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  • 1. Edström-Plüss, Catrin
    et al.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Wallén, Håkan N
    Billing, Ewa
    Held, Claes
    Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation2008Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, nr 4, s. 306-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the effects of expanded cardiac rehabilitation with multifactorial interventions on metabolic and inflammatory markers, exercise performance and on established cardiovascular risk factors. DESIGN: Single-centre prospective randomized controlled trial. SETTING: A university hospital. SUBJECTS: Two hundred and twenty-four patients with an acute myocardial infarction or patients undergoing coronary artery by-pass grafting. INTERVENTION: Patients were randomized to expanded cardiac rehabilitation including stress management, increased physical training, staying at a 'patient hotel' and cooking sessions, or to usual cardiac rehabilitation. MAIN MEASURES: Biochemical risk markers and exercise performance; follow-up was one year. RESULTS: There were no significant differences between the two treatment groups in the changes of biochemical risk markers or in exercise performance. Thus, low-density lipoprotein (LDL)-cholesterol levels decreased from 3.00 (0.97) to 2.54 (0.66) mmol/L in the intervention group and from 3.20 (0.85) to 2.54 (0.63) mmol/L in the control group, fibrinogen levels decreased from 5.30 (2.00) to 4.25 (1.01) g/L in the intervention group and from 5.29 (1.89) to 4.33 (0.83) g/L in the control group and C-reactive protein (CRP) levels decreased from 3.04 (2.79) to 2.09 (2.13) mg/L in the intervention group and from 4.01 (3.49) to 2.39 (2.49) mg/L in the control group. Total workload (W) improved from 118 (35) to 136 (34) in the intervention group and from 117 (36) to 133 (39) in the control group. CONCLUSION: There was no further significant benefit in biochemical risk markers or in exercise performance among patients undergoing the expanded rehabilitation as compared to the control group which received usual cardiac rehabilitation.

  • 2. Franzén-Dahlin, Åsa
    et al.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Mejhert, Märit
    Laska, Ann-Charlotte
    Quality of life in chronic disease: a comparison between patients with heart failure and patients with aphasia after stroke.2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 13-14, s. 1855-60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Nottingham Health Profile can easily be used as a screening instrument, aiming to identify patients at risk for adverse effects on QoL. A better understanding of the subjective QoL of patients with chronic disease is fundamental for health care professionals to be able to identify and support vulnerable patients.

  • 3.
    Gellerstedt, Linda
    et al.
    Sophiahemmet Högskola.
    Medin, Jörgen
    Sophiahemmet Högskola.
    Kumlin, Maria
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Nurses' experiences of hospitalised patients' sleep in Sweden: a qualitative study2015Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, nr 23/24, s. 3664-3673Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS AND OBJECTIVES:

    The aim was to describe nurses' experiences of patients' sleep at an emergency hospital and their perceptions of sleep-promoting interventions.

    BACKGROUND:

    Promotion of patients' sleep during hospital care is an important intervention for the nursing profession. To promote sleep and to initiate sleep-promoting interventions, nurses need basic knowledge about sleep and its physiology. Therefore, it is of importance to explore and expand knowledge about how nurses experience patients' sleep and how they perceive working with it while providing care.

    DESIGN:

    A qualitative descriptive design was used.

    METHODS:

    Data were collected from four focus groups and seven individual interviews. A total of twenty-two registered nurses participated. Data were analysed using a qualitative content analysis.

    RESULTS:

    Nurses expressed a desire and an ambition to work in ways that promote patients' sleep during hospitalisation. Nurses reported that health care services and emergency hospitals were not organised according to patients' perspective and needs. Furthermore, they did not have opportunities to work effectively to promote sleep according to the patients' wishes. Several nurses stated that they did not have sufficient knowledge about sleep and that they did the best they could under prevailing circumstances. Nurses emphasised the importance of sleep for patients and that it was an area that should be given far greater priority.

    CONCLUSIONS:

    The results indicate that nurses currently have insufficient knowledge about sleep and sleep-promoting interventions. These aspects of nursing is based on personal experience and common sense rather than being evidence based. Furthermore, sleep as a nursing topic needs to be developed and given more focus in order for nurses to be able to deliver high quality care at emergency hospitals.

    RELEVANCE TO CLINICAL PRACTICE:

    Nurses require more knowledge and education to gain deeper understanding of sleep and to deliver evidence-based, high quality care.

  • 4.
    Gellerstedt, Linda
    et al.
    Sophiahemmet Högskola.
    Medin, Jörgen
    Sophiahemmet Högskola.
    Kumlin, Maria
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Patients' experiences of sleep in hospital: a qualitative interview study2014Konferansepaper (Annet vitenskapelig)
  • 5.
    Gellerstedt, Linda
    et al.
    Sophiahemmet Högskola.
    Medin, Jörgen
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Patient's experiences of sleep in hospital: a qualitative interview study2014Inngår i: Journal of Research in Nursing, ISSN 1744-9871, E-ISSN 1744-988X, Vol. 19, nr 3, s. 176-188Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many patients experience sleep disturbances and a reduced quality of sleep while hospitalised. Studies have shown that a person with a disease and/or a bodily injury has an increased need for sleep. Patients' experiences of sleep should govern how sleep disturbances should be managed. It is thus necessary to focus upon and describe patients’ needs and experiences. The aim of this study was to explore and describe patients’ experiences of sleeping in hospital. This study is based on qualitative semi-structured interviews with 10 consecutively included patients. The interviews were conducted between October 2010 and March 2011 and were audio recorded and transcribed verbatim. Collected data were analysed by qualitative content analysis. The participants reported physical and psychological experiences that had affected their sleep. Their experiences were categorised using four themes: bedside manner, physical factors, being involved and integrity. Patients considered that experiencing some degree of control, feeling involved and preserving one’s integrity affect sleep during hospitalisation. Several factors have an impact on patients’ sleep. It is not only physical factors but also psychological factors such as bedside manner and having the opportunity to influence and be involved. The patients’ accounts provide a new perspective and open the door to changes in nursing care regarding patients’ sleep.

  • 6.
    Löfvenmark, Caroline
    et al.
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Edner, Magnus
    Billing, Ewa
    Mattiasson, Anne-Cathrine
    A group-based multi-professional education programme for family members of patients with chronic heart failure: effects on knowledge and patients' health care utilization2011Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 85, nr 2, s. e162-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim was to investigate if family members of patients with chronic heart failure (CHF) increased knowledge about CHF through a group-based multi-professional educational programme and whether there was an effect on patients' health care utilization. METHODS: Family members (n=128) were randomly assigned to intervention-group (IG) who received CHF education programme or control-group (CG) who received information according to hospital routines. Programme effects were evaluated with CHF knowledge questionnaire, patient readmissions and number of days hospitalised during 18 months. RESULTS: Knowledge about CHF increased in both groups, significantly higher in IG at second assessment (IG 16±1.9 vs. CG 14.9±2.1, p=0.006), and knowledge maintained at third assessment. In IG 17 patients were re-admitted at least once and 28 patients in CG due to CHF (p=0.085). There were no differences in frequency of readmissions or number of days hospitalised. CONCLUSION: A group-based multi-professional education programme increased family members' knowledge about CHF. Despite this, effect on patient's health care utilization could not be seen during follow-up period. PRACTICAL IMPLICATIONS: We suggest that CHF education programmes for family members should be provided at clinics, with information preferably repeated 2-3 times during a period of six months to maintain knowledge level.

  • 7. Plüss Edström, Catrine
    et al.
    Billing, Ewa
    Held, Claes
    Henriksson, Peter
    Kiessling, Anna
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Wallen, Håkan N
    Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study2011Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 25, nr 1, s. 79-87Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Expanded cardiac rehabilitation after acute myocardial infarction or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons.

  • 8.
    Rydell Karlsson, Monica
    et al.
    Sophiahemmet Högskola.
    Edner, Magnus
    Billing, Ewa
    Kiessling, Anna
    Henriksson, Peter
    Patients with chronic heart failure who plan their own self- care education decrease their outpatient visits2011Inngår i: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 1, nr 4, s. 705-718Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

     

    Background, aims and objectives: Patient education programs delivering a defined package of information aimed to optimise the care of chronic heart failure have been evaluated. However, there is a lack of knowledge about the effects of programs designed to support the patients’ learning by allowing them to self-direct their learning activities. We aimed to contribute to the associated knowledge base.

    Method: We compared an intervention group of patients choosing among different learning activities with a control group, where the nurse practitioner scheduled a package of learning activities. One hundred and eighty two patients with chronic heart failure in NYHA class I-IV who were referred to the nurse practitioner outpatient clinic randomised to either a structured control education program (92 patients) or to a self-directed intervention program (90 patients). Additionally, both groups received the same nurse-practitioner based self-care advice and treatment. Outcome measures were quality of life, knowledge acquisition, visits to the outpatient clinic, readmissions and medication during one year.

    Results: All patients significantly increased their knowledge and quality of life, with no difference between the groups. However, the intervention group patients had fewer visits to the outpatient clinic as compared to controls (p=0.007). This was accomplished without a concomitant increase in re-admission rate. Both groups increased, as intended, their use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers.

    Conclusion: In conclusion, our findings show that it is safe and results in fewer outpatient visits if patients with chronic heart failure actively plan their own education program. To encouraging patients taking own decisions lead to an increased self-control of their healthcare behaviour.

  • 9.
    Rydell Karlsson, Monica
    et al.
    Sophiahemmet Högskola.
    Edner, Magnus
    Henriksson, Peter
    Patient-based vs. nurse-based NYHA classification of patients with chronic heart failure: influence of mood2008Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, nr Suppl 1, s. S17-Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Patients' symptom perceptions and grade of depression have recently been recognized to hold otherwise unrecognized prognostic information in patients with chronic heart failure (CHF)

  • 10.
    Rydell Karlsson, Monica
    et al.
    Sophiahemmet Högskola.
    Edner, Magnus
    Henriksson, Peter
    Mejhert, Märit
    Persson, Hans
    Grut, Mikaela
    Billing, Ewa
    A nurse-based management program in heart failure patients affects females and persons with cognitive dysfunction most2005Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 58, nr 2, s. 146-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It is important that congestive heart failure (CHF) patients know how to monitor and manage disease-associated signs and symptoms. CHF patients were randomised to follow-up at a nurse-based outpatient clinic (intervention group (IG); n = 103), or to follow-up in primary healthcare (control group (CG); n = 105). Patient knowledge of CHF and self-care were assessed by a questionnaire and cognitive function by a Mini Mental State Examination (MMSE) at baseline and at six months. Men knew more about CHF as compared to females at baseline (p < 0.01). However, females in the IG increased their knowledge of self-care between baseline and six months as compared to CG females (p < 0.05). Patients with cognitive dysfunction (MMSE < 24) presented lower scores on knowledge as compared to those with a MMSE of >24 at baseline (p < 0.01). These differences disappeared after the intervention. Thus, females seemed to gain more than men from a nurse-based management program and patients with in-hospital signs of cognitive dysfunction should be encouraged to participate.

  • 11.
    Rydell Karlsson, Monica
    et al.
    Sophiahemmet Högskola.
    Edström-Plüss, Catrin
    Held, Claes
    Henriksson, Peter
    Billing, Ewa
    Wallén, Håkan N
    Effects of expanded cardiac rehabilitation on psychosocial status in coronary artery disease with focus on type D characteristics2007Inngår i: Journal of behavioral medicine, ISSN 0160-7715, E-ISSN 1573-3521, Vol. 30, nr 3, s. 253-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Type D personality has been shown to increase the risk for cardiovascular events in patients with coronary artery disease (CAD). We investigated the effects of expanded cardiac rehabilitation on type D score and psychosocial characteristics in 224 CAD patients randomised to either expanded cardiac rehabilitation (stress management, increased physical training, stay at a "Patient Hotel" after discharge and cooking sessions), or routine rehabilitation. Follow-up was 1 year. At baseline patients with a high type D score [patients in the upper quartile of type D score (Q4) i.e., type D patients] had a lower sense of coherence (p < 0.001), a lower quality of life (p < 0.001), more depressive symptoms (p < 0.001) and increased anxiety (p < 0.001) as compared to patients with a low type D score (Q1). During follow-up, type D patients (Q4) randomised to intervention had significant decrements in type D-score (p < 0.01), depression and anxiety (p < 0.05) and an increment in quality of life scores (p < 0.001). Quality of life was also improved in control type D patients (Q4; p < 0.01) but no significant changes were seen in type D score, depression or anxiety. Expanded cardiac rehabilitation reduces type D score, anxiety and depressive symptoms, and improves the quality of life in type D patients.

  • 12.
    Rydell-Karlsson, Monica
    Sophiahemmet Högskola.
    Knowledge Acquisition in Patients with Heart Disease2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The general aim was to evaluate different aspects of the knowledge acquisition process in patients with heart disease. Three different education programs were evaluated.

    In Paper I 208 patients with systolic heart failure (HF) aged >60 years, were included. They were randomized to the nurse-based outpatient clinic or to the patients´ general practitioners (GP). The aim was to assess effects of a nurse-based management program – intended to increase the knowledge of the HF disease and its self-care – and relate the results to gender and cognitive function. The results showed that the nurse-based outpatient clinic has an important role in patient education, and increases patients´ knowledge about self-care and the disease. The results indicate that females have more to gain than men from such management programs. Patients demonstrating signs of cognitive dysfunction when in hospital did also benefit.

    In Paper II 224 patients, aged <75 years suffering from an acute AMI or who had underwent coronary artery by-pass grafting, were randomized to intervention (an expanded cardiac rehabilitation program) or to control (usual care). The aim was to investigate the effect of an expanded cardiac rehabilitation program on psychosocial characteristics including depression, anxiety, and quality of life (QoL) in type D and non-type D coronary artery disease (CAD) patients. The results show that an expanded rehabilitation program significantly reduces type D score, improves QoL, and decreases self-estimated depression and anxiety in CAD patients in the highest quartile of type D score.

    In Paper III and IV 182 patients with chronic heart failure (CHF) were included and referred to the nurse-based outpatient clinic. They were randomized to intervention (patients decided on how they should be informed and by which information technique) or to control (the nurse decided according to usual routine).

    The aim in Paper III was to compare patient-based selection of information with nurse-based selection of information in patients with HF and to evaluate the effects on knowledge acquisition, QoL, visits to the outpatient clinic, drug therapy and readmissions. Patients had fewer visits to the nurse-based outpatient clinic and a trend to a more flexible diuretic regimen, if patients were involved in the decision on how to be informed. Both groups increased QoL, knowledge their doses of relevant medication, and readmissions did not differ between the two groups.

    The aim in Paper IV was to compare patient-based and nurse-based New York Heart Association (NYHA) classification and its relation to grade of depression and knowledge acquisition in patients with HF. The results show a mismatch between the NYHA classifications performed by patients respectively by the nurse. Furthermore, patients in a depressed mood at baseline had more clinical events during the first year after hospitalization due to CHF. However, there was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood.

    The conclusion is that information given at a nurse-based outpatient clinic has an important role in patient education. Females and patients with in-hospital cognitive dysfunction had the greatest gains Patients who are involved in the decision on how to be informed had fewer visits to the nurse-based outpatient clinic. The fewer visits did not affect knowledge, QoL, readmissions, or medical treatment in a negative way. Patients assessed a higher NYHA class than a nurse. Patients who were depressed had an increased incidence of clinical events during the first year after hospitalisation due to HF. There was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood. An expanded rehabilitation program significantly reduces type D score, improves quality of life, and decreases self-estimated depression and anxiety in patients with CAD in the upper quartile of type D score.

  • 13. Söderberg, AnneCharlotte
    et al.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Löfvenmark, Caroline
    Sophiahemmet Högskola.
    Upplevelse av trygghet och otrygghet bland patienter med hjärtsvikt som får avancerad vård i hemmet: Experience of security and insecurity among patients with heart failure in advanced home care2015Inngår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 35, nr 4, s. 203-209Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim The aim of this study was to describe the experience of security and insecurity in patients with chronic heart failure who were treated by Advanced Home Care (AHC) in a city in Sweden.

    Background It is common for patients with heart failure to have frequent readmissions to hospital due to deterioration. The patients have various symptoms such as breathing problems, oedema and fatigue. Being cared for by AHC has become more common for patients with heart failure to reduce deterioration of heart failure and prevent hospitalization.

    Method A qualitative method with semi-structured interviews was used. Eight patients with heart failure participated in the study. The interviews were analysed by content analysis.

    Findings Three categories were identified: ‘home care’, ‘the social network’ and ‘internal and external resources’.

    Conclusion The experience was complex and depended on several factors both within and outside the health care situation. The need for access to a multidisciplinary team was great and it was important that the nursing staff had time to listen. It was important that the care had focus on the patient’s perspective to create security and avoid insecurity.

  • 14.
    Tunedal, Ulla
    et al.
    Sophiahemmet Högskola.
    Hansson, Anna
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Lundh Hagelin, Carina
    Sophiahemmet Högskola.
    Distance only separates the bodies - four years of experiences from an online distance learning programKonferansepaper (Annet vitenskapelig)
  • 15.
    Wahlström, Maria
    et al.
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Medin, Jörgen
    Sophiahemmet Högskola.
    Frykman, Viveka
    Effects of yoga in patients with paroxysmal atrial fibrillation - a randomized controlled study.2016Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr 1, s. 57-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Patients with atrial fibrillation often have an impaired quality of life (QoL). Practising yoga may decrease stress and have positive effects on mental and physical health. The aim of this study was to investigate whether yoga can improve QoL and decrease blood pressure and heart rate in patients with paroxysmal atrial fibrillation (PAF).

    METHODS: In this pilot study, 80 patients diagnosed with PAF were randomized to standard treatment (control group, n=40) or standard treatment in combination with yoga (yoga group, n=40) during a 12-week period. QoL, blood pressure and heart rate were evaluated at baseline and at the end of the study (12 (+2) weeks). EuroQoL-5D (EQ-5D) Visual Analogue Scale (VAS) and the two dimensions in Short-Form Health Survey (SF-36) were used to evaluate QoL.

    RESULTS: At baseline there was a significant difference in QoL between the groups in EQ-5D VAS- scale (p=0.02) and SF-36 mental health score (p<0.001) in which the control group had higher scores. At the end of the study, the yoga group averaged higher SF-36 mental health scores. There was a significant difference between the two groups (p=0.016), but no differences in EQ-5D VAS- scale and physiological health score was seen between the two groups. At the end of the study, the yoga group had significantly lower heart rate (p=0.024) and systolic (p=0.033) and diastolic blood pressure (p<0.001) compared to the control group.

    CONCLUSIONS: Yoga with light movements and deep breathing may lead to improved QoL, lower blood pressure and lower heart rate in patients with PAF compared to a control group. Yoga could be a complementary treatment method to standard therapy.

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