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Wallin, J., Jacobson, S. H., Axelsson, L., Lindberg, J., Persson, C. I., Stenberg, J. & Wennman-Larsen, A. (2023). Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study. Hemodialysis International, 27(4), 454-464
Open this publication in new window or tab >>Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study
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2023 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 27, no 4, p. 454-464Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The surprise question (SQ) "Would I be surprised if this patient died within the next xx months" can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics.

METHODS: This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics.

FINDINGS: Proportions of nurses and physicians responding to the SQ with "no, not surprised" was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded "no, not surprised", within 6 (κ = 0.366, p < 0.001, 95% CI = 0.288-0.474) and 12 months (κ = 0.379, p < 0.001, 95% CI = 0.281-0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ.

DISCUSSION: Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.

Keywords
Comparative study, Multi-professional, Palliative care, Renal dialysis, Surprise question
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4984 (URN)10.1111/hdi.13103 (DOI)37318069 (PubMedID)
Available from: 2023-08-11 Created: 2023-08-11 Last updated: 2023-10-17Bibliographically approved
Wallin, J., Jacobsson, S. H., Axelsson, L., Lindberg, J., Persson, C. I., Stenberg, J. & Wennman-Larsen, A. (2023). Discrepancy of clinical appraisal between hemodialysis nurses' and physicians' responses to the surprise question. In: : . Paper presented at 18th World Congress of the European Association for Palliative Care (EAPC), Rotterdam, Nederländerna, 15-17 juni 2023.
Open this publication in new window or tab >>Discrepancy of clinical appraisal between hemodialysis nurses' and physicians' responses to the surprise question
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2023 (English)Conference paper, Oral presentation only (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-5096 (URN)
Conference
18th World Congress of the European Association for Palliative Care (EAPC), Rotterdam, Nederländerna, 15-17 juni 2023
Available from: 2023-12-20 Created: 2023-12-20 Last updated: 2023-12-20Bibliographically approved
Norinder, M., Axelsson, L., Årestedt, K., Grande, G., Ewing, G. & Alvariza, A. (2023). Enabling professional and personal growth among home care nurses through using the Carer Support Needs Assessment Tool Intervention: An interpretive descriptive study. Journal of Clinical Nursing, 32(13-14), 4092-4102
Open this publication in new window or tab >>Enabling professional and personal growth among home care nurses through using the Carer Support Needs Assessment Tool Intervention: An interpretive descriptive study
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2023 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 13-14, p. 4092-4102Article in journal (Refereed) Published
Abstract [en]

AIM: To explore nurses' experiences of supporting family caregivers in specialised home care while learning to use the Carer Support Needs Assessment Tool Intervention.

BACKGROUND: The Carer Support Needs Assessment Tool Intervention can provide guidance for discussions with family caregivers in specialised home care concerning their specific support needs. Little attention has been paid to how nurses experience the use of the intervention in their everyday practice.

DESIGN: This longitudinal study adopted an inductive qualitative approach using interpretive description.

METHODS: Interviews were conducted at two time points. A total of 22 interviews took place with 12 nurses recruited from six specialised home care services. Data were analysed using interpretive description.

RESULTS: Nurses' everyday clinical practice changed while learning to use the Carer Support Needs Assessment Tool Intervention, and they experienced professional and personal growth. Their supportive inputs shifted from being reactive towards being more proactive. Their approach changed from taking on great professional responsibility, towards a shared responsibility with family caregivers. The support altered from ad hoc contacts in the hallway, towards scheduled trustful conversations. Nurses were concerned about the amount of time and energy this kind of support might require. They pointed to the importance of holding good nursing skills to conduct this new way of having conversations.

CONCLUSION: Nurses' everyday clinical practice can be further developed through the use of the Carer Support Needs Assessment Tool Intervention. Nurses may develop both professionally and personally, increasing their ability to provide person-centred support.

RELEVANCE TO CLINICAL PRACTICE: With the use of the Carer Support Needs Assessment Tool Intervention, nurses can create trusting conversations with family caregivers of patients with life-threatening illnesses cared for in specialised home care.

REPORTING METHOD: Reporting of the study follows the Consolidated Criteria For Reporting Qualitative Research (COREQ) checklist (File S1).

PATIENT OR PUBLIC CONTRIBUTION: Participating nurses were involved in discussing the study design.

Keywords
Family caregivers, Intervention nursing, Palliative care, Support needs
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4671 (URN)10.1111/jocn.16577 (DOI)36345120 (PubMedID)
Available from: 2022-12-08 Created: 2022-12-08 Last updated: 2024-03-26
Carlsson, N., Årestedt, K., Alvariza, A., Axelsson, L. & Bremer, A. (2023). Factors associated with symptoms of prolonged grief and psychological distress among bereaved family members of persons who died from sudden cardiac arrest. Journal of Cardiovascular Nursing, 38(5), 454-461
Open this publication in new window or tab >>Factors associated with symptoms of prolonged grief and psychological distress among bereaved family members of persons who died from sudden cardiac arrest
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2023 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 38, no 5, p. 454-461Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Death from sudden cardiac arrest implies a stressful and challenging situation for bereaved family members with an increased risk of prolonged grief disorder and psychological distress.

OBJECTIVES: The aims of this study were (1) to explore the associations between symptoms of prolonged grief and psychological distress and (2) to identify factors associated with symptoms of prolonged grief and psychological distress among bereaved family members of persons who died from sudden cardiac arrest.

METHODS: This cross-sectional survey included bereaved adult family members. Demographic data and measures of prolonged grief (Prolonged Grief Disorder-13), anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and perceived social support (Multidimensional Scale of Perceived Social Support) were analyzed using Spearman's correlations (rs) as well as univariate and multiple linear regression analyses.

RESULTS: In total, 108 family members participated. Significant associations between symptoms of prolonged grief, anxiety, depression, and posttraumatic stress were identified (rs = 0.69-0.79, P < .001). Offered, sought, and/or received professional support from healthcare, lower levels of perceived social support, being a spouse of the deceased, female sex, younger age, and family presence during resuscitation were significantly associated with higher symptom levels of prolonged grief, anxiety, depression, and/or posttraumatic stress.

CONCLUSIONS: The results indicate that family members with higher levels of symptoms were offered, sought, and/or received professional support. However, because a minority are offered professional support after deaths from cardiac arrest, future interventions need to proactively identify family members in need of support. Furthermore, perceived social support seems to be an important factor for family members of persons who died from cardiac arrest.

Keywords
Bereavement, Cardiopulmonary resuscitation, Family, Grief, Heart arrest, Sudden death
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4705 (URN)10.1097/JCN.0000000000000937 (DOI)35953072 (PubMedID)
Available from: 2023-01-12 Created: 2023-01-12 Last updated: 2024-03-26Bibliographically approved
Norinder, M., Axelsson, L., Årestedt, K., Grande, G., Ewing, G. & Alvariza, A. (2023). Family caregivers' experiences of discussing their needs with a nurse during specialised home care utilizing the carer support needs assessment tool intervention: A qualitative study. European Journal of Oncology Nursing, 66, Article ID 102412.
Open this publication in new window or tab >>Family caregivers' experiences of discussing their needs with a nurse during specialised home care utilizing the carer support needs assessment tool intervention: A qualitative study
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2023 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 66, article id 102412Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The Carer Support Needs Assessment Tool Intervention (CSNAT-I) was designed to help family caregivers identify, reflect upon, and express their support needs in a conversation with a health care professional and gain tailored support. The CSNAT-I has shown positive effects for both nurses and family caregivers but for more comprehensive understanding this study aims to examine family caregivers' experiences of discussing their needs with a nurse during specialised home care, utilizing the CSNAT-I.

METHODS: The study used an inductive qualitative descriptive design based on framework analysis. Data was collected using individual semi-structured telephone interviews with 10 family caregivers, with a median age of 66, from four specialised home care services.

RESULTS: Family caregivers appreciated having scheduled meetings with nurses utilizing the CSNAT-I which gave them an opportunity to focus on what was important to them. Family caregivers experienced that the conversations were co-created with a flexible dialogue. The conversations provided new perspectives and insights which helped in finding possible solutions. Family caregivers felt empowered by the co-created conversation and took on a more active role in involving the rest of their family to find support to themselves and the patients.

CONCLUSION: The CSNAT-I can facilitate communication between family caregivers and nurses leading to adequate supportive inputs. The intervention gives family caregivers an increased opportunity to be involved in their own support, which may enhance their sense of security. According to family caregivers' experiences, CSNAT-I may be an adequate way to support family caregivers to reflect and discuss their needs.

Keywords
Caregivers, Home care, Intervention, Palliative, Qualitative, Support
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-5037 (URN)10.1016/j.ejon.2023.102412 (DOI)37742425 (PubMedID)
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-12-21Bibliographically approved
Norinder, M., Årestedt, K., Axelsson, L., Grande, G., Ewing, G. & Alvariza, A. (2023). Increased preparedness for caregiving among family caregivers in specialized home care by using the Carer Support Needs Assessment Tool Intervention. Palliative & Supportive Care
Open this publication in new window or tab >>Increased preparedness for caregiving among family caregivers in specialized home care by using the Carer Support Needs Assessment Tool Intervention
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2023 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Family caregivers often feel insufficiently prepared for a caregiving role, experiencing challenges and demands related to care at home that may negatively affect their own quality of life. Supportive interventions have been shown to influence negative effects, but more studies are needed. Therefore, this study aims to explore potential effects of the Carer Support Needs Assessment Tool Intervention on preparedness, caregiver burden, and quality of life among Swedish family caregivers in specialized home care.

METHODS: The study had a pre-post intervention design and was conducted at 6 specialized home care services in Sweden. Family caregivers who received the intervention completed a questionnaire, including the Preparedness for caregiving scale, Caregiver Burden Scale, and Quality of Life in Life-Threatening Illness - Family carer version, at 2 time points, baseline and follow up, about 5 weeks later. Data were analyzed using descriptive statistics and Wilcoxon signed-rank test.

RESULTS: Altogether, 33 family caregivers completed the baseline and follow-up assessment. A majority were retired (n = 26, 81%) and women (n = 19, 58%) and two-fifths had a university degree (n = 13, 41%). The family caregivers had significantly increased their preparedness for caregiving between the baseline and follow-up assessment (Mdn = 18 vs. 20, p = 0.002). No significant changes were found on caregiver burden or quality of life.

SIGNIFICANCE OF RESULTS: The results add to knowledge regarding the Carer Support Needs Assessment Tool Intervention's potential to improve family caregiver outcomes. Findings suggest that the intervention may be used to improve the preparedness for caregiving and support among family caregivers in specialized home care.

Keywords
Caregivers, Home care, Intervention, Palliative, Preparedness
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4969 (URN)10.1017/S1478951523000639 (DOI)37278216 (PubMedID)
Available from: 2023-06-19 Created: 2023-06-19 Last updated: 2023-06-19Bibliographically approved
Carlsson, N., Alvariza, A., Axelsson, L., Bremer, A. & Årestedt, K. (2022). Grief reactions in relation to professional and social support among family members of persons who died from sudden cardiac arrest: A longitudinal survey study. Resuscitation Plus, 12, 100318, Article ID 100318.
Open this publication in new window or tab >>Grief reactions in relation to professional and social support among family members of persons who died from sudden cardiac arrest: A longitudinal survey study
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2022 (English)In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 12, p. 100318-, article id 100318Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The loss of a close person from sudden cardiac arrest (CA) leaves family members at risk of developing grief reactions such as symptoms of prolonged grief, anxiety, depression, and posttraumatic stress. The aim was to describe longitudinal variations in grief reactions and its association with professional and social support among bereaved family members after a close person's death from sudden CA.

METHODS: This longitudinal multimethod survey included 69 bereaved family members who completed a questionnaire 6 and 12-months after the CA, including the Prolonged Grief Disorder-13, Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, and Multidimensional Scale of Perceived Social Support. Qualitative data were collected by open-ended questions. Quantitative data was analyzed using Wilcoxon signed-rank test and linear regression analysis while written comments were analyzed using qualitative content analysis.

RESULTS: The median age was 62 years, 67 % were women, and 38 % had been present during the resuscitation attempts. Using the cut-off scores at the 6- and 12-month assessments respectively, 14 % and 17 % reported symptoms of prolonged grief, 32 % and 26 % symptoms of anxiety, 14 % and 9 % depression, and 4 % and 1 % posttraumatic stress. Professional and social support at the 6-month assessment were significantly associated with symptoms of prolonged grief, anxiety, depression, and/or posttraumatic stress at the 12-month assessments but could not predict any changes in the grief reactions.

CONCLUSIONS: Family members' grief reactions point to the importance of proactive and available support over time to meet family members' needs.

Keywords
Anxiety, Cardiac arrest, Depression, Posttraumatic stress, Prolonged grief, Social support
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4670 (URN)10.1016/j.resplu.2022.100318 (DOI)36299826 (PubMedID)
Available from: 2022-12-08 Created: 2022-12-08 Last updated: 2022-12-08Bibliographically approved
Carlsson, N., Bremer, A., Alvariza, A., Årestedt, K. & Axelsson, L. (2022). Losing a close person following death by sudden cardiac arrest: Bereaved family members' lived experiences. Death Studies, 46(5), 1139-1148
Open this publication in new window or tab >>Losing a close person following death by sudden cardiac arrest: Bereaved family members' lived experiences
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2022 (English)In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683, Vol. 46, no 5, p. 1139-1148Article in journal (Refereed) Published
Abstract [en]

The death of a close person has profound impact on people's lives, and when death is sudden there are no possibilities to prepare for the loss. The study aimed to illuminate meanings of losing a close person following sudden cardiac arrest. A qualitative interpretive design was used, and twelve bereaved family members were interviewed. The results show a transition from pending between life and sudden loss during resuscitation and proceeding with life after the sudden loss. These results of being in liminality illuminate the family members' essential narration and the importance of compassionate care throughout this challenging transition.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-3789 (URN)10.1080/07481187.2020.1799453 (DOI)32755272 (PubMedID)
Available from: 2020-09-09 Created: 2020-09-09 Last updated: 2022-05-03Bibliographically approved
Doveson, S., Wennman-Larsen, A., Fransson, P. & Axelsson, L. (2022). Mäns erfarenheter av beslutsfattande om livsförlängande behandlingarvid obotlig, avancerad prostatacancer: En önskan om en personligt anpassad process. In: : . Paper presented at 7:e nationella konferensen i palliativ vård, Göteborg, 5-7 september 2022.
Open this publication in new window or tab >>Mäns erfarenheter av beslutsfattande om livsförlängande behandlingarvid obotlig, avancerad prostatacancer: En önskan om en personligt anpassad process
2022 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4709 (URN)
Conference
7:e nationella konferensen i palliativ vård, Göteborg, 5-7 september 2022
Available from: 2023-01-13 Created: 2023-01-13 Last updated: 2023-01-13Bibliographically approved
Doveson, S., Holm, M., Axelsson, L., Fransson, P. & Wennman-Larsen, A. (2021). Facing life-prolonging treatment: The perspectives of men with advanced metastatic prostate cancer. In: : . Paper presented at The 22nd World Congress of Psycho-Oncology and Psychosocial Academy (IPOS), Kyoto, Japan, 25-29 maj 2021 (digital konferens).
Open this publication in new window or tab >>Facing life-prolonging treatment: The perspectives of men with advanced metastatic prostate cancer
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2021 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-4277 (URN)
Conference
The 22nd World Congress of Psycho-Oncology and Psychosocial Academy (IPOS), Kyoto, Japan, 25-29 maj 2021 (digital konferens)
Available from: 2022-01-05 Created: 2022-01-05 Last updated: 2022-01-07Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-3647-1686

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