Health Promotion in Nursing Education: attitudes among nurse students.

BACKGROUND: The World Health Organization (WHO) European Strategy for Nursing and Midwifery has called for the explicit inclusion and application of health promotion in all nursing curricula. However, research indicates that there are deficiencies in nursing education regarding health promotion in both the theoretical and practical elements of education. Insight into the experiences of European nursing students' attitudes, positive or negative, about working in health promotion may provide a clue whether health promotion will be regarded as an important task and to what extent it will have priority in different parts of Europe. AIM: The aim of this study was to compare Italian and Swedish nursing students' attitudes towards health promotion practice on matriculation to nursing school and after a three-year nursing education, and to explore whether attitudes towards health promotion practice correlate with BMI and smoking. METHOD: The study involved students who started their nursing education in autumn 2009 (n =240). Data were collected via a questionnaire. RESULTS: The results show that the Swedish students had a more positive stance on health promotion than Italian students did. After completion of a three-year nursing education programme, Italian students' attitudes on health promotion had improved, while no such development was seen in Sweden. Further, no correlation between lifestyle issues and attitudes to health promotion was found. CONCLUSION: Health promotion in nursing education may have important influence on students' attitudes and thereby on the quantity and quality of future health promotion practice.

Awareness of demands and unfairness and the importance of connectedness and security: Teenage girls' lived experiences of their everyday lives.

In recent years, a number of studies have demonstrated that stress and mental health problems have increased among adolescents and especially among girls, although little is still known concerning what girls experience in their everyday lives. The aim of this study was to describe the phenomenon of teenage girls' everyday lives, as experienced by the girls themselves. A phenomenological approach of reflective lifeworld research was used, and the findings are based on eight qualitative interviews with girls aged 13-16 years. The essence of teenage girls' everyday lives as experienced by the girls themselves can be described as consciousness regarding demands and unfairness and regarding the importance of connectedness and security. The girls are aware of the demands of appearance and success, and they are conscious of the gender differences in school and in the media that affect them. The girls are also conscious about the meaning of connectedness with friends and family, as well as the importance of the security of their confidence in friends and feeling safe where they stay. If teenage girls feel connected and secure, protective factors in the form of manageability and meaningfulness can act as a counterweight to the demands and unfairness of everyday life. For professionals who work with teenage girls, the results from this study can be important in their work to support these girls.

Health-related quality of life in European women following myocardial infarction: a cross-sectional study.

BACKGROUND: Coronary heart disease is a major contributor to women's health problems. DESIGN: Self-perceived social support, well-being and health-related quality of life (HRQL) were documented in the cross-sectional HeartQoL survey of European women one and six months after a myocardial infarction. METHODS: European women were recruited in 18 European countries and grouped into four geographical regions (Southern Europe, Northern Europe, Western Europe and Eastern Europe). Continuous socio-demographic variables and categorical variables were compared by age and region with ANOVA and χ(2), respectively; multiple regression models were used to identify predictors of social support, well-being and HRQL. RESULTS: Women living in the Eastern European region rated social support, well-being and HRQL significantly lower than women in the other regions. Older women had lower physical HRQL scores than younger women. Eastern European women rated social support, well-being and HRQL significantly lower than women in the other regions. Prediction of the dependent variables (social support, well-being and HRQL) by socio-demographic factors varied by total group, in the older age group, and by region; body mass index and managerial responsibility were the most consistent significant predictors.

Health-care professionals' documentation of wellbeing in patients following open heart surgery: a content analysis of medical records.

AIM: To explore health-care professionals' documentation of patient wellbeing in the first five months after open heart surgery. BACKGROUND: Open heart surgery (coronary artery bypass grafting or heart valve replacement) is an intervention aimed at relief of symptoms and increased wellbeing. It is a complex procedure with deep experiences encompassing physiological, psychological and social aspects. Health-care professionals' documentation of expressions of decreased wellbeing related to open heart surgery is an important basis for decisions and for the understanding of patients' overall health situation. METHOD: Eighty medical records were examined by means of qualitative and quantitative methods in order to explore documentation of patient wellbeing at four points in time. The analysis was performed by content analysis and descriptive statistics. RESULTS: Documentation of physical wellbeing was dominant on all occasions, while psychological wellbeing was moderately well documented and social aspects of wellbeing were rarely documented. CONCLUSION: The medical records did not adequately reflect the complexity of undergoing open heart surgery. Hence the holistic approach was not confirmed in health-care professionals' documentation. IMPLICATIONS FOR NURSING MANAGEMENT: Managers need to support and work for a patient-centred approach in cardiac care, resulting in patient documentation that reflects patient wellbeing as a whole.

Possibilities for dialogue on sexuality and sexual abuse--midwives' and clinicians' experiences.

OBJECTIVE: to describe midwives' and clinicians' experiences of the possibilities and obstacles for dialogue with young women on sexuality and sexual abuse, focusing on the possibilities. DESIGN: qualitative study with interview data analysed by qualitative content analysis. SETTING: South-west Sweden. PARTICIPANTS: a purposive sample, consisting of 15 midwives, six gynaecologists and five general practitioners aged 30-65 years, was chosen in order to obtain as many different experiences as possible. The participants' professional experiences varied, ranging from five to more than 35 years, and they were employed at youth clinics, primary health-care centres, gynaecology clinics, a specialist sexual medicine centre and antenatal care centres, situated in small and large cities. FINDINGS: the participants described the respectful encounter that can be created when young women meet midwives and clinicians in the context of a gynaecological consultation. In this situation, there was a potential to strengthen women while attempting to improve their sexual health. Support from the organisation and the use of personal skills and assets were found to be promoting factors for dialogue. Lack of organisational support or communication skills and difficult emotions complicated the situation, which might, in turn, restrain midwives and clinicians from raising sexual issues. IMPLICATIONS FOR PRACTICE: increased knowledge, support and opportunities for reflection concerning dialogue regarding sexual issues might evoke the interest and intent of health professionals to approach these issues. Guidelines regarding dialogue about both sexuality and sexual abuse should be routine in health-care services.

Young women's perceptions of being asked questions about sexuality and sexual abuse: a content analysis.

OBJECTIVE: to describe young women's perceptions of being asked questions by midwives or doctors pertaining to sexuality and sexual abuse in connection with visits for gynaecological examination. DESIGN: a qualitative study. Data comprised responses to open-ended questions in a questionnaire and were analysed by qualitative content analysis. SETTING: a county in the south-west of Sweden. PARTICIPANTS: all of the 23-, 26- and 29-year-old women who attended eight midwife and youth centres for cervical screening during the period between March and July 2006 were invited to participate. The open-ended question about sexuality was answered by 413 women, and 409 women answered the question about sexual abuse, representing approximately 84% of the women who answered the questionnaire as a whole. FINDINGS: the data resulted in a total of eight categories and 31 codes, which showed the women's perceptions of being asked questions about sexuality and sexual abuse. Six of the categories dealt with why it was considered natural to be questioned. Health professionals can be trusted and questions can open up a dialogue as well as clarify the woman's situation. The context of a visit for a gynaecological examination is relevant and questions will make it possible for the professionals to strengthen the woman. Another reason was that sexuality is an essential part of life. Those women who felt that it would not feel natural to be asked questions about sexuality and sexual abuse considered that the context is wrong and that such questions will encroach on the woman's personal sphere. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: women's responses indicate that there are good reasons for midwives and doctors to raise questions about sexuality and sexual abuse when they meet young women. Taking opportunity to find those who have sexual problems and/or experience of sexual abuse could reduce the suffering of these women and lead to an economic gain to society. The provision of training and supervision for midwives and doctors is important to enhance the quality of conversations about sexual matters. In order to deal with such issues, it is necessary to have knowledge of sexual health, relationships and violence, as well as a professional stance and a good conversational technique.

Well-being in patients and relatives after open-heart surgery from the perspective of health care professionals.

AIM: The aim of this study was to explore how health care professionals perceive the well-being of patients and relatives following open-heart surgery. BACKGROUND: Open-heart surgery is an extraordinary life event associated with hope and fear among both patients and relatives, thus they require attention from health care professionals. Patients' short stay in hospital after surgery and the workload of health care professionals increase the risk that reduced well-being will be overlooked. Health care professionals need to become familiar with the signs of reduced well-being. DESIGN: The study has an observational design and was performed using a qualitative method. METHOD: Health care professionals working with patients who have undergone open-heart surgery participated in focus group discussions. The data were analysed by means of content analysis. RESULTS: Two categories emerged: signs of vulnerability and signs of insecurity. The latent meaning of the study was interpreted as awareness of an exposed position. CONCLUSION: The health care professionals were aware of patients' and relatives' exposed position following open-heart surgery. Reduced well-being was communicated by bodily and emotional signs, which were captured using direct communication or intuition. RELEVANCE TO CLINICAL PRACTICE: Developing the ability to recognise signs of reduced well-being is important for minimising the negative influences associated with open-heart surgery for patients and relatives. Increased awareness that both anger and avoidance can mask depression is important. Patients and their relatives, particularly younger ones, should be observed to ensure early detection of a life crisis provoked by the heart disease. Furthermore, staff should invite patients and their partners to talk about sexuality. Changes aimed at increasing patients' and relatives' well-being would be facilitated by interdisciplinary teamwork, 'reflection groups' for a greater exchange of knowledge and the implementation of a patient/family perspective. The latter would lead to greater interest in the relatives' situation and position in cardiac care.

"Time for dialysis as time to live": experiences of time in everyday life of the Swedish next of kin of hemodialysis patients.

The aim of this study was to explore the content of time in everyday life as experienced by the next of kin of patients on hemodialysis in Sweden. Chronic renal disease often requires hemodialysis, which is a time-consuming treatment that makes it necessary to carefully plan everyday life and involves the next of kin to a large degree. This study used a descriptive design with a content analysis approach. The analysis of the data from the twenty interviews revealed the experiences of time in the everyday lives of the next of kin of a patient on hemodialysis. The content of time in everyday life can be described as follows: fragmented time, vacuous time, and uninterrupted time. The findings show how everyday life time for the next of kin is minimized and that the common life space is contracted. The next of kin must be provided with supervision in order to provide them with more of their own time in everyday life, which can benefit their health.

Arterial baroreflex dysfunction after coronary artery bypass grafting.

Although uncommon, the incidence of ventricular arrhythmia is high in certain subsets of patients after coronary artery bypass grafting. Arterial baroreflex dysfunction has been linked to increased risk of ventricular arrhythmia and sudden cardiac death. The aim of the current study was to explore arterial baroreflex function during the early recovery phase and up to five months after surgery. Electrocardiogram and beat-to-beat blood pressures were registered in patients (n=92) undergoing coronary artery bypass grafting five weeks and five months after surgery. Healthy subjects (n=31) were examined for comparison. The arterial baroreflex sensitivity and the baroreflex effectiveness index were calculated. The baroreflex sensitivity and the baroreflex effectiveness index were reduced by 36% and 64%, respectively (P<0.01 for both) in patients five weeks after coronary artery bypass grafting compared to healthy subjects (HS). Values increased during follow-up but the baroreflex effectiveness index remained reduced by 55% in patients compared to HS five months after cardiac surgery (P<0.01). Arterial baroreflex dysfunction prevails both early and long-term after coronary artery bypass grafting. Reduced modulation of cardiac parasympathetic nervous activity could contribute to the increased risk of ventricular arrhythmia observed during the early recovery phase after cardiac surgery.

The influence of conscience in nursing.

The influence of conscience on nurses in terms of guilt has frequently been described but its impact on care has received less attention. The aim of this study was to describe nurses' conceptions of the influence of conscience on the provision of inpatient care. The study employed a phenomenographic approach and analysis method. Fifteen nurses from three hospitals in western Sweden were interviewed. The results showed that these nurses considered conscience to be an important factor in the exercise of their profession, as revealed by the descriptive categories: conscience as a driving force; conscience as a restricting factor; and conscience as a source of sensitivity. They perceived that conscience played a role in nursing actions involving patients and next of kin, and was an asset that guided them in their efforts to provide high quality care.

Medication usage among young adult women: a comparison between Sweden, the USA, and Greece.

This study evaluated whether or not medication usage among young adult women differed across three countries. An additional aim was to evaluate the association between medication use and sociodemographic factors and exercise habits. A sample of 1098 young adult women were selected in Sweden, the USA, and Greece. Consistent medication usage by young adult women in the three countries related to oral contraceptives and vitamins; nevertheless, there were differences. The main differences were found in the use of laxatives, iron supplements, analgesics, antidepressants, and antacid medication. The most outstanding differences were the frequent use of laxatives in Sweden and vitamins in the USA. Different association patterns were found between medication use and culture, sociodemographic factors, and exercise. The assessment of medication use among young adult women can be performed very easily and provides an immediate indication of their well-being and needs for preventative care.

Depressed mood over time after open heart surgery impacts patient well-being: a combined study.

BACKGROUND: Depression is a common cause of decreased well-being after open heart surgery (OHS) and a risk factor for new cardiac events. Little is known about the long-term prevalence of depressive symptoms after OHS or their effect on well-being. The aim of this study was to explore the presence of depressed mood in patients during the recovery phase after open heart surgery as well as depressed mood and well-being 3 years later. METHOD: Eighty consecutively included patients completed a questionnaire about depressed mood at 5 weeks, 5 months and 3 years after OHS. A telephone interview took place after receipt of the third questionnaire to explore their well-being. Quantitative and qualitative data were analysed separately and thereafter together. RESULT: Depressed mood occurred in 52% of the patients during recovery or 3 years after OHS. The qualitative content analysis produced the theme of transition, which was based on three categories. CONCLUSION: Depressed mood was reported by the majority of patients during recovery after OHS and had a long-term effect on their well-being. OHS constituted a transition for all patients, but those with depressed mood had difficulty finishing the transition process and reorientating life.

Women's experiences of recovery after myocardial infarction: a meta-synthesis.

BACKGROUND: Women report lower well-being, compared with men, during recovery after myocardial infarction (MI). To support women in their recovery it is important to understand their experiences from their own perspective. However, a single study using a qualitative method does not have the potential to contribute to evidence-based nursing practice, and it is therefore important to synthesize findings from several qualitative studies. OBJECTIVES: The aim of this study was to perform a meta-synthesis of findings of women's experiences of recovery after MI. METHODS: A meta-synthesis with seven qualitative studies, including a total of 70 women, was performed. RESULTS: Recovery was characterized by subordination and superordination. The women strived to preserve their self, and at the same time they were strongly oriented toward other people. Four concepts emerged: protecting, adjusting, downgrading, and succumbing. CONCLUSION: Women oscillate between subordination and superordination. Protecting the matriarchy and being a victim of the patriarchy shed light on this ambivalence in the same way as adjusting to the situation and succumbing to the disease do.

Young women's sexual health and their views on dialogue with health professionals.

BACKGROUND: Many women who experience sexual problems or who have been subjected to sexual abuse, do not seek help, and often health professionals avoid raising such issues. The aim of this study was to describe young women's sexual health and their views on a dialogue about aspects of sexuality in connection with a gynecologic examination. METHOD: Cross-sectional study. Women, 23, 26 and 29 years of age, called for gynecologic screening between March and July 2006 (n=488; response rate 75%). Descriptive statistics, multiple logistic regression and bivariate analysis were used. RESULTS: The majority (95%) had a positive attitude towards sexuality, although many women reported sexual problems, and one-fifth (22%) were dissatisfied with their sex life. Women considered it appropriate to be asked about sexuality in general (92%), while a majority (72%) found questions about sexual abuse appropriate. However, depending on the area, the majority (76-99%) had never been asked such questions. Demographic variables, aspects of life, sexuality and sexual abuse were irrelevant for whether women considered it appropriate to be asked questions about aspects of sexuality, by a midwife/doctor in connection with a gynecologic examination. CONCLUSION: The result can activate health professionals to initiate a dialogue about sexual issues among young women. In this way, many women who experience sexual problems or have been subjected to sexual abuse, may be provided the opportunity to improve their sexual health.

Professional support for next of kin of patients receiving chronic haemodialysis treatment: a content analysis study of nursing documentation.

AIM AND OBJECTIVES: The aim of this study was to examine the content of nursing documentation with a focus on professional support for next of kin (NoK) of patients receiving chronic haemodialysis treatment. BACKGROUND: Professional support in nursing focuses on promotion, maintenance and restoration of health and prevention of illness. DESIGN: The study had a descriptive design and qualitative content analysis was used to search for themes based on descriptions contained in the collected nursing documentation. METHODS: The total number of nursing records of patients receiving chronic haemodialysis treatment (n = 50) for the 5-year period 1998-2002 was included. All nursing documentation was systematic in accordance with the VIPS-documentation model. RESULTS: The professional support could be described within the framework of three themes: to explore NoK's supportive resources, to enable NoK' readiness in caring for the patient and to co-operate with NoK in the care of the patient in the home, captured by the core theme which described the professional support as a continuous process. CONCLUSIONS: Next of kin are a supportive resource in the nursing care of patients receiving chronic haemodialysis treatment and professional support for NoK focuses on planning their participation in the care of patients in the home. RELEVANCE TO CLINICAL PRACTICE: Professional support for NoK should be documented in family focused nursing diagnoses, which would make it possible to search for different types of support. Future research might explore nurses' or NoK's views on carer support.

Keeping the maintenance of daily life in spite of chronic heart failure. A qualitative study.

BACKGROUND: Patients with CHF (Chronic Heart Failure) is an increasing group in the society. They often experience increasing powerlessness and depression in daily life as well as difficulties adhering to other physical symptoms. Many patients have difficulties to deal with daily demands. AIMS: To describe how persons, living with CHF, perceived the maintenance of their daily life. METHODS: This study was following a phenomenographic method in order to describe variations of perceptions. Data was collected through taped interviews, taken from 17 patients. The sample was selected from patients attending a specialist Chronic Heart Failure day care unit. RESULTS: Five main categories were identified from 345 statements describing variations in how patients with CHF kept maintenance in their daily life. The categories include: dealing with the realities of life, dealing with thoughts about life's infinity, taking responsibility, dealing with the surrounding world and keeping up with values of life. CONCLUSION: The illness symptoms clearly affected daily routines but participants showed remarkable resolve and showed that values in life could be maintained albeit with a few adjustments. No patient expressed a desire to give up. Understanding patients' perceptions the specialist nurse can transfer these knowledge to other patients in similar situations.

Status and trends in Swedish dissertations in the area of cardiovascular nursing.

In Europe, cardiovascular nursing (CVN) is a young branch of nursing science. The explicit knowledge contained in CVN dissertations has, so far, not been studied in Europe, and this is especially true in the case of Sweden. Accordingly, the aim of this literature study was to describe the status of and compare trends in Swedish dissertations in the area of CVN in terms of organisational structure, approach, research strategy, social orientation and socio-demographic aspects. The literature search resulted in 29 dissertations and a 26-item questionnaire that illuminated the problem areas. Most dissertations were produced in the universities of Göteborg, Halmstad and Linköping; a minority had a nurse as main supervisor; rehabilitation was the most common CVN approach; very few of the dissertations had an experimental design; and the majority was hospital-based. The main trends were (A) an increase in dissertations that were written during the last 6 years, (B) an increased number of nurses as main supervisors as well as publication in nursing journals, (C) an increase in hospital care settings while a decrease in community settings, and finally, (D) an increased number of dissertations addressing the issues of tertiary prevention as well as focusing on patients and next-of-kin as target groups. An important implication is to stimulate nurse-led interventions at all preventative levels in order to maintain or improve the cardiac health of both healthy and sick individuals, but also in order to visualize CVN and distinguish it from cardiology.

Stress, health complaints and self-confidence: a comparison between young adult women in Sweden and USA.

Transition to adulthood is a period in life when women encounter conflicts, ambiguities and rapidly expanding roles that may be stressful and difficult to manage. The aim of this study was to compare stress in daily life, health complaints and self-confidence in 26-year old women in two different cultures. A health survey study was performed among Swedish women (n = 386) and American women (n = 201) living in urban areas at the West coast of Sweden and in Minnesota. Both Swedish and American women reported stress in their everyday life, with higher figures for the Americans. Overall health was rated lower by the Swedish women and they reported more health complaints such as headache, general tiredness, irritability, depression and sleeping disorders. There was a difference between groups in self-confidence with higher figures for excellent self-confidence among American women. However, low self-confidence was reported by more American than Swedish women. A good work situation predicted self-confidence in Swedish women and financial confidence in American women. Physical fitness was associated with self-confidence in both groups. Young women in both cultures experienced high level of stress but health related complaints were more common among Swedish women. High stress and health complaints must be taken seriously and interventions to support young women in the midst of transition to adulthood should contain stress reduction as well as empowerment performed in a more effective way than today in different health care settings and at place of work.

Health in everyday life among spouses of haemodialysis patients: a content analysis.

Despite the fact that haemodialysis requires that spouses support and assist their partner during the treatment period, little attention has been focused on their health. The aim of this study was to explore experiences of health in everyday life among spouses of haemodialysis patients. The study had an explorative and descriptive design based on content analysis. Thirteen participants were interviewed in their home without the presence of the patient. The results show that arduousness was experienced when that spouses' everyday life was taken up by caring for the patient at the expense of his/her own health. Spouses exhibited stamina and neglected their own health when focusing on the patient and minimising their own condition. Independence in everyday life revealed that spouses who cared about themselves and looked after their own health experienced relaxation and happiness, which protected their health. Clinical interventions should include an assessment of the spouses' health and everyday life in order to plan the care to ensure that it is directed towards increasing their independence. Instruments need to be developed that assess when and how spouses experience the greatest sense of well-being, if they have scope for relaxation and recovery, and what type of support they require in their everyday life.

Access to the world after myocardial infarction: experiences of the recovery process.

Myocardial infarction (MI) is a traumatic health event and at the same time a transition of vital importance in human life. The purpose of this study was to elucidate recovery patterns after myocardial infarction with regard to the content of patients' experiences. The study used a descriptive design and a qualitative method. Interviews with 16 men and women were performed, and data were subjected to a thematic content analysis. The recovery process had a pattern of ability, restraints, and reorientation. Through self-help and help from others, the mutual sharing of burdens, and clarifying restraints to recovery, the recovery process progressed toward reorientation. New values and motivation for change, as well as a new balance within the self and relationships were found. The MI had been integrated into life and, through the recovery process, patients' attitudes were better focused, leading to an enhanced quality of life.