The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross‐Sectional Study

Objectives: To assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation. Design and setting: This is a cross-sectional study. The population were all patients discharged (2008–2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited. Main outcome measures: Symptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life. Results: Symptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function. Conclusion: Patients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.publishedVersio

The predictive value of post-traumatic stress disorder symptoms for quality of life: a longitudinal study of physically injured victims of non-domestic violence

<p>Abstract</p> <p>Background</p> <p>Little is known about longitudinal associations between post-traumatic stress disorder (PTSD) and quality of life (QoL) after exposure to violence. The aims of the current study were to examine quality of life (QoL) and the predictive value of post-traumatic stress disorder (PTSD) for QoL in victims of non-domestic violence over a period of 12 months.</p> <p>Methods</p> <p>A single-group (n = 70) longitudinal design with three repeated measures over a period of 12 months were used. Posttraumatic psychological symptoms were assessed by using the Impact of Event Scale, a 15-item self-rating questionnaire comprising two subscales (intrusion and avoidance) as a screening instrument for PTSD. The questionnaire WHOQOL-Bref was used to assess QoL. The WHOQOL-BREF instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. Results of the analysis were summarized by fitting Structural Equation Modelling (SEM).</p> <p>Results</p> <p>For each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOL-Bref subscales (the four domains and the two single items) were stable across time of assessment. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. In addition, the two items examining perception of overall quality of life and perception of overall health in WHOQOL showed the same results according to PTSD symptoms such as QoL domains. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3.</p> <p>Conclusion</p> <p>The presence of PTSD symptoms predicted lower QoL, both from an acute and prolonged perspective, in victims of non-domestic violence. Focusing on the individual's perception of his/her QoL in addition to the illness may increase the treatment priorities and efforts.</p

Veiledning av dr. grads kandidater ved Seksjon for sykepleievitenskap-viktige aspekter i samarbeidet mellom veileder og kandidat-kompetanseforventning

Målsettingen i reglement for PhD-veiledning ved UiB (2003) fremhever at veiledning skal være individuell og foregå jevnlig. Veiledningsprosessen kan inndeles i ulike faser og kan forstås i form av ulike modeller som undervisnings-, lærling- og partnerskaps modellen (Dysthe 2003, Dysthe og Breistein 1999). Vårt prosjekt omhandler veiledning av dr.grads kandidater der intensjonen er å få frem både veilederes og kandidaters erfaringer og tanker rundt veiledningsprosessen. Det er foretatt semistrukturerte intervju med tre veiledere og fire dr.grads kandidater. Intervjuene setter blant annet fokus på hva det er viktig å vektlegge i ulike faser, hvilke rammer som er avtalt, hvordan kandidatene ”bruker” veileder og hvilken kompetanse en forventer at kandidaten skal ha etter gjennomført studie. Resultatene viser blant annet at alle orienterer seg i forhold til en treleddet veiledningsprosess med start-, gjennomførings- og avslutningsfase, med størst behov for veiledning i første og siste fase. Vedrørende tolking av materialet med henblikk på modeller for veiledning, synes tyngdepunktet å ligge på en kombinasjon av undervisnings- og partnerskapsmodellen. Det vektlegges et likeverdig forhold mellom kandidat og veileder, hvor kandidaten etter hvert arbeider svært selvstendig. Dette i kombinasjon med at det er ønskelig med en detaljert tilbakemelding på innlevert tekst. Klare rammer og avtaler for veiledning forekommer sjeldent, samtidig som det uttrykkes et sterkt behov for dette. Begge gruppene ser det som vesentlig at veileder har god kjennskap til kandidatens fagområde, og begge ser støtte og oppmuntring som svært viktig i de ulike faser. Kandidatene er mer spesifikk enn veilederne når det gjelder forventet kompetanse. Resultatene av undersøkelsen viser at det er viktig å løfte frem veiledning som et diskusjonstema for ansatte og dr.grads kandidater ved seksjonen

Exposure to non-domestic violence : short- and long-term psychological reactions and the impact on quality of life

The purpose of this study was to describe characteristics of exposure to non-domestic violence, and to evaluate short- and long-term psychological consequences and the impact on quality of life. Demography, physical injuries, crime characteristics, and emotions during the assault were described, based on a cross-sectional design that combined data collected by questionnaires and semi-structured interviews. The association between these factors was also evaluated (Paper I). Our results showed that most of the victims were young men assaulted by unknown attackers in public places. Seventy-six per cent of the participants suffered injuries to the head, face or eyes. Anxiety was the most frequent emotion felt during the assault. About 60% experienced a combination of subjective factors, such as fear of serious injury or fear of being killed during the assault, and actual physical injury. Acute and subacute post-traumatic reactions were described through the examination of frequency and intensity of peritraumatic dissociation (PD), post-traumatic stress disorder (PTSD) symptoms, and anxiety and depressive symptoms, and the relationships between psychological reactions, level of physical injury, perceived threat, and sociodemographic variables were explored (Paper II). Thirty-three per cent of the victims scored as probable PTSD cases according to the PTSS-10; the corresponding IES-15 score identified prevalence of 34% respectively. Forty-four per cent scored as cases with probable anxiety and depression, according to the HSCL-25. Severity of perceived threat predicted higher scores on all measures of psychological reactions. Analyses of acute or subacute reactions showed no statistical significant differences between elapsed time since exposure to violence and PD, PTSD, anxiety and depression, or threat level. The prevalence of PTSD symptoms was measured in a one-year longitudinal perspective of physically injured victims. Furthermore, the predictors of PTSD symptoms were analysed in relation to PD, physical injury, perceived life threat, prior experience of violence, perceived social support, and perceived self-efficacy (Paper III). Results showed a high prevalence and severity of PTSD on all outcomes. Either injury severity or prior experience of being a victim of violence predicted PTSD in this study. Perceived life threat was a predictor of PD and early PTSD predicted subsequent PTSD in the present study. Low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1. Furthermore, lack of perceived social support was a predictor of PTSD symptoms at T3. Quality of life (QoL) was also assessed in a one-year longitudinal perspective, and finally, possible predictive factors of QoL (prior experience of violence, level of physical injury, perceived life threat, cohabitation, and PTSD symptoms) were examined (Paper IV). Generally, WHOQOL-Bref values associated with probable PTSD were lower than values associated with no cases. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. For each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOLBref subscales (the four domains and the two single items) were stable across time of assessment. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3. Our findings support the understanding of PTSD as a complex phenomenon. Early identification of important risk factors, included in an optimal treatment strategy, would perhaps protect against the development of PTSD. Being aware of symptoms such as perceived life threat and PD during the event and PTSD symptoms in the acute phase, would help to identify some of those in need of special follow-ups

Longitudinal relationship between self-efficacy and posttraumatic stress symptoms 8 years after a violent assault: An autoregressive cross-lagged model

Self-efficacy is assumed to promote posttraumatic adaption, and several cross-sectional studies support this notion. However, there is a lack of prospective longitudinal studies to further illuminate the temporal relationship between self-efficacy and posttraumatic stress symptoms. Thus, an important unresolved research question is whether posttraumatic stress disorder (PTSD) symptoms affect the level of self-efficacy or vice versa or whether they mutually influence each other. The present prospective longitudinal study investigated the reciprocal relationship between general self-efficacy (GSE) and posttraumatic stress symptoms in 143 physical assault victims. We used an autoregressive cross-lagged model across four assessment waves: within 4 months after the assault (T1) and then 3 months (T2), 12 months (T3) and 8 years (T4) after the first assessment. Stress symptoms at T1 and T2 predicted subsequent self-efficacy, while self-efficacy at T1 and T2 was not related to subsequent stress symptoms. These relationships were reversed after T3; higher levels of self-efficacy at T3 predicted lower levels of posttraumatic stress symptoms at T4, while posttraumatic tress symptoms at T3 did not predict self-efficacy at T4. In conclusion, posttraumatic stress symptoms may have a deteriorating effect on self-efficacy in the early phase after physical assault, whereas self-efficacy may promote recovery from posttraumatic stress symptoms over the long term

Pasienters opplevelser og erfaringer med regional anestesi i den perioperative fasen

Bakgrunn: Operasjonspasienter som får regional anestesi, er ofte våkne perioperativt og møter flere profesjonsgrupper i det perioperative forløpet. Det er derfor viktig å få økt innsikt i pasienters opplevelser og erfaringer. Hensikt: Beskrive og øke forståelsen om hvordan pasienter opplever og erfarer den perioperative fasen i regional anestesi, noe som kan bidra til økt trygghet hos pasienten gjennom en enda bedre ivaretakelse. Metode: Studien har et kvalitativ deskriptivt design og omfatter femten individuelle intervju av urologiske og ortopediske pasienter som har fått utført et kirurgisk inngrep. Intervjuene er analysert ved bruk av Malteruds systematiske tekstkondensering. Resultat: Det var viktig å kjenne seg ivaretatt og trygg gjennom hele det perioperative forløpet. Flere opplevde det trygt å ha flere profesjonsgrupper rundt seg. I tillegg var det viktig å få detaljert informasjon under forløpet, samt at personalet opptrådte rolig og vennlig. Noen pasienter ønsket å sove for å unngå å oppleve smerter og annet ubehag, mens andre ønsket å være våkne under operasjonen på grunn av et behov for å ha kontroll. Flere opplevde hjelpeløshet og at det var vanskelig å være avhengig av hjelp under og etter operasjon. I tillegg opplevde noen en krenkelse av bluferdigheten og tap av kontroll i forbindelse med intime gjøremål. Pasientene opplevde at det var utfordrende å uttrykke sine smerter på en smerteskala. Erfaringer fra tidligere operasjoner hadde betydning. Konklusjon: Det er viktig å tilpasse forholdene til den enkelte pasient slik at de får best mulig opplevelser og erfaringer. God ivaretagelse, som ved tilstrekkelig informasjon, god smertelindring og rolig opptreden, er sentralt. Å ha flere profesjonsgrupper rundt seg i den perioperative fase oppleves trygt

The relationship between perceived social support and PTSD symptoms after exposure to physical assault: An 8 years longitudinal study

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time (p .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions

The relationship between perceived social support and PTSD symptoms after exposure to physical assault: An 8 years longitudinal study

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time ( p &lt; .001); PSS were significantly correlated only between T1 and T2 ( p &lt; .001), T1 and T3 ( p &lt; .05), and between T2 and T3 ( p &lt; .05). Cross-lagged analyses showed an inverse relationship between prior PSS and later PTSD symptoms across all time points ( ps &lt; .05); not proved between prior PTSD symptoms and later PSS ( ps &gt; .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions

The relationship between perceived social support and PTSD symptoms after exposure to physical assault: An 8 years longitudinal study

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time (p .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions