To evaluate health-related quality of life (HRQoL) in patients in different stages of chronic kidney disease (CKD) up to initiation of dialysis treatment and to explore possible correlating and ...influencing factors.
Cross-sectional design with 535 patients in CKD stages 2-5 and 55 controls assessed for HRQoL through SF-36 together with biomarkers.
All HRQoL dimensions deteriorated significantly with CKD stages with the lowest scores in CKD 5. The largest differences between the patient groups were seen in 'physical functioning', 'role physical', 'general health' and in physical summary scores (PCS). The smallest disparities were seen in mental health and pain. Patients in CKD stages 2-3 showed significantly decreased HRQoL compared to matched controls, with differences of large magnitude - effect size (ES) ≥ .80 - in 'general health' and PCS. Patients in CDK 4 demonstrated deteriorated scores with a large magnitude in 'physical function', 'general health' and PCS compared to the patients in CKD 2-3. Patients in CKD 5 demonstrated deteriorated scores with a medium sized magnitude (ES 0.5 - 0.79) in 'role emotional' and mental summary scores compared to the patients in CKD 4. Glomerular filtration rate <45 ml/min/1.73 m², age ≥ 61 years, cardiovascular disease (CVD), diabetes, C-reactive protein (CRP) ≥5 mg/L, haemoglobin ≤110 g/L, p-albumin ≤ 35 g/L and overweight were associated with impaired HRQoL. CRP and CVD were the most important predictors of impaired HRQoL, followed by reduced GFR and diabetes.
Having CKD implies impaired HRQoL, also in earlier stages of the disease. At the time for dialysis initiation HRQoL is substantially deteriorated. Co-existing conditions, such as inflammation and cardiovascular disease seem to be powerful predictors of impaired HRQoL in patients with CKD. Within routine renal care, strategies to improve function and well-being considering the management of co-existing conditions like inflammation and CVD need to be developed.
To explore the impact of chronic kidney disease (CKD) on individual illness representations, including symptoms and causal attributions.
Fifty-four patients responded to the Illness Perception ...Questionnaire (IPQ-R) and a further seven patients undertook cognitive interviews regarding the IPQ-R. All respondents had CKD stage 2-5, not undergoing renal replacement therapy.
Those in earlier CKD stages and those with fewer symptoms perceived a significantly different understanding of their condition than those in more advanced disease stages or with more symptoms. Behavioural and psychological attributions were commonly referred to as contributing causes to CKD. These attributions were associated to negative illness representations. An uncertainty assessing symptoms attributed to CKD was indicated, especially in earlier disease stages.
Illness representations differ with CKD stages and symptom burden. The patients in earlier disease stages or with fewer symptoms did not hold as strong beliefs about their illness as being a threat as those in advanced stages or with more symptoms. Self-blame emerged as a common causal attribution. Patients did not always relate symptoms to CKD, therefore this study identifies a gap in patients' disease knowledge, especially in earlier stages of the condition.
Scand J Caring Sci; 2012; 26; 474–484
Evaluating the illness perception questionnaire on patients with chronic kidney disease in Sweden
Background: The Revised Illness Perception Questionnaire ...(IPQ‐R) measures illness perception according to the Common Sense Model of Self‐Regulation. Illness perception relates to coping, health management, treatment outcomes and health‐related quality of life. IPQ‐R has been used in many contexts. However, there is yet no Swedish version evaluated for validity, reliability and usability in the context of a Swedish, adult population with Chronic Kidney Disease (CKD).
Objectives: To evaluate usability and psychometric properties of a Swedish translation of IPQ‐R on a group of adults in different stages of CKD.
Methods: Usability evaluation was carried out through cognitive interviews and psychometrics was assessed by internal consistency, test‐retest, inter‐correlations, correlations to health‐related quality of life and coping and testing for concurrent validity.
Results: Content validity was strongly supported, but an uncertainty assessing symptoms attributed to CKD was indicated. All dimensions showed internal consistency, except the treatment control dimension. The IPQ‐R showed good stability over time except the personal control dimension. Most IPQ‐R dimensions distinguished illness representations between groups of different disease stages and symptom burden. The most supported IPQ‐R dimensions for inter‐correlations and convergent validity were identity, timeline cyclical, consequences and emotional representations.
Conclusions: The evaluation of the Swedish version of IPQ‐R on patients with CKD showed support for construct validity, except for the dimensions controllability, illness coherence and timeline, which were less supported. These dimensions should therefore be interpreted with care in CKD patients. There is a need to capture uncertainty regarding illness identity. IPQ‐R should be interpreted with care in earlier stages of CKD or if few symptoms are reported. IPQ‐R may be applicable and useful as a tool in nursing practice to support healthy behaviour as well as assessing clinical interventions in patients with CKD.
Purpose
Performing venepuncture is one of the most routinely performed invasive procedures in nursing care. The aim of this study was to develop instruments for the assessment of nursing students' ...knowledge and skills when performing venepuncture and inserting a peripheral venous catheter.
Methods
Two instruments were developed using the following steps. 1) Assessment items of importance for the procedures (venepuncture 48 items and peripheral venous catheter 51 items) were collected from focus groups including nurses, lecturers and patients. 2) The number of items was reduced using a method based on the Delphi method. Experts (n=51) reviewed the instruments in two rounds. The revised versions included 31 items for venepuncture and 33 items for peripheral venous catheter insertion. 3) Usability tests were conducted by nurses who tested the instruments to confirm that items were possible to assess. 4) Inter-rater reliability was assessed by twelve lecturers who in pairs, but independently of each other, used the instruments to assess 50 nursing students.
Results
Proportion of agreement and Cohen's kappa coefficient were calculated for each item to determine inter-rater reliability. Among the tested items for both instruments, the median proportion of agreement was 1 (range 0.66-1) and the median kappa was 0.52 (range 0.22-1).
Conclusions
The instruments developed for assessing nursing students' knowledge and skills of venepuncture and peripheral venous catheter insertion showed satisfactory inter-rater reliability.
Abstract Objective The aim of the study was to explore the structure, content in communication and self-management education in patients’ first consultations at nurse-led chronic obstructive ...pulmonary disease (COPD) clinics in primary healthcare. Method Thirty consultations performed by seven registered nurses were videotaped; structure and content in the consultation was analyzed using Pendleton's Consultation Map. Nurses’ self-management education was assessed from the content of the conversation: whether important and relevant information and self-management education was given, and how investigations were performed. Results Each consultation lasted for a mean time of 37.53 min. Communication about reasons for consultations concerned mainly medical and physical problems and to a certain extent patients’ perceptions. Teaching about self-management and smoking cessation was of an informative nature. Two consultations ended with shared understanding, and none of the patients received an individual treatment-plan. Conclusion Nurses rarely planned the consultations on an individual basis and rarely used motivational dialogue in self-management education and in smoking cessation. Practice implications The findings could be used to help nurses to reflect on how to improve the structure of the visit, self-management education, smoking cessation and patient communication.
Home mechanical ventilation (HMV) is known to be a successful therapy for chronic respiratory insufficiency, with regard to long-term survival. However, the quality of life (QoL) of patients ...receiving HMV has not previously been systematically investigated. The purpose of this study was to assess the QoL of patients with neuromuscular disorders and skeletal deformities (ie, restrictive lung disease) receiving HMV.
Patients receiving HMV treated by tracheostomy or noninvasive ventilation (NIV). Three different, standardized, and validated questionnaires were used: the Sickness Impact Profile (SIP), the Health Index (HI), and the Sense of Coherence (SOC) scale. Underlying diseases were postpolio dysfunction (37%), neuromuscular disorder (20%), scoliosis (15%), and other diseases (28%).
The group treated with tracheostomy had higher HI scores than the group treated with NIV. For the three main diagnosis groups treated with tracheostomy or NIV, the patients with postpolio dysfunction treated with tracheostomy had lower SIP scores than the patients with postpolio dysfunction treated with NIV. This was in contrast to the patients with neuromuscular disorders treated with tracheostomy, who had higher scores in the SIP, compared with patients with postpolio dysfunction treated with tracheostomy and patients with neuromuscular disorders treated with NIV. A SIP score > 10% indicates a functional disability of clinical importance, and a high score on the HI and SOC scale indicates good perceived health. For the three main diagnosis groups treated with NIV, the patients with scoliosis had no dysfunction of clinical importance (4.6 ŷ 3.7) on the SIP score compared with patients with postpolio dysfunction (15.5 ŷ 7.6) and patients with neuromuscular disorders (13.2 ŷ 5.2) mean ŷ SD. The men showed more dysfunction in the SIP score than the women.
Patients receiving HMV reported a good perceived health, despite severe physical limitations. The patients with postpolio dysfunction and the patients with scoliosis treated with tracheostomy perceived the best health, compared with NIV for this diagnosis.
Information and effective communication is an essential element in treating children in hospital. Researches have shown that parents who are well informed and well prepared were less anxious, a fact ...that was found to decrease the child’s level of stress. Studies in the head injury population reveal that not only patients but their families need support such as general information about a head injury but also individual support, independent of the severity of the head injury.
Aim: To describe the families’ perceptions of information provided in relation to a head injury during their visit at the emergency department at Astrid Lindgren children’s hospital.
Design: Retrospective, descriptive study.
Method: Postal questionnaires at 3 months posthead injury.
Results: There were 96 families that participated, 51 families with children <5 years and 45 families with children >5 years. Eighty‐five per cent of all families understood the information concerning head injury they had been given during the visit to the emergency department. However, only 69% received the information they needed about head injury in children before discharge from the emergency department. There were significant differences between the two age groups as to whether or not the information was addressed to the child or that the information was age appropriate. The results from our study should be interpreted with caution because of the relatively low number of respondents and the fact that the study was conducted using a questionnaire. Another limitation is the fact that we asked for the information 3 months posthead injury.
Conclusions: Most families do understand the information that was provided and they also generally received the information they needed. However, they had not received information about common symptoms after a head injury. Strategies to improve information to families who experience a childhood head injury therefore seem necessary.
kneck å., klang b. & fagerberg i. (2012) Learning to live with diabetes – integrating an illness or objectifying a disease. Journal of Advanced Nursing68(11), 2486–2495.
Aim. This paper is a report ...of a study of illuminating the meaning of ‘learning to live with diabetes’ 3 years after being diagnosed.
Background. A changed situation, for example, in relation to living with diabetes, raises a need to understand. How time for experience contributes to this learning process for people living with diabetes is not yet well understood. It would therefore seem valuable to ask people, who have had diabetes over a similar length of time, to narrate their experience in relation to daily life situations in order to understand better how learning is established.
Design. The study has a qualitative design.
Methods. A life world approach was used, with interviews being conducted with 13 people who had been diagnosed with diabetes 3 years earlier. Data were collected in 2007, and analyses were conducted using a phenomenological‐hermeneutic method.
Findings. How a person experiences the physical body was found to be crucial in the learning process. If the body with its signals is understood it can be a tool for experiencing and understanding the world and oneself. Feeling insecure about one’s own needs, and not trusting or understanding bodily signs, made participants dependent on others to make decisions for them.
Conclusion. This study showed that duration of illness was ‘not’ of importance for the understanding of living with diabetes. Living with diabetes 3 years after being diagnosed meant to experience both an overall balance in one’s existence and a daily struggle.
The study compared patterns of reported symptoms between a mild head injury group and a group of children with abdominal complaints visiting an emergency department. Children (0—15 years) admitted to ...an emergency department during a three-month period with a history of head injury and a comparison group of children were included. Medical records at the time of injury were reviewed and follow-up questionnaires focused on presumed symptoms related to concussion at three months post-visit. The comparison group reported significantly more change in behaviour than the head injury group. However, for the older children, higher intensity of symptoms was reported by the comparison group compared to the head injury group. Initial differences in the amount and presence of symptoms between the two groups did not reflect the findings at three months; both groups reported symptoms or changes at three months after the event. Evaluating children aged under five, their symptoms and recovery patterns after a head injury is recommended.
Aims and objectives. The aim of the study was to examine differences in clinical reasoning among novice, experienced and specialist paediatric nurses.
Background. Highly specialised paediatric care ...requires specific knowledge and ongoing skill performance of the nurses employed. There is a lack of research in how paediatric nurses manage the daily care problems they encounter and how they acquire the skills required to give patients the best possible care. More knowledge is needed about how paediatric nurses with different experience and education reason and communicate about paediatric patient situations.
Design. The study was based on six recorded group discussions of a fictitious, but realistic paediatric case. Three categories of nurses: novices (n = 7), experienced (n = 7) and specialists (n = 7) from a paediatric hospital participated. A qualitative content analysis approach was chosen to examine differences in clinical reasoning.
Results. Several themes were uncovered: child’s social situation, child abuse and the child’s illness, qualitative differences emerged in how the nurses discussed the case. Three approaches were identified: a task‐oriented approach (novices and experienced), an action‐oriented approach (novices and experienced) and hypothesis‐oriented approach (specialists) while discussing the case.
Conclusion. When comparing nurses in three competence groups, it was established that the groups with extensive experience and specialist education reasoned differently than the other groups. Between the novice and experienced groups, no obvious differences were found. Thus, the importance of experience alone for the development of competence is still an open question. Experience combined with further education appears important for developing professional competence in paediatric care.
Relevance to clinical practice. Nurses’ reasoning in clinical paediatric care is related to experience and training.
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