäkerhets- och samhällsperspektiv. Är det lämpligt att fördela rättsskipning på detta sätt i samhället? Bör rättsskipningen vara förbehållet allmän domstol?Common knowledge among Swedish lawyers is that the Swedish Court – in cases regarding the interpretation of a contract – uses certain established methods for determining the proper content of that contract. These methods help the interpreter (in most cases a judge or an arbitrator) to uphold uniformity so that all cases that are alike are treated the same. These methods also help in withholding a certain amount of predictability. The National Board for Consumer Disputes (Allmänna reklamationsnämnden, ARN) is a Swedish government authority whose main task is to settle disputes between businessmen and consumers. The authority can be compared to a Swedish Court. One important distinction is however that the Board only gives recommendations to parties as to how a dispute should be settled. It is – in other words – up to the contending parties to decide for themselves whether they should abide by the recommendation or not. The author has in this essay chosen to inquire into which methods the Board applies when it is obligated to interpret a contract between two disputing parties. Does the Board use the same methods as a Swedish Court would (and which have been codified in different books by recognized authors) or does it use its own methods? The main purpose of this essay is to try to bring some clarity into that question. With that question (hopefully) answered, the author would also like to inquire into which disputes that arises at the authority in relation to the field of interpretation of contracts and what the outcome is. The Board’s own research for example, shows that the consumer is proven right in almost half of the disputes, is this also the case when it comes to disputes involving the interpretation of a contract – when one studies those disputes isolated? And if not, what may be the reason for these discrepancies? Finally, the author would also like to, in the discussion, compare The National Board for Consumer Disputes to a Swedish Court in a legal- and societal perspective. Is it appropriate to divide access to justice in this way or should justice be maintained solely by the Swedish Court
The Development of a Preceptor Training Program on Clinical Nursing Education in Jordan in Collaboration With Sweden
No full textBackground: As part of the Swedish-Jordanian International Collaboration Project, this study developed, implemented, and evaluated a preceptor training program to enhance pedagogical strategies for integration of theory and practice in nursing education in Jordan. Methods: A three-phase program was developed and implemented (2006 to 2007) focusing on experiential learning using drama, case-method, and photo language methods. Data were collected from 12 preceptors in Jordan using questionnaires and interviews. Results: Four themes reflected experiences gained from participating in the program, including bridging the gap between theory and practice, enhancing students' imminent potential, promoting the role of preceptor, and facing challenges in applying pedagogical strategies. Participants noted a positive effect on their personal and professional growth as a preceptor, students' learning process, and the quality of health care. Conclusion: Preceptors perceived that the model program helped to bridge the gap between theory and practice, improved communication and networking, and improved the quality of health care in Jordan. © SLACK Incorporated.</p
