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  • 1.
    Andersson, Susanne
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Berglund, Mia
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Vestman, Caroline
    Primary Health Care Center, Gullspång, Sweden.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden.
    Experiences of specially trained personnel of group education for patients with type 2 diabetes: A lifeworld approach2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 635-641Article in journal (Refereed)
    Abstract [en]

    Aim:To describe how the group education process for people with type 2 diabetes is experienced by diabetes nurses and dietitians who support the patients’ learning, in a primary care setting.

    Design:The project took place at two primary care settings in the south of Sweden.

    Methods:Data collected from focus‐group interviews and reflection notes were subjected to phenomenological analysis.

    Results:The specially trained personnel experienced that group education made it possible for the patients to learn through reflection concerning their own and others’ experiences. Furthermore, group education entailed increased knowledge for the trained personnel. When the patients were challenged to make changes in their lives with the illness, the personnel experienced that both patients and personnel supported each other. The study concludes that the trained personnel person‐centred approach, with help of the didactic model, get tools to support patients learning.

  • 2.
    Berglund, Mia
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Susanne
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Kjellsdotter, Anna
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Att drabbas av långvarig sjukdom2017In: Vägen till patientens värld och personcentrerad vård: Att bli lyssnad på och förstådd / [ed] Karin Dahlberg, Inger Ekman, Stockholm: Liber, 2017, 1, p. 93-116Chapter in book (Refereed)
  • 3.
    Johansson, Anna
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Cardiology, Skaraborgs Hospital, Skövde / Department of Medical and Health Sciences, University of Linköping, Sweden.
    Adamson, Anita
    Department of Physical Therapy, Skaraborgs Hospital, Skövde, Sweden.
    Ejdebäck, Jan
    Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, University of Linköping, Sweden.
    Evaluation of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease - a randomised intervention study2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2822-2834Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease. Background: Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients' sleep quality and sleep efficiency independent of gender, age and co-morbidity. Design: A randomised pretest-post-test control design. Methods: Forty-seven patients who had undergone a coronary revascularisation procedure and/or pharmacological treatment three to seven weeks earlier at a general hospital were randomised to either an intervention group or a control group. Data collection was carried out by questionnaires, a study-specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods, with a follow-up after three to four months. The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity. Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse. Individual advice on physical training, relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist. Both groups received a brochure about sleep and stress. Results: At a three- to four-month follow-up, the main improvements were seen in the intervention group regarding sleep quality, sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy. Statistical improvements in health-related quality of life were revealed. This was not so obvious in the control group. Conclusions: An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality. However, a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time. Relevance to clinical practice: Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients' needs, supported by a healthcare team and led by nurses, is important in clinical practice. © 2014 John Wiley & Sons Ltd.

  • 4.
    Johansson, Anna
    et al.
    Department of Cardiology, Kärnsjukhuset, Skövde Hospital, Skövde / Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Johan
    Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Brödje, Karin
    University Hospital, Linköping / Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Edell-Gustafsson, Ulla
    Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Self-care strategies to facilitate sleep in patients with heart disease—A qualitative study2012In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 18, no 1, p. 44-51Article in journal (Refereed)
    Abstract [en]

    This study aimed at exploring and describing the self-care management strategies used by patients with coronary artery disease to facilitate sleep. Qualitative interviews in a dialogue manner, in a phenomenographic reference frame analyzed according to manifest and latent principles of qualitative content analysis, were performed. A purposeful sampling technique was used including 11 patients with coronary heart disease in a Heart Medical Unit in a general hospital setting. Two main themes were identified: 'sleep-rhythm' and 'sleep-hygiene' including four descriptive categories. The categories reveal five basic responses including emotions, cognition, physical symptoms (reactions), behaviours and/or the sleep environment, which were related to perceived or actual presence of sleep-wake problems and health that were the underlying reason for the self-care management strategies. Basically, intervention studies that address these five responses for choice of non-pharmacological methods based on cognitive behavioural therapy provided by nurses are needed.

  • 5.
    Johansson, Anna
    et al.
    University of Skövde, School of Life Sciences. Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden, Department of Medical and Health Sciences, University of Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine Linköping University Hospital, Faculty of Health Sciences, University of Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, University of Linköping, Sweden.
    Sleep-wake activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample: An actigraphy and questionnaire study2013In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 19, no 4, p. 390-401Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore whether there are gender differences in sleep and health-related quality of life in patients with coronary artery disease (CAD) and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty-seven patients with stable CAD and 47 participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for seven 24-h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses. © 2013 Wiley Publishing Asia Pty Ltd.

  • 6.
    Johansson, Anna
    et al.
    Department of Cardiology, Kärnsjukhuset, Skövde Hospital, Skövde / Department of Medical and Health Sciences, University of Linköping.
    Svanborg, Eva
    Department of Clinical and Experimental Medicine/Clinical Neurophysiology, University of Linköping/University Hospital.
    Swahn, Eva
    Department of Medical and Health Sciences, Division of Cardiology, Linköping University, Linköping.
    Ejdebäck, Jan
    Department of Cardiology, Kärnsjukhuset, Skövde Hospital, Skövde.
    Tygesen, Hans
    Department of Cardiology, Borås Hospital, Borås.
    Edell-Gustafsson, Ulla
    Department of Medical and Health Sciences, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sleep, arousal and health-related quality of life in men and women with coronary artery disease2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2787-2801Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate whether there are gender differences in insomnia, sleep quality, sleep efficiency (%), general arousal, disease-specific and health-related quality of life in patients with coronary artery disease, compared with an age- and gender-matched randomly selected group from the general population.

    BACKGROUND: There are gender difference effects of sleep disturbances in the general population, but this perspective among patients with coronary artery disease has been poorly analysed.

    DESIGN: In this prospective study, comparative, descriptive and model testing designs were used.

    METHOD: The patients with coronary artery disease, 556 men and 324 women aged 25-86, were compared with a matched population-based group. Data were collected by validated and reliability-tested questionnaires.

    RESULTS: The prevalence of severe insomnia varied between 17-44% in all four groups. The severe insomniac coronary artery disease patients displayed a two- or threefold higher presleep arousal, had two hours shorter nocturnal sleep duration/night and were more limited in their physical exercise level than the population-based group. Gender differences in sleep quality, sleep efficiency (%) and general arousal disappeared with increased insomnia severity.

    CONCLUSIONS: Independent of gender, age and comorbidity, physical exercise, general arousal behaviour and delayed poststress recovery after mental stress were found to have a negative impact on the coronary artery disease patients' sleep quality and sleep efficiency (%), interfering with their health-related quality of life. The variables significantly explained 41% of the sleep quality outcome and 29% of the sleep efficiency (%).

    RELEVANCE TO CLINICAL PRACTICE: Insomnia because of hyperarousal behaviour can be an important factor in the development of an individual self-care management programme supported by a healthcare team.

  • 7.
    Johansson, Anna
    et al.
    Department of Cardiology, Skövde Hospital, Skövde, Sweden / Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linkoping, Linkoping.
    Windahl, Maria
    Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linkoping, Linkoping.
    Svanborg, Eva
    Department of Neuroscience, Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Fredrichsen, Maria
    Department of Social and Welfare Studies, Palliative Research Unit, Vrinnevi Hospital, Norrköping, Sweden.
    Swahn, Eva
    Department of Cardiology, University Hospital Linköping, Linköping.
    Uhlin, Pia Yngman
    Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Nursing Science - Department of Medicine and Care, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
    Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: a phenomenographical study2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 467-475Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A framework is needed for identifying internal and external factors essential for the nursing management of psychological supportive health care and education for patients' self-care in sleep. In order to generate more knowledge from the patient's perspective, the aim of this study was to describe how patients with coronary artery disease (CAD) perceive that their sleep is influenced by rest, activity and health in outpatient care.

    DESIGN: Qualitative interviews were performed with 33 outpatients.

    METHOD: The data were analysed using a phenomenographic method.

    FINDINGS: Three descriptive categories of the phenomenon were described: my lifestyle is reflected in my sleep behaviour; handling the practices around tiredness and sleep; and feelings of negative and positive efficacy. Feelings of tiredness, fatigue and sleepiness were different pre-sleep stages, but were also related to the patient's adaptation and recovery. Creating one's own personal time and feelings of efficacy gave an inner sense of strength which is indicated as being particularly important in managing stress and the demands of everyday life in a satisfactory manner.

    CONCLUSION: From a contextual, holistic perspective on health, it is important to identify the patient's needs, symptoms and intentional or unintentional self-care management strategies regarding sleep and lifestyle. To promote a positive health outcome it is essential to identify sleeplessness behaviour and perceived self-efficacy for self-care in sleep.

  • 8.
    Kjellsdotter, Anna
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Lantz, Björn
    Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden.
    Ottosson, Cornelia
    Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Healthcare Professionals' Views on Parental Participation in the Neonatal Intensive Care Units2018In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 41, no S1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine the associations between age, gender, and profession in relation to the perceived importance of parental participation in Neonatal Intensive Care Units.

    DESIGN AND METHODS: A quantitative cross-sectional design was used. Participants were recruited consecutively from all 40 existing NICU units in Sweden. A total of 443 healthcare professionals (372 nurses and 71 physicians) participated in the study. Participants completed the Swedish version of the Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N) questionnaire. Data were analyzed using multiple regression analyses.

    RESULTS: The findings indicated that profession and age, but not gender, had an overall perceived importance on how nurses and physicians rated specific aspects of parental participation in NICUs.

    CONCLUSIONS: Being a nurse, compared to a physician, was associated with an increase in overall perceived importance of parental participation in NICUs. These differences may affect and may be crucial for how parents take a part in the care of their infant and also for how they adapt to the parental role.

    PRACTICE IMPLICATIONS: Nurses and physicians require education and training that support parental participation based on age and their different roles, rather than simply conveying information about the technical medical aspects of NICU care. For a sustainable outcome all team members should be invited to discuss cases from their perspectives.

  • 9.
    Klaeson, Kicki
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Oncology Department, Skaraborgs hospital, Sweden.
    Hovlin, Lina
    Home care, Skara Municipality, Skara, Sweden .
    Guvå, Hanna
    Psychiatric Department, Skaraborgs hospital, Sweden.
    Kjellsdotter, Anna
    University of Skövde, Health and Education. University of Skövde, School of Health and Education.
    Sexual Health in Primary Healthcare: A Qualitative Study of Nurses' Experiences2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1545-1554Article in journal (Refereed)
    Abstract [en]

    Aim and objectives: To illuminate nurses’ experiences and opportunities to discuss sexual health with patients in primary healthcare.

    Background: Sexual health is a concept associated with many taboos and research shows that nurses feel uncomfortable talking to patients about sexual health and therefore avoid it. This avoidance forms a barrier between patient and nurse which prevents nurses from giving satisfactory healthcare to patients.

    Design: A qualitative descriptive design.

    Method: Semi-structured interviews were conducted with nine nurses in primary healthcare in Sweden. Data were analysed by using qualitative content analysis.

    Results: During the analysis phase, five subcategories and two main categories were identified. The two main categories were: “Factors that influence nurses’ opportunities to talk to patients about sexual health” and “Nurses’ experiences of talking to patients about sexual health”. Social norms in society were an obstacle for health professionals’ opportunities to feel comfortable and act professionally. The nurses’ personal attitude and knowledge were of great significance in determining if they brought up the topic of sexual health or not. The nurses found it easier to bring up the topic of sexual health with middle-aged men with for example diabetes. One reason for this is that they found it easier to talk to male patients. A further reason is the fact that they had received training in discussing matters of sexual health in relation to diabetes and other conditions affecting sexual health.

    Conclusion: Nurses in primary care express the necessity of additional education and knowledge on the subject of sexual health. The healthcare organization must be reformed to put focus on sexual health.

    Relevance for clinical practiceGuidelines for addressing the topic of sexual health must be implemented to establish conditions that will increase nurse's knowledge and provide them with the necessary tools for discussing sexual health with patients.

  • 10.
    Yngman-Uhlin, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden / Department of Nephrology, University Hospital, Linköping, Sweden.
    Johansson, Anna
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden / Department of Cardiology, Skövde Hospital, Skövde, Sweden.
    Fernström, Anders
    Department of Nephrology, University Hospital, Linköping, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden.
    Fragmented sleep: an unrevealed problem in peritoneal dialysis patients2011In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 45, no 3, p. 206-215Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe the sleep-wake cycle, sleep quality, fatigue and Health Related Quality of Life (HRQoL) measured with questionnaires, actigraphy and a sleep diary during a one-week period in patients undergoing peritoneal dialysis (PD) treatment at home. A further aim was to explore differences compared with patients with coronary artery disease (CAD) and individuals from the general population.

    MATERIAL AND METHODS: In this study one-week actigraphy registration, four questionnaires (Uppsala Sleep Inventory, SF-36, FACIT-fatigue, International Restless Legs Study Groups' form) and a sleep diary were used.

    RESULTS: Data from 68 participants and 470 nights were collected. PD patients (n = 28) had more fragmented sleep (p < 0.001) and worse sleep efficiency (SE%) (p < 0.0001) than the CAD (n = 22) and the population (n = 18) groups. Pruritus (57%), restless legs (46%) and fatigue (89%) were prevalent in PD patients. Pruritus correlated with fragmented sleep (r = -0.45, p = 0.01) and SE (r = -0.49, p = 0.01). In HRQoL, the physical component score was decreased in the PD and CAD groups (p < 0.01) compared to the population group.

    CONCLUSIONS: To the authors' knowledge this study is the first to demonstrate that PD patients have deteriorated sleep, with serious fragmentation measured by a one-week actigraphy registration. Further, PD patients exhibit worse sleep quality than CAD patients and individuals in the population. Evaluation of sleep in clinical practice is highly recommended since PD patients are vulnerable individuals with extended self-care responsibilities and at risk for comorbidity secondary to insufficient sleep. Future research on whether PD patients' sleep problems and fatigue can be improved by an individual non-pharmacological intervention programme is required.

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