Health predicting factors in a general population over an eight-year period in subjects with and without chronic musculoskeletal pain

<p>Abstract</p> <p>Background</p> <p>Many factors are proposed to be associated with health-related quality of life. Knowledge of health factors associated to development of a good health-related quality of life could be of use in clinical practice and public health work. The aim of this study was to investigate the associations between suggested health factors and health-related quality of life at baseline and in an eight-year follow up in subjects with and without chronic musculoskeletal pain in a cohort from a general population.</p> <p>Methods</p> <p>The study was designed as a longitudinal study in a Swedish general population (N = 1 849) with a postal questionnaire at baseline 1995 and at follow up 2003. Subjects were divided into two groups, according to their response about chronic musculoskeletal pain at baseline. Health-related quality of life was assessed by the SF-36 together with suggested health factors. The associations between SF-36 subscales and suggested health factors were estimated by OR and 95% CI calculated by multivariable logistic regressions, with adjustment for all health factors, age, sex and baseline SF-36 values.</p> <p>Results</p> <p>Although subjects without chronic musculoskeletal pain reported better health-related quality of life than subjects with chronic pain, similar health factors were found to be associated to higher scores in SF-36 at baseline and predicted a better outcome in the eight-year follow up. The most consistent finding was a better health outcome in the eight-year follow up for subjects that were feeling rested after sleep. Other factors that in some aspects predicted a better outcome were belonging to higher socioeconomic group, being a native Swede, having emotional support, having good sleep structure, never being or being a former smoker, and regularly drinking alcohol.</p> <p>Conclusion</p> <p>The most important health factor in subjects with and without chronic musculoskeletal pain was feeling rested after sleep, but also emotional support, sleep structure, smoking and alcoholic habits appears to be important components. These health factors could be important to address in clinical work with painful musculoskeletal disorders. Since several health factors are common in both subjects with and without pain there could be a common strategy to be formed in public health programmes.</p

“Striving for a Good Life” – The Management of Rheumatoid Arthritis as Experienced by Patients

Aim: To generate a theoretical model how patients experience their management of rheumatoid arthritis (RA) in everyday life.Method: An explorative design with the grounded theory approach was used by interviewing 16 informants with RA.Results: The generated theoretical model emerged in a core category- Striving for a good life with two categories; making use of personal resources and grasping for support from others, which formed the base of managing RA. When relating these categories together, four dimensions emerged which characterised patients’ different ways of managing RA: mastering, relying, struggling and being resigned.Discussion: The management of RA incorporated the use of personal resources and the grasping for support from others. Both self-management strategies and patients’ need of support were highlighted as aspects that were of importance when managing RA. Patients’ experiences of their need of support to manage RA give extended knowledge that is of importance for nurses and other healthcare providers. The relationship between patients and healthcare providers is always the key to a good encounter. Interventions to increase self-management in RA have to incorporate this knowledge when trying to increase patients’ self-efficacy and with their experience of suppor

“Delivering knowledge and advice”: Healthcare providers’ experiences of their interaction with patients’ management of rheumatoid arthritis

Rheumatic diseases are often chronic and involve a lifetime of suffering. The focus of rheumatology care is to support patients to manage their lives and master their disease. Healthcare providers and patients have different views on the consequences of living with rheumatic diseases and patients are reporting unmet healthcare needs. There is a need to integrate providers’ perspective to develop the quality of rheumatology care. The aim was to explore healthcare providers’ experiences of their interaction with patients in their management of RA. Interviews with 18 providers from different clinical settings were analysed in accordance with the grounded theory method. A core category; Delivering knowledge and advice was found to be the most important task and involved providing the patient with information about the disease and appropriate forms of treatment. Healthcare providers’ attitudes and patients’ responses influenced the outcome of the delivery of knowledge and advice and three dimensions emerged; completed delivery, adjusted delivery and failed delivery. There were differences in the providers’ experiences in their interaction with patients as well as in reflections on their role as the delivering part. There could be difficulties in the interaction when patients’ expectations and preferences were not taken into account when giving advice. These findings highlight the importance of developing rheumatology care, as no provider or patient benefits if the delivery of knowledge and advice becomes a failed delivery. The healthcare organization must acknowledge the difficulties involved in the interaction with patients in their management of RA and find methods to develop a more person-centred approach to care

Factors promoting health-related quality of life in people with rheumatic diseases: a 12 month longitudinal study

<p>Abstract</p> <p>Background</p> <p>Rheumatic diseases have a significant adverse impact on the individual from physical, mental and social aspects, resulting in a low health-related quality of life (HRQL). There is a lack of longitudinal studies on HRQL in people with rheumatic diseases that focus on factors promoting HRQL instead of risk factors. The aim of this study was to investigate the associations between suggested health promoting factors at baseline and outcome in HRQL at a 12 month follow-up in people with rheumatic diseases.</p> <p>Methods</p> <p>A longitudinal cohort study was conducted in 185 individuals with rheumatic diseases with questionnaires one week and 12 months after rehabilitation in a Swedish rheumatology clinic. HRQL was assessed by SF-36 together with suggested health factors. The associations between SF-36 subscales and the health factors were analysed by multivariable logistic regressions.</p> <p>Results</p> <p>Factors predicting better outcome in HRQL in one or several SF-36 subscales were being younger or middle-aged, feeling painless, having good sleep structure, feeling rested after sleep, performing low effort of exercise more than twice per week, having strong sense of coherence (SOC), emotional support and practical assistance, higher educational level and work capacity. The most important factors were having strong SOC, feeling rested after sleep, having work capacity, being younger or middle-aged, and having good sleep structure.</p> <p>Conclusions</p> <p>This study identified several factors that promoted a good outcome in HRQL to people with rheumatic diseases. These health factors could be important to address in clinical work with rheumatic diseases in order to optimise treatment strategies.</p

Patients' independence of a nurse for the administration of subcutaneous anti-TNF therapy: A phenomenographic study

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

Group supervision in nursing care. A longitudinal study of psychiatric nurses´ experiences and conceptions

The purpose of group supervision in nursing care is to understand nurses’ experiences from real care settings and to structure these in a professional and personal context. An interventional and longitudinal method of research was chosen in this study of group supervision in nursing care. The overall aim of the present study was to examine and investigate how psychiatric nurses’ professional competence changed over time as a result of group supervision in nursing care. The sample consisted of two groups (N=12) of nurses, who received clinical supervision over a period of two years. The study is composed of three interim studies. The aim of Interim study 1 was to describe how psychiatric nurses experienced group supervision in nursing care. A questionnaire was constructed to investigate if, and to what degree, the participants experienced safety, trust and learning during the supervision sessions. The questions asked focused on the concepts ‘a feeling of friendship’, ‘allowing atmosphere’, ‘understanding’ and ‘competence’. Data was analysed using descriptive statistics, and the informants’ comments were categorised. Dairy notes were presented as a background to the ratings, words and quotations. The supervision process was analysed based on theories on supervision, including Maslow’s need theory. The results showed that the supervision climate was, to a high degree, characterised by safety, trust and learning regardless of when the rating was made. The theoretical basis of the interim study and the most common words and expressions appearing in the results were used to design a general model of supervision. The aim of Interim studies 2 and 3 was to investigate the influence of supervision in nursing care, after one and after two years of ongoing supervision as well as four years after completed supervision, on the psychiatric nurses’ professional competence. Data consisted in answers provided during interviews with the informants. Data was analysed according to the phenomenographical method. Interim studies 2 and 3 resulted in four description categories: ‘a feeling of job satisfaction’, ‘gaining knowledge and competence’, ‘gaining a sense of security in nursing situations’ and ‘a feeling of personal development’. In Interim study 3, an additional two description categories emerged: ‘realising the value of supervision’ and ‘a sense of professional solidarity’. The findings gave valuable proof that group supervision in nursing care has a lasting influence on nurses’ professional competence in the form of a distinct professional identity and an integrated nursing care perspective. Group supervision contributes to maintaining the participants’ strength and energy to carry on working, which makes continuing supervision necessary

Grupphandledning i omvårdnad utmanar sjuksköterskans kompetens

Handledning i omvårdnad startade bland sjuksköterskor inom den psykiatriska vården i England. Under 1960-talet började handledning av sjuksköterskor införas på en psykiatrisk avdelning vid Ullevåls sjukhus i Norge. Utvecklingen av handledning i omvårdnad/yrkesmässig handledning i omvårdnad har sedan dess spridits via den psykiatriskavården till den somatiska (Hermansen, m.fl ., 1994), och kom i slutet av 1980-talet även till Sverige. Grupphandledning i omvårdnad är en betydelsefull källa till medvetandegörande, lärande och kompetensutveckling. Den utgår från en verklighet och verksamhetsom är deltagarnas. Det är när de handledda ges möjlighet till refl ektion som fördjupning och nya insikter i arbetet sker. Detta ställer stora krav på handledaren. Handledningen måste därför bedrivas av en erfaren kollega med speciell handledarkompetens

Sjuksköterskornas uppfattning av hur processorienterad omvårdnadshandledning kan befrämja deras psykiska hälsa

Nursing is a profession involving mental strain. Sick-rates among nurses are increasing. Positive working conditions are essential in order to prevent the negative effects of work-related stress. The aim of this study was to describe how clinical group supervision can promote mental health among nurses. Data was collected by means of semi-structured interviews with 12 nurses having attended clinical supervision for 1,5 year. The material was analysed using a qualitative method with reference to phenomenography. The analysis resulted in three qualitatively different descriptive categories: 1. To reflect; to talk and work with emotions. 2. To feel support; to feel strengthened personally and professionally. 3. To have control; to delimit and cope with stress. The result shows that clinical supervision has an impact when it comes to preventing negative effects of work-related stress. Karasek-Theorell´s ”demand-control-support-model” confirms the conception that clinical group supervision has a protective and supporting effect on nurses’ mental health. The consensus of opinion is that clinical group supervision prevents the negative effects of work-related stress. Further research is therefore needed to investigate if there is a connection between clinical group supervision and sick-rates among nurses

Patients’ dependence on a nurse for the administration of their intravenous anti-TNF therapy : A phenomenographic study

Background. Pain, stiffness and functional restrictions of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well independence. Therefore, it is important that the patient perspective is focused upon in order to improve the care. Aim. To describe variations in how patients with rheumatic conditions perceive their dependence on intravenous anti-TNF therapy provided by a nurse. Method. The study has a descriptive qualitative design and a phenomenographic approach. Interviews were conducted with 20 patients suffering from rheumatoid arthritis and spondyloarthropathies who were treated by means of intravenous anti-TNF therapy. Results. Three descriptive categories and ten sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence, having accessibility and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation, being seen as an individual, being taken care of and encountering the environment). The patients perceived that the treatment led to feelings of security and involvement and stated that regular encounters with a nurse were invigorating. The patients’ needs should constitute the basis for the nurse’s role in the provision of intravenous anti-TNF therapy in an outpatient clini

Children´s anwers in interrogations and effect of different instructions

Syftet är att undersöka hur barns svar i utredande samtal påverkas av ledande och/eller pressande frågor och påståenden samt av olika instruktioner angående betydelsen av korrekhet hos svaren. Totalt 36 barn i sexårsåldern medverkade i studien. Resultaten antyder att instruktionen påverkar korrekthet, konfidens samt utförlighet i svaren.The purpose is to investigate how children´s answers to questions can be influenced by leading and pressing  questions and by instructions. In all 36 children, six year old, participated. The results suggest that different instructions influence correctness, confidence and fullness of the answers.  </p