Process evaluation of the CO-WORK-CARE model: Collaboration and a person-centred dialogue meeting for patients with common mental disorder in primary health care.

RATIONALE: To ensure optimal patient care based on evidence, it is crucial to understand how to implement new methods in practice. However, intervention studies often overlook parts of the implementation process. A comprehensive process evaluation is necessary to understand why interventions succeed or fail in specific contexts and to integrate new knowledge into daily practice. This evaluation examines the full implementation of the Co-Work-Care model in Swedish primary healthcare to identify strengths and weaknesses. AIM: This study aimed to evaluate the process of implementing the CO-WORK-CARE model that focuses on close collaboration and the use of a person-centred dialogue meeting in primary healthcare for patients on sick leave due to common mental disorders. METHOD: The CO-WORK-CARE model emphasises collaboration among the GP, rehabilitation coordinator and care manager, along with person-centred dialogue meetings involving employers. Following UK Medical Research Council guidelines, we conducted a process evaluation. Data from previous studies were reanalysed. We also analysed field notes and meeting notes using Malterud's qualitative method. RESULTS: The evaluation identified key facilitators for model implementation, including regular visits by facilitators and guidance from the research physician. Peer support meetings also bolstered implementation. However, challenges emerged due to conflicts with existing structures and limitations in person-centred dialogue meetings. CONCLUSION: Adapting the CO-WORK-CARE model to Swedish primary care is feasible and beneficial, with collaboration among the care manager, rehabilitation coordinator and GP and person-centred dialogue meetings. Thorough preparations, ongoing facilitator and peer support and integrated information enhanced implementation efficiency, despite challenges posed by existing structures.

Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain.

BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. METHOD: The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. RESULTS: Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to 14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. CONCLUSION: Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience.

A cognitive behavior intervention program in women with unexplained chest pain--a pilot study.

BACKGROUND: Unexplained chest pain (UCP) affects everyday life, causing fear and anxiety. Patients often have difficulty understanding their symptoms. AIM: To test a cognitive behavior group intervention program designed for women with UCP, and investigate its effects in terms of participants' ideas and perceptions of the program as well as their pain experience. METHOD: Nine women aged 44-69 participated in the pilot study, which included six group sessions. Three months after the intervention, interviews were conducted, followed by content analysis. RESULTS: Narrating and sharing experiences led to awareness and understanding of what may affect chest pain. Knowledge about how stress affects the body and an understanding of one's own situation and what may affect the pain changed participants' patterns of thinking. The treatment provided tools to take control over beginning reactions to stress and thus prevent chest pain. Fewer pain attacks were reported but there was no pronounced decrease in pain intensity. CONCLUSION: This pilot study shows that it is possible, through a cognitive behavior group intervention program, to generate positive experiences of managing stress and inner pressure and to change thinking patterns. The possibility to use these strategies and techniques to improve sleeping problems and alleviate pain is also presented.

Pain characteristics in patients with unexplained chest pain and patients with ischemic heart disease.

BACKGROUND: Little scientific attention has been paid to providing a comprehensive multidimensional description of chest pain in patients with unexplained chest pain. AIMS: The aims of the present study were: (1) to describe the symptom chest pain, including the dimensions of intensity, quality, duration and location in patients with unexplained chest pain (UCP); and (2) to identify similarities and differences in how patients with UCP and patients with ischemic heart disease (IHD) describe chest pain. METHOD: A descriptive, correlational and comparative design. Totally 208 consecutive UCP patients and 40 IHD patients below 70 years of age participated. Pain was assessed using the instrument Pain-O-Meter. RESULTS: The occurrence of chest pain was 79% (n=165) in UCP patients versus 60% (n=22) in the IHD patients (p=0.001). Patients with UCP reported greater pain intensity and used more sensory and affective words than IHD patients (p<0.01). Relationships between pain location and amount of body surface involved in the pain and pain intensity in both groups were found (p<0.001). CONCLUSIONS: Our results showed some defining characteristics of the UCP group, but the many similarities between the two groups in their experience of chest pain made it impossible to clearly differentiate the groups' pain profiles.

Living with unexplained chest pain.

AIM: The aim was to describe patients' experience of unexplained chest pain, and how the pain affected their everyday life. BACKGROUND: Chest pain is one of the most common reasons for patients to consult the emergency department. Often no clear ischaemic heart disease or any other somatic explanation is found. Exploring the pain experience and how the pain affects everyday life may provide insights into the patients' perspective, fill the gaps in our knowledge about this condition and give needed direction for nursing practice. METHOD: The study sample (n = 19) included 11 men and eight women admitted to the emergency department. An open-ended unstructured interview was conducted with each patient and the data were analysed using content analysis. RESULTS: The categories concerning pain include the informants' descriptions of several aspects of pain. These aspects are described in four categories and four subcategories: (i) pain location, (ii) pain duration with the subcategories 'periodic pain' and 'continuous pain', (iii) pain intensity, (iv) quality of pain with the subcategories 'sensory aspects' and 'affective aspects' . The content of pain experience in everyday life was divided into four subthemes and was further abstracted into a theme. Four subthemes, each comprising several meaning units, were created and labelled: (i) fear and anxiety, (ii) feeling of uncertainty, (iii) feeling of stress, and (iv) loss of strength. In these descriptions, it was obvious that chest pain considerably disturbed and affected the informants' lives and an overall theme 'intrusion into the everyday life world' emerged. CONCLUSION: The results of this study show that unexplained chest pain intrudes into everyday life in a destructive manner that cannot be ignored. RELEVANCE TO CLINICAL PRACTICE: Patients are not receiving optimal care to relieve their pain and there is therefore a need for specialized nurses who can give adequate help and support.

Academic nursing education guidelines: tool for bridging the gap between theory, research and practice.

The aim of the present study was to develop educational guidelines to be used as a tool for the integration of theory, research and practice to ensure that nursing knowledge and practical skills form the basis of academic nursing education. An additional aim was to describe the nursing competence expected of the students at four academic levels: introductory, intermediate and advanced levels I and II. Clinical nursing education plays a crucial role in assisting nursing students to integrate the theory and practice of nursing at the baccalaureate level, as well as in further specialization and in-depth nursing studies at the advanced level. A research group consisting of lecturers from the Institute of Nursing, Göteborg University, Sweden, was given the objective to formulate educational guidelines for clinical practice within nursing education. The study took the form of a literature search. In addition, the Delphi method, aimed at reaching a consensus of opinion among colleagues, was used. Based on the literature review and the collegial discussions, four core concepts emerged: professional stance, reflective processes, problem-solving processes, and practical skills, from which the educational guidelines were developed. Guidelines were formulated both in general and abstract form. They were not connected to a specific care context, specific patient group or specific nursing problems. The most important objective of academic education is that the student develops abilities and techniques necessary for life-long learning. Students will, in their professional life as nurses, continuously meet situations where they are challenged to take appropriate decisions and actions. This demands training in problem-solving, reflection, decision-making and the ability to use both deductive and inductive learning strategies. The guidelines describe what is expected of the students in terms of nursing competence and personal qualifications to ensure that they will be ready to meet the demands of their future profession.