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  • 1.
    Eckerblad, J.
    et al.
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Hellstrom, I.
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Ekdahl, A.
    Vrinnevi Hosp, Dept Geriatr, Norrkoping, Sweden..
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Jaarsma, T.
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Symptom burden in elderly patients with cardiac disease and multimorbidity2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, p. S52-S53Article in journal (Other academic)
  • 2.
    Eckerblad, J
    et al.
    Linköping University.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Ekdahl, A
    Linköping University, Karolinska Institutet.
    Jaarsma, T
    Linköping University.
    Hellstrom, I
    Linköping University, Ersta Sköndal University College.
    To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity.2015In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 28, no 4, p. 322-327Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life.

    OBJECTIVES: The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.

    METHOD: A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.

    RESULTS: The experience of living with a high symptom burden revealed the overall theme, "To adjust and endure" and three sub-themes. The first sub-theme was "To feel inadequate and limited". Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.

    CONCLUSION: This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.

  • 3.
    Eckerblad, J
    et al.
    Linköping university.
    Tödt, K
    Linköping university.
    Jakobsson, P
    Linköping university hospital.
    Unosson, M
    Skargren, E
    Linköping university.
    Kentsson, M
    Ryhov Hospital Jönköping.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Symptom burden in stable COPD patients with moderate or severe airflow limitation2014In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 4, p. 351-357Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

    BACKGROUND: Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

    METHODS: A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

    RESULTS: The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

    CONCLUSIONS: Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

  • 4.
    Eckerblad, Jeanette
    et al.
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Ekdahl, Anne
    Linkoping Univ, Dept Geriatr Med, Norrkoping, Sweden.;Linkoping Univ, Dept Social & Welf Studies, Norrkoping, Sweden.;Karolinska Inst KI, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc NVS, Solna, Sweden..
    Unosson, Mitra
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Wirehn, Ann-Britt
    Linkoping Univ, Cty Council Ostergotland, Local Hlth Care Res & Dev Unit, Linkoping, Sweden..
    Milberg, Anna
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden.;Linkoping Univ, Dept Social & Welf Studies, Norrkoping, Sweden.;Linkoping Univ, Dept Adv Home Care, Norrkoping, Sweden.;Linkoping Univ, Palliat Educ & Res Ctr, Norrkoping, Sweden..
    Krevers, Barbro
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Jaarsma, Tiny
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study2015In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods: A cross-sectional study including 378 community-dwelling people >= 75 years, who had been hospitalized >= 3 times during the previous year, had >= 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results: The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion: The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.

  • 5. Falk, B
    et al.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    En vårdavdelnings utveckling sedd ur patienters och personals behovsperspektiv1987Report (Other academic)
  • 6.
    Gardulf, Ann
    et al.
    Karolinska Univ Hosp, Karolinska Inst, Dept Lab Med, Div Clin Immunol,Unit Clin Nursing Res & Clin Res, SE-14186 Stockholm, Sweden.;Japanese Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Nilsson, Jan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Japanese Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Florin, Jan
    Dalama Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Leksell, Janeth
    Dalama Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.;Uppsala Univ, Dept Med Sci Clin Diabetol & Metab, Uppsala, Sweden..
    Lepp, Margret
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Gothenburg, Sweden.;Ostfold Univ Coll, Holden, Norway..
    Lindholm, Christina
    Sophiahemmet Univ, Stockholm, Sweden..
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Hedmark University College, Hedmark, Norway.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Hedmark Univ Coll, Hedmark, Norway..
    Carlsson, Marianne
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.;Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Johansson, Eva
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Dept Nursing, Stockholm, Sweden..
    The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 36, p. 165-171Article in journal (Refereed)
    Abstract [en]

    Background: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. Objectives: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. Methods and participants; The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1[20-56] years, 87.3% women) from 11 universities/university colleges participated. Results: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27 years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (932% vs 875% of NSPGs). Summary and conclusion: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs. (C) 2015 Elsevier Ltd. All rights reserved.

  • 7.
    Hall-Lord, Marie Louise
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013).
    Athlin, Elsy
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    A clinical supervision model in bachelor nursing education: Purpose, content and evaluation2013In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 13, no 6, p. 506-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Collaboration between universities and clinical placements has been highlighted as a weak point of the nursing education. To facilitate a good academic learning environment a clinical supervision model had been developed. The aim of this study was to evaluate to what extent the goals of the model were met after one and a half years of utilisation.

    METHODS: A questionnaire was responded to by 30 head nurses, 12 main preceptors, 193 personal preceptors, and 11 clinical nurse lecturers.

    RESULTS: Most of the participants perceived that the quality criteria in the model were met to a large extent, the students' individual goals were achieved, and the supervision model contributed to fulfilment of goals, and assessment of the students. The nurse lecturers scored highest and the personal preceptors lowest in most of the questions. The conditions stated in the model were not always fulfilled. The deficiencies found were especially related to education level, time for supervision, and support to the personal preceptors.

    CONCLUSIONS: Despite some shortcomings the supervision model was considered by most participants as a valuable tool to be used in an academic nursing education. Improvements of the model in regard to the findings were suggested.

  • 8. Johansson, Iréne
    et al.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Rondsystem - Parvård. Uppföljning av en organisationsförändring på kirurgkliniken vid Centralsjukhuset i Karlstad1992Report (Other academic)
  • 9. Larsson, G.
    et al.
    Johansson, Iréne
    Gustavsson, E.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Medicinskt färdigbehandlade patienters vårdbehov - Reviderad version1993Report (Other academic)
  • 10.
    Nilsson, Jan
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Carlsson, Marianne
    Johansson, Eva
    Karolinska Institutet.
    Egmar, Ann-Charlotte
    Röda Korsets Högskola.
    Florin, Jan
    Högskolan Dalarna.
    Leksell, Janeth
    Högskolan Dalarna.
    Lindholm, Christina
    Sophiahemmet Högskola.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Lepp, Margret
    Göteborgs universitet.
    Gardulf, Ann
    Nursing in a globalized world: Nursing students with international study experience report higher competence at graduation2014In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, no 4, p. 848-858Article in journal (Refereed)
    Abstract [en]

    Due to globalization, there is a need for nurses with skills and competence in providing safe, competent and culturally appropriate care. The aim of the study was to investigate whether International Study Experiences (ISE) in other countries during basic nursing education had an impact on newly graduated nurses as regards to self-reported competence. Moreover, a second aim was to explore what background factors that facilitated or constituted a hindrance for nursing students to choose to conduct part of their basic nursing education abroad. At 11 Universities/University Colleges (henceforth called Higher Education Institutions [HEIs]) in Sweden, 565 nursing students responded to the Nurse Professional Competence (NPC) Scale. Students with ISE rated their competence significantly higher on three NPC competence areas; “Legislation in nursing and safety planning”, “Leadership and development of nursing” and “Education and supervision of staff/students”. Background factors that significantly seemed to enhance ISE were; living alone, not having children or other commitments, international focus at the HEI and previous international experience. Lack of financial means was reported to prevent students from choosing ISE. The study implies that several background factors are of importance whether students choose ISE or not. ISE during basic nursing education might result in better self-reported competence in leading and developing nursing care, including education of future nurses, and in providing safe care.

  • 11.
    Nilsson, Jan
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Johansson, Eva
    Karolinska institutet.
    Egmar, Ann-Charlotte
    Röda korsets sjuksköterskeskola.
    Florin, Jan
    Högskolan Dalarna.
    Leksell, Janeth
    Högskolan Dalarna.
    Lepp, Margret
    Göteborgs universitet.
    Lindholm, Christina
    Sophiahemmet.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Development and validation of a new tool measuring nursesself-reported professional competence—The nurse professionalcompetence (NPC) Scale2014In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 2014, no 34, p. 574-580Article in journal (Refereed)
    Abstract [en]

    Objectives: To develop and validate a new tool intended for measuring self-reported professional competenceamong both nurse students prior to graduation and among practicing nurses. The new tool is based on formalcompetence requirements from the Swedish Board of Health and Welfare, which in turn are based on WHOguidelines.Design: A methodological study including construction of a new scale and evaluation of its psychometricproperties.Participants and settings: 1086 newly graduated nurse students from 11 universities/university colleges.Results: The analyses resulted in a scale named the NPC (Nurse Professional Competence) Scale, consisting of 88items and covering eight factors: “Nursing care”, “Value-based nursing care”, “Medical/technical care”, “Teaching/learning and support”, “Documentation and information technology”, “Legislation in nursing and safetyplanning”, “Leadership in and development of nursing care” and “Education and supervision of staff/students”.All factors achieved Cronbach's alpha values greater than 0.70. A second-order exploratory analysis resulted intwo main themes: “Patient-related nursing” and “Nursing care organisation and development”. In addition,evidence of known-group validity for the NPC Scale was obtained.

  • 12.
    Nordin, Anna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hallberg, Anders
    Landstinget i Värmland.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Patient safety culture over time– health care staffs’ perceptionsManuscript (preprint) (Other academic)
  • 13.
    Nordin, Anna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Health care staffs’ perception of patient safety culture in hospital settings and factors of importance for this2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, p. 28-40Article in journal (Refereed)
    Abstract [en]

    Many hospital patients are affected by adverse events. Managers are important when improving safety. The perception of patient safety culture varies among health care staff. Health care staff (n = 1023) working in medical, surgical or mixed medical-surgical health care divisions answered the 51 items (14 dimensions) Swedish Hospital Survey on Patient Safety Culture (S-HSOPSC). Respondents with a managerial func- tion scored higher than non-managers for 11 of 14 dimensions, indicating patient safety culture strengths for a majority of dimensions. Enrolled nurses and staff with experience > 10 years also scored high for several dimensions. The 12 dimensions and sample characteristics explained 49% and 26% of the vari- ance for the outcome dimensions Overall Perceptions of Safety and Frequency of Incident Reporting, re- spectively. RNs, ENs and physicians have different views on patient safety culture. Hospital Management Support and Organisational Learning is some im- portant factors influencing patient safety culture. Bridging the gap in health care staff’s perceptions of safety in order to improve patient safety is of utmost importance. Managers have the responsibility to fos- ter patient safety culture at their workplace and can thus benefit from results when improving safety for patients.

  • 14.
    Nordin, Anna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Improvements of patient safety - suggestions from health care staffManuscript (preprint) (Other academic)
  • 15.
    Nordin, Anna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Nordström, Gun
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Swedish Hospital Survey on Patient Safety Culture: Psychometric properties and health care staff’s perception2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, p. 41-50Article in journal (Refereed)
    Abstract [en]

    This study examined the psychometric properties of the Swedish and the original version of the Hospital Survey on Patient Safety Culture within a Swedish hospital setting and described health care staff’s per- ceptions of patient safety culture. A web-survey was used to obtain data from registered nurses, enrolled nurses and physicians (N = 1023). Psychometric properties were tested using Confirmatory Factor Analysis and internal consistency using Cronbach’s alpha coefficient. Root mean square error of ap- proximation and other fit indices indicated psycho- metric properties for both versions to be acceptable. Internal consistency for the dimensions varied be- tween 0.60 and 0.87. Staff scored the dimension “Teamwork Within Units” highest and the dimension “Hospital Management Support” the lowest. The safety was graded as very good or excellent by 58.9% of the respondents and one third had reported more than one event in the past 12 months. The question- naire is considered to be useful for measuring patient safety culture in Swedish hospital settings. Managers have a great responsibility to work with improving patient safety culture.

  • 16.
    Nordin, Anna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Mätning av patientsäkerhetskultur på sjukhus2011Conference paper (Refereed)
  • 17.
    Odencrants, Sigrid
    et al.
    Örebro universitet.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Assessment of nutritional status and meal-related situations among patients with chronic obstructive pulmonary disease in Primary health care - obese patients; a challenge for the future.2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 7-8, p. 977-985Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe nutritional status, meal related situations, food habits and food preferences of patients with chronic obstructive pulmonary disease (COPD) in a Primary health care (PHC) setting.

    BACKGROUND: To date, guidelines have mainly focused on underweight patients with COPD, as a low body mass index (BMI) is a risk factor for mortality. However, in recent years there has been an increase in the number of overweight patients with COPD, and therefore nutritional management must be developed to cover problems related to both under and overweight.

    DESIGN: Descriptive.

    METHODS: One hundred and three patients from PHC centres representing COPD stages 2 and 3 were included. The Mini Nutritional Assessment (MNA) was used to collect nutritional status data while semi-structured interviews provided information on food and meal related situations.

    RESULTS: Mean age was 69 (± 5)years and 45% were women. Among all patients mean BMI was 27 and 14% had a BMI ≤ 21 kg/m(2) . More women (31%) than men (26%) had a BMI ≥ 30 kg/m(2) . According to the MNA screening score, 86% of the patients were assessed as normal or not at risk of malnutrition. The total MNA assessment score revealed that 10 patients were at risk of malnutrition or malnourishment. Problems with meal related situations were mostly associated with eating, and only a small number reported difficulties with shopping or preparing food.

    CONCLUSIONS: In PHC, more patients with COPD were obese than malnourished and their self-reported nutritional status was not always accurate.

    RELEVANCE TO CLINICAL PRACTICE: It is challenging to identify the patient's nutritional status, individualize nutritional care and educate obese patients with COPD at PHC centres. It is necessary to develop screening instruments to assess the risk of both obesity and malnutrition.

  • 18.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Fatigue, functional status, health and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease2007Doctoral thesis, monograph (Other academic)
  • 19.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kroniskt obstruktiv lungsjukdom och fatigue2003Conference paper (Refereed)
  • 20.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Omvårdnad i Värmland, några utgångspunkter för god omvårdnad och goda omvårdare1997Report (Other academic)
  • 21.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Trötthet hos patienter med kroniskt obstruktiv lungsjukdom2001Conference paper (Refereed)
  • 22.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Carnevali, D
    Helhetssyn och omvårdnadsdiagnostik1997In: sjukskötersketidningen, 8/1997Article in journal (Other (popular science, discussion, etc.))
  • 23.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Cliffordson, C
    Högskolan i Trollhättan.
    Torstensson, Olof
    Oskarshamns sjukhus.
    Jakobsson, P
    Linköpings universitet.
    Unosson, M
    Linköpings universitet.
    Fatigue Impact Scale: Its validation in patients with chronic obstructive pulmonary disease2007In: Psychology, Health & Medicine, ISSN 1354-8506, E-ISSN 1465-3966, Vol. 12, no 4, p. 470-484Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the reliability and validity of the Fatigue Impact Scale (FIS) among patients with chronic obstructive pulmonary disease (COPD) and shorten the questionnaire. The empirically developed FIS, which comprised three subscales (cognitive, physical and psychosocial), was tested originally on Pipers theoretical framework of subjective manifestations of fatigue, including behavioural, physical, emotional and cognitive expressions. The data analyzed here consisted of responses from 296 patients with COPD who reported fatigue. The dimensionality of the FIS was examined using confirmatory factor analysis. A reduction of 15 items from the original FIS was made based on theory, modification indices and factor loadings. The results indicate that a nested-factor model with one general behavioural factor and three specific factors, physical, emotional and cognitive, shows acceptable fit. A modified version of 25 items, FIS-25 was developed. The original FIS and the FIS-25 were able to discriminate between patients with differing duration of fatigue. Test-retest correlations ranged from .70 to .85 for items and .94 for the total scale. Due to modification, the FIS-25 needs to be validated on a new group of patients with COPD

  • 24.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Eckerblad, Jeanette
    Hellström, Ingrid
    Unosson, Mitra
    High symptom burden in early stages of COPD.2011Conference paper (Refereed)
  • 25.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hasselgren, Mikael
    County Council of Värmland, Karlstad.
    Luhr, Kristina
    Örebro County Council.
    Eckerblad, Jeanette
    Linköping University.
    Unosson, Mitra
    Karlsson, Ingela
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care2014In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 9, p. 785-794Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare.

    AIM: Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC).

    METHOD: The study is cross sectional, including patients with COPD (n=437) and CHF (n=388), registered in the patient administrative systems of PHC. The patients received specific questionnaires--the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale--by mail and additional questions about psychological and physical health.

    RESULTS: The mean age was 70 ± 10 years and 78 ± 10 years for patients with COPD and CHF respectively (P=0.001). Patients with COPD (n=273) experienced more symptoms (11 ± 7.5) than the CHF patients (n=211) (10 ± 7.6). The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background characteristics, there were no differences regarding feeling irritable, worrying, and sexual problems. There were no differences in impact of symptoms or health.

    CONCLUSION: Patients with COPD and CHF seem to experience similar symptoms. There were no differences in how the patients perceived their functioning according to their cardinal symptoms; dyspnea and fatigue, and health. An intervention for both groups of patients to optimize the management of symptoms and improve function is probably more relevant in PHC than focusing on separate diagnosis groups.

  • 26.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Jakobsson, P.
    Torstensson, O.
    Unosson, M.
    Severity of fatigue is related to functional limitations and health in patients with chronic obstrutive pulmonary disease2008In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 14, p. 453-460Article in journal (Refereed)
  • 27.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Jakobsson, P
    Torstensson, P
    Unosson, M
    Fatigue and quality of life among patients with COPD2005Conference paper (Refereed)
  • 28.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Jakobsson, P
    Unosson, M
    No gender differences in fatigue and functional limitations due to fatigue among patients with COPD2010Conference paper (Refereed)
  • 29.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Jakobsson, Per
    Jörgensen, Nils
    Unosson, Mitra
    Effects of pulmonary rehabilitation on fatigue, functional status and health perceptions in patients with chronic obstructive pulmonary disease:: a randomized controlled trial2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 2, p. 125-136Article in journal (Refereed)
  • 30.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Odenkrants, Sigrid
    Not only malnutrition among patients with chronic obstructive pulmonary disease in primary health care2011Conference paper (Refereed)
  • 31.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Unosson, M
    Functional impact of fatigue in patients with chronic obstructive pulmonary disease2004Conference paper (Refereed)
  • 32.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Unosson, M
    No gender differences in fatigue and functional limitations due to fatigue among patients with chronic obstructive pulmonary disease2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 9/10, p. 1303-1310Article in journal (Refereed)
  • 33.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Unosson, Mitra
    Effects of pulmonary rehabilitation on fatigue, functional status and health in patients with chronic obstructive pulmonary disease2008Conference paper (Refereed)
  • 34.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Unosson, Mitra
    Fatigue in patients with chronic obstructive pulmonary disease2004In: Journal of advanced nursingArticle in journal (Refereed)
  • 35.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Hedmark Univ Coll, Dept Nursing & Mental Hlth, Fac Publ Hlth, Hedmark, Norway..
    Carlsson, Marianne
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.;Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Florin, Jan
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Gardulf, Ann
    Karolinska Univ Hosp, Karolinska Inst, Dept Lab Med, Unit Clin Nursing Res & Clin Res Immunotherapy,Di, Stockholm, Sweden.;Japan Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Johansson, Eva
    Karolinska Univ Hosp, Karolinska Inst, Dept Lab Med, Unit Clin Nursing Res & Clin Res Immunotherapy,Di, Stockholm, Sweden.;Japan Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Lindholm, Christina
    Sophiahemmet Univ, Stockholm, Sweden..
    Nordström, Gun
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nilsson, Jan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Japan Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 37, p. 178-183Article in journal (Refereed)
    Abstract [en]

    Background: Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported. Objectives: To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented. Setting: A higher education nursing program at a Swedish university. Participants: In total, 119 (2011 n = 69, 2014 n = 50) nursing students responded. Methods: Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale. Results: There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students. Conclusions: Our findings indicate that newly graduated nursing students- both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing. (C) 2015 Elsevier Ltd. All rights reserved.

  • 36.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Zakrisson, Ann-Britt
    Anderzen-Karlsson, Agneta
    Patients’ with COPD experience of a nurse-led multidisciplinary programme in primary health care, one year after participation.2011Conference paper (Refereed)
  • 37.
    Theander, Kersti
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Zakrisson, Ann-Britt
    Engfeldt, Peter
    Hägglund, Doris
    Odencrants, Sigrid
    Hasselgren, Mikael
    Arne, Mats
    Exacerbations in patients with COPD in primary care, a quasi-experimental longitudinel study2010Conference paper (Refereed)
  • 38.
    Todt, Kristina
    et al.
    Linkoping Univ, Dept Social & Welf Studies, S-60174 Norrkoping, Sweden.;Linkoping Univ, Dept Resp Med, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Skargren, Elisabeth
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Jakobsson, Per
    Linkoping Univ, Dept Resp Med, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Unosson, Mitra
    Linkoping Univ, Dept Social & Welf Studies, S-60174 Norrkoping, Sweden..
    Factors associated with low physical activity in patients with chronic obstructive pulmonary disease: a cross-sectional study2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, p. 697-707Article in journal (Refereed)
    Abstract [en]

    Objectives: Low physical activity (PA) in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. In addition, physical activity seems to be low early in the disease. The aim of this study was to describe the level of PA in patients with stable COPD and to explore factors associated with low PA, with a focus on fatigue, symptom burden and body composition Methods: In a cross-sectional study, 101 patients (52 women) with COPD were classified having low, moderate or high PA according to the International Physical Activity Questionnaire - Short. Fatigue, dyspnoea, depression and anxiety, symptom burden, body composition, physical capacity (lung function, exercise capacity, muscle strength), exacerbation rate and systemic inflammation were assessed. A multiple logistic regression was used to identify independent associations with low PA. Results: Mean age was 68 (+/- 7) years, and mean percentage of predicted forced expiratory volume in 1 second was 50 (+/- 16.5). Forty-two patients reported a low PA level, while 34 moderate and 25 reported high levels. Factors independently associated with low PA, presented as odds ratio (95% confidence interval), were severe fatigue 5.87 (1.23-28.12), exercise capacity 0.99 (0.99-1.0) and the number of pack-years 1.04 (1.01-1.07). No relationship was found between depression, anxiety, body composition, exacerbation rate or systemic inflammation and PA. Conclusions: Severe fatigue, worse exercise capacity and a higher amount of smoking were independently associated with low PA. Promoting physical activity is important in all patients with COPD. Our result suggests that patients with severe fatigue might need specific strategies to prevent physical inactivity.

  • 39.
    Todt, Kristina
    et al.
    Linkoping Univ, Dept Social & Welf Studies, Fac Hlth Sci, S-60174 Norrkoping, Sweden.;Linkoping Univ, Dept Pulm Med, Univ Hosp, Linkoping, Sweden..
    Skargren, Elisabeth
    Linkoping Univ, Fac Hlth Sci, Dept Med & Hlth, Linkoping, Sweden..
    Kentson, Magnus
    Ryhov Hosp, Dept Pulm Med, Jonkoping, Sweden..
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Jakobsson, Per
    Linkoping Univ, Dept Pulm Med, Univ Hosp, Linkoping, Sweden..
    Unosson, Mitra
    Linkoping Univ, Dept Social & Welf Studies, Fac Hlth Sci, S-60174 Norrkoping, Sweden..
    Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD2014In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 9, p. 17-25Article in journal (Refereed)
    Abstract [en]

    Introduction: Several differences have been reported in the clinical characteristics of chronic obstructive pulmonary disease (COPD) between men and women. Differences have been found in the association between respiratory symptoms and lung function, and in the factors associated with dyspnea. This raises the question of whether there are differences between the sexes in the relationship between fatigue, the second most prevalent symptom, and the variables of physical capacity and disease severity. Objectives: To examine the experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD. Methods: In a cross-sectional study 121 patients with COPD (54 men and 67 women), the experience of fatigue (frequency, duration, and severity) and physical capacity (lung function, 6-minute walk distance [6MWD], grip strength, and timed-stand test) were assessed. Disease severity was graded according to the Body mass index, airway Obstruction, Dyspnoea and Exercise capacity (BODE) index. Two multiple logistic regression models were tested, both of which were performed separately in men and women, to examine the association between the experience of fatigue and variables of physical capacity and the BODE index. Results: Eighty-nine (73.6%) patients experienced fatigue, with similar proportions in men and women. The men with fatigue had worse physical capacity and more severe disease than did the men without fatigue: for men with and without fatigue, respectively, the percent of predicted forced expiratory volume in 1 second (FEV1) (mean [standard deviation]) was 47 (14) vs 64 (17); the 6MWD (mean [standard deviation]) was 398 (138) vs 539 (105) m; and the BODE index (median [quartile 1-3]) was 3 (2-5) vs 1 (0-1) (P<0.01). In women, only higher leg fatigue post-6MWD was seen among those experiencing fatigue compared with women without fatigue: for women with and without fatigue, respectively, leg fatigue (median [quartile 1-3]) was 4 (3-5) vs 2 (0-3) (P<0.001). The regression models showed that the 6MWD and the BODE index were associated with fatigue in both men and women, but in women, leg fatigue remained an independent associate in both models. Conclusion: Exercise capacity and disease severity were associated with fatigue in both men and women. In women, leg fatigue was strongly associated with fatigue, which warrants further investigation.

  • 40. Tödt, Kristina
    et al.
    Skargren, Elisabeth
    Kentson, Magnus
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Jakobsson, Per
    Unosson, Mitra
    Fatigue is associated with reduced physical capacity and disease severity in men but not in women with COPD2011Conference paper (Refereed)
    Abstract [en]

    Purpose: The purpose was to examine the association between perception of fatigue, and physical capacity and disease severity in men and women with chronic obstructive pulmonary disease (COPD). Relevance: Fatigue is the second most common symptom among patients with COPD. Fatigue is shown to be associated with reduced functional status and perceived health. To optimize rehabilitation program in patients with COPD, knowledge about the association between fatigue and physical capacity in men and women is needed. Participants: In total 121 patients (67 women) with stable COPD, consecutively selected through the patient administrative system at two hospitals, were included. Mean age was 67 (± 7) years and FEV1% of predicted was 49 (± 16) with no differences between genders. Methods: Fatigue was assessed with structured questions covering frequency, duration and severity. The patients were classified into no, mild and severe fatigue. Physical capacity included lung function (FEV1 and FVC), 6-minute walk distance (6MWD), timed stands test and grip strength. Disease severity was classified with BODE-index including the body mass index, the degree of airway obstruction (FEV1% predicted), the degree of dyspnoea measured with the MRC-dyspnoea scale and exercise capacity measured as 6MWD. Analysis: Differences between patients with no, mild and severe fatigue were tested using the Kruskal-Wallis test with Bonferroni correction. Results: The proportion of patients with no, mild and severe fatigue was 26%, 52% and 22% respectively. This proportion was similar in men and women. Association between fatigue and physical capacity were seen in lung function (FVC) and 6MWD.  FVC was more deteriorated (p=0.02) and the 6MWD was shorter (p=0.008) in patients with mild and severe fatigue than in those with no fatigue.  The patients with mild and severe fatigue had a more severe disease compared with those with no fatigue (p<0.001). These differences in physical capacity and disease severity were only evident in men (FVC p= 0.02, FEV1 p=0.008, 6MWD p=0.003 and BODE-index p<0.001) and not in women (p=0.648, p=0.462, p=0.442 and p=0.285). Conclusions: The association between fatigue and physical capacity and disease severity seems to be evident in men only. Implications: The gender differences suggest different rehabilitation approaches in reducing fatigue in men and women with COPD. The results need to be confirmed in larger studies. :Funding acknowledgements: The study was supported by the Swedish Hearth Lung Foundation, Medical Research Council of Southeast Sweden and the Swedish Heart and Lung Association. Ethics approval: The study was approved by the Regional Ethical Review Board, Linköping, Sweden.

  • 41.
    Zakrisson, Ann-Britt
    et al.
    Family Medicine Research Centre, Örebro University, Sweden.
    Engfeldt, Peter
    Family Medicine Research Centre, Örebro University, Sweden.
    Hägglund, Doris
    School of Health and Medical Sciences, Örebro University, Sweden.
    Odencrants, Sigrid
    School of Health and Medical Sciences, Örebro University, Sweden.
    Hasselgren, Mikael
    Centre for Assessment of Medical Technology in Örebro, Sweden.
    Arne, Mats
    Centre for Assessment of Medical Technology in Örebro, Sweden.
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). METHOD: A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records. RESULTS: No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = –0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009). CONCLUSIONS: The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 42. Zakrisson, Ann-Britt
    et al.
    Engfeldt, Peter
    Hägglund, Doris
    Odenkrants, Sigrid
    Hasselgren, Mikael
    Arne, Mats
    Theander, Kersti
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Nurse-led multidisciplinary programme for patients with Chronic Obstructive Pulmonary Disease (COPD) in Primary Health Care2010Conference paper (Refereed)
    Abstract [en]

    AIM: To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). METHOD: A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records. RESULTS: No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = –0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009). CONCLUSIONS: The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 43.
    Zakrisson, Ann-Britt
    et al.
    Univ Orebro, Fac Hlth & Med, Univ Healthcare Res Ctr, SE-70182 Orebro, Sweden.;Univ Orebro, Ctr Assessment Med Technol, SE-70182 Orebro, Sweden..
    Hiyoshi, Ayako
    Univ Orebro, Fac Hlth & Med, Clin Epidemiol & Biostat, SE-70182 Orebro, Sweden..
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Cty Council Varmland, Primary Care Res Unit, Karlstad, Sweden..
    A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 962-971Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over threeyears among patients with Chronic Obstructive Pulmonary Disease. BackgroundAlthough Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established. DesignA quasi-experimental design. MethodPrimary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after oneyear and threeyears. Exacerbation frequency was calculated from oneyear before to threeyears after the programme. ResultsNo significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after oneyear and threeyears. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p=0091) but increased again in both groups after threeyears. ConclusionThere was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after oneyear. There is a need for support and coaching at regular follow-ups in primary health care. Relevance to clinical practiceThere is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow-ups.

  • 44.
    Zakrisson, Ann-Britt
    et al.
    Örebro University.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Anderzén-Carlsson, Agneta
    Örebro University.
    How life turned out one year after attending a multidisciplinary pulmonary rehabilitation programme in primary health care.2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 3, p. 302-311Article in journal (Refereed)
    Abstract [en]

    AIM: To describe experiences among patients with chronic obstructive pulmonary disease (COPD) of the lasting usefulness one year after participating in a multidisciplinary pulmonary rehabilitation (PR) programme in a primary health care (PHC) setting.

    BACKGROUND: COPD affects patients' functioning in daily life. In a previous study, the patients participated in a programme for PR and were found to increase their functional capacity, quality of life and decrease exacerbations. The present study aims to provide a deeper understanding of the experience of participating in the programme.

    DESIGN: The study has a descriptive, qualitative design and is part of a longitudinal study on a multidisciplinary programme for PR of patients with COPD.

    METHOD: Semi-structured interviews with 20 participants were performed and data analysed by qualitative content analysis.

    FINDINGS: The findings are presented in one theme that illustrates the participants' experience of their current situation; I live life at my own pace, and three sub-themes illustrating this experience related to the participation in the programme; Awareness of limitations in my life; Regained control over my life; and No change in my life.

    CONCLUSION: Irrespective of whether the patients had already found their own strategies for managing the disease or whether the programme changed their lives, they lived their lives at their own pace. However, their lives were shadowed by worry.

    RELEVANCE TO CLINICAL PRACTICE: A multidisciplinary programme for PR in PHC could be an alternative for patients suffering from COPD, in order to facilitate for them in their daily life. It is suggested that the inclusion of patients in such groups should be based on each individual's need based on symptoms or functional capacity in everyday life, not based on spirometry values.

  • 45.
    Zakrisson, Ann-Britt
    et al.
    Örebro universitet.
    Theander, Kersti
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Anderzén-Carlsson, Agneta
    Örebro universitet.
    The experience of a multidisciplinary programme of pulmonary rehabilitation in primary health care from the next of kin's perspective: a qualitative study.2013In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 22, no 4, p. 459-65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pulmonary rehabilitation increases functional capacity and quality of life and decrease exacerbations in patients with chronic obstructive pulmonary disease (COPD), but there is little knowledge of how it influences their next of kin.

    AIMS: To describe the experience of a multidisciplinary programme of pulmonary rehabilitation in primary health care from the perspective of the next of kin.

    METHODS: A descriptive qualitative study was undertaken as part of a longitudinal study comprising a multidisciplinary programme for patients with COPD where the next of kin were invited to one session. Semi-structured interviews were conducted with 20 next of kin and analysed by qualitative content analysis.

    RESULTS: One main theme emerged - Life still remains overshadowed by illness. There were three sub-themes: a sense of deepened understanding; a sense of personal vulerability; and a sense of relief of burden.

    CONCLUSIONS: The next of kin's life was still overshadowed by illness, despite the multidisciplinary programme. Although experiencing positive outcomes two years after the programme, the next of kin expressed a need for more support. This study has shown that next of kin could benefit from their own participation and/or that of the patient in a multidisciplinary programme of pulmonary rehabilitation. We believe that next of kin should be offered primary health care support for the sake of their own health, but also in order to manage their informal caregiver role. The experiences described here could form a basis for further development of interventions for next of kin of patients with COPD.

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