Nursing care and management of patients' sleep during hospitalisation: A cross-sectional study.

AIM: To explore and describe how patients' sleep is addressed at acute-care hospitals in Sweden with regard to nursing care, management and the development of knowledge in this area. BACKGROUND: Sleep is a basic human need and thus important for health and health maintenance. Patients describe sleeping in hospital as a stressor, and research shows that nurses tend to underestimate patients' perceived problems with sleep during hospitalisation. How do nursing staff at acute hospitals address patients' sleep and the development of knowledge in this area? DESIGN/METHOD: A cross-sectional descriptive study was conducted based on data collected through a web survey. Head nurses, registered nurses, nursing care developers and local training supervisors at 36 randomised acute-care hospitals in Sweden were invited to participate. This study was executed and reported in accordance with SQUIRE 2.0. RESULTS: The results of the survey (53 responses from 19 wards at 15 acute-care hospitals) showed that no policy documents exist and no current training addresses sleep during hospital stay. All participants agreed that sleep should be considered a nursing topic and that it is important for hospitalised patients. CONCLUSION: Patients' sleep during hospitalisation is undermanaged at acute-care hospitals. Nurses, health care managers and organisations face challenges if they are to achieve better outcomes. RELEVANCE TO CLINICAL PRACTICE: This study shows that nurses do consider patients' sleep important and addressing sleep as part of nursing care. Future studies in the area should focus on what kinds of support and education are needed in the clinical context.

Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice.

BACKGROUND: Cardiovascular disease is still the leading cause of premature death world-wide with factors like abdominal obesity, hypertension and dyslipidemia being central risk factors in the etiology. The aim of the present study was to investigate the effects on cardiovascular risk factors and cardiovascular risk after 6 months and 1 year, in individuals with increased cardiovascular risk enrolled in a lifestyle multidisciplinary program in a clinical setting. METHOD: Individuals with increased cardiovascular risk were referred from primary health care and hospitals to a program at an outpatient clinic at a department of cardiology. The program consisted of three individual visits including a health check-up with a physical examination and blood sampling, and a person-centered dialogue for support in behavioural change of unhealthy lifestyle habits (at baseline, 6 months and 1 year). Furthermore, five educational group sessions were given at baseline. Cardiovascular risk was assessed according to Framingham cardiovascular risk predicting model. RESULTS: One hundred individuals (mean age 59 years, 64% women) enrolled between 2008 and 2014 were included in the study. Waist circumference, systolic and diastolic blood pressure and total cholesterol decreased significantly over 1 year. In parallel, cardiovascular risk according to the cardiovascular risk profile based on Framingham 10-year risk prediction model, decreased with 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease. CONCLUSION: Participating in a structured lifestyle program over a year was associated with significant improvement in multiple cardiovascular risk factors and decreased overall cardiovascular risk. TRIAL REGISTRATION: The study is registered at www.clinicaltrials.gov (ClinicalTrial.gov ID: NCT02744157 ).

Long-term effects of a Swedish lifestyle intervention programme on lifestyle habits and quality of life in people with increased cardiovascular risk.

AIMS: The aim of this study was to evaluate the effects of a structured intervention programme on lifestyle habits and quality of life after six months and one year in participants with increased cardiovascular risk. METHODS: Participants aged ≥18 years with increased cardiovascular risk were referred from primary health care and hospitals. The programme was launched at an outpatient clinic in a department of cardiology at a university hospital. It consisted of individual visits to a nurse for a health check-up and lifestyle counselling at baseline, after six months and at one year. In addition, five group sessions - focusing on nicotine, alcohol, physical activity, eating habits, stress, sleep and behavioural change - were offered to the participants and their relatives or friends. Lifestyle habits and quality of life were assessed with questionnaires at baseline, after six months and at one year. RESULTS: One hundred participants (64 women, 36 men, age 58±11 years) were included in the programme. Compared with the baseline, significant and favourable changes in reported lifestyle habits were noted. Exercise levels were higher after one year and sedentary time decreased from 7.4 to 6.3 h/day. Dietary habits improved and the number of participants with a high consumption of alcohol decreased. Quality of life improved after one year. CONCLUSIONS: Participating in a structured lifestyle programme resulted in improved lifestyle habits and quality of life over one year in people with increased cardiovascular risk. Components such as an inter-professional teamwork, a focus on lifestyle rather than the disease, and combining individual visits and group sessions, might be central to the positive outcome of the programme.

Characteristics and survival of adult Swedish PAH and CTEPH patients 2000-2014.

OBJECTIVES: The Swedish Pulmonary Arterial Hypertension Register (SPAHR) is an open continuous register, including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients from 2000 and onwards. We hereby launch the first data from SPAHR, defining baseline characteristics and survival of Swedish PAH and CTEPH patients. DESIGN: Incident PAH and CTEPH patients 2008-2014 from all seven Swedish PAH-centres were specifically reviewed. RESULTS: There were 457 PAH (median age: 67 years, 64% female) and 183 CTEPH (median age: 70 years, 50% female) patients, whereof 77 and 81%, respectively, were in functional class III-IV at diagnosis. Systemic hypertension, diabetes, ischaemic heart disease and atrial fibrillation were common comorbidities, particularly in those >65 years. One-, 3- and 5-year survival was 85%, 71% and 59% for PAH patients. Corresponding numbers for CTEPH patients with versus without pulmonary endarterectomy were 96%, 89% and 86% versus 91%, 75% and 69%, respectively. In 2014, the incidence of IPAH/HPAH, associated PAH and CTEPH was 5, 3 and 2 per million inhabitants and year, and the prevalence was 25, 24 and 19 per million inhabitants. CONCLUSION: The majority of the PAH and CTEPH patients were diagnosed at age >65 years, in functional class III-IV, and exhibiting several comorbidities. PAH survival in SPAHR was similar to other registers.

Nurses' experiences of hospitalised patients' sleep in Sweden: a qualitative study.

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.

Gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga.

Introduction: Patients with paroxysmal atrial fibrillation experience low health-related quality of life which can be improved by performing yoga. The aim of this study was to evaluate gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga. Methods: This is a secondary analysis of subgroups, investigating the yoga groups, from two randomized controlled trials (RCT 1: yoga group versus control group, RCT 2: a three-armed randomized study with yoga, control and relaxation groups). The yoga groups performed MediYoga for one hour/week over a 12-week period in both studies. Quality of life (SF-36), blood pressure and heart rate were collected at baseline and end of study. Results: No differences were found between the women and men. Within the women's group, there were improvements in vitality (p = 0.011), social function (p = 0.022), mental health (p = 0.007) and Mental Components Summary (p = 0.022). There were differences within the men's group in bodily pain (p = 0.005), general health (p = 0.003), vitality (p = 0.026), social function (p = 0.005), role-emotion (p = 0.011) and Mental Components Summary (p = 0.018). Within the women's group, differences were observed in systolic blood pressure (p = 0.010) and diastolic blood pressure (p = <0.001). The men's group also showed improvement in diastolic blood pressure (p = 0.021). Conclusion: MediYoga improved mental health as well as diastolic blood pressure in both men and women with PAF. This study suggests that both men and women, with PAF, may benefit from complementary treatment such as yoga.Clinical Trial Gov Id: NCT01789372.

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 study.

OBJECTIVE: To investigate the long-term effect of expanded cardiac rehabilitation on a composite end-point, consisting of cardiovascular death, myocardial infarction or readmission for cardiovascular disease, in patients with coronary artery disease. DESIGN: Single-centre prospective randomized controlled trial. SETTING: University hospital. SUBJECTS: Two hundred and twenty-four patients with acute myocardial infarction or undergoing coronary artery by-pass grafting. INTERVENTION: Patients were randomized to expanded cardiac rehabilitation (a one-year stress management programme, increased physical training, staying at a 'patient hotel' for five days after the event, and cooking sessions), or to standard cardiac rehabilitation. MAIN MEASURES: Data on cardiovascular death, myocardial infarction, readmission for cardiovascular disease and days at hospital for cardiovascular reasons were obtained from national registries of the Swedish National Board of Health and Welfare. RESULTS: The primary end-point occurred in 121 patients altogether (54%). The number of cardiovascular events were reduced in the expanded rehabilitation group compared with the standard cardiac rehabilitation (53 patients (47.7%) versus 68 patients (60.2%); hazard ratio 0.69; P =0.049). This was mainly because of a reduction of myocardial infarctions in the expanded rehabilitation group. During the five years 12 patients (10.8%) versus 23 patients (20.3%); hazard ratio 0.47; P =0.047 had a myocardial infarction. Days at hospital for cardiovascular reasons were significantly reduced in patients who received expanded cardiac rehabilitation (median 6 days) compared with standard cardiac rehabilitation (median 10 days; P =0.02). CONCLUSION: Expanded cardiac rehabilitation after acute myocardial infarction or coronary artery bypass grafting reduces cardiovascular morbidity and days at hospital for cardiovascular reasons.

Effects of Structured Lifestyle Education Program for Individuals With Increased Cardiovascular Risk Associated With Educational Level and Socioeconomic Area.

Background. Differences in socioeconomic status contribute to inequalities in lifestyle habits and burden of noncommunicable diseases. We aimed to examine how the effects of a 1-year structured lifestyle education program associate with the participant's educational level and socioeconomic area (SEA) of residence. Methods. One hundred individuals (64% women) with high cardiovascular risk were included. Education level (nonuniversity vs university degree) was self-reported and SEA (low vs high) defined by living in different SEAs. Lifestyle habits and quality of life were self-reported, cardiovascular risk factors and Framingham 10-year cardiovascular disease risk were measured at baseline and after 1 year. Results. Sedentary behavior decreased in both nonuniversity degree and low SEA group over 1 year, with a significantly greater improvement in daily activity behavior in low- compared with high-SEA group. Abdominal obesity decreased significantly more in the nonuniversity compared with the university degree group. Cardiovascular risk and quality of life improved in all groups, however, with greater discrimination when using educational level as the dichotomization variable. Conclusion. The results are clinically and significantly relevant, suggesting that low socioeconomic status measured both as educational level and SEA are no barriers for changing unhealthy lifestyle habits and decreasing cardiovascular risk after participation in a lifestyle program.

Quality of life in chronic disease: a comparison between patients with heart failure and patients with aphasia after stroke.

OBJECTIVES: This study aimed to describe the impact of heart failure and of stroke with aphasia on quality of life (QoL) and to compare the different domains of QoL in these groups. BACKGROUND: The prevalence of chronic conditions has increased during the last decades, and chronic diseases such as stroke and heart failure may have a great impact on QoL. DESIGN: Comparative study of patients from two randomised controlled studies. METHOD: Seventy-nine patients with heart failure and 70 patients with aphasia after stroke were evaluated concerning the severity of their disease and by QoL, as measured with the Nottingham Health Profile, in the acute phase and after six months. RESULTS: The severity of the disease improved between baseline and six month for both groups. Correlations between New York Heart Association (NYHA) class and all QoL domains were seen in patients with heart failure after six months. The degree of aphasia correlated to mobility, social, emotional and total score after six month. QoL in patients with heart failure was more affected in the domains of sleep and energy in the acute phase and in the energy domain at six months. CONCLUSION: Although low energy is more frequent among patients with heart failure, both groups report poor QoL. Improvement in severity of the disease is not necessarily accompanied by improvement in QoL. RELEVANCE TO CLINICAL PRACTICE: 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.

MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation - a randomised study.

BACKGROUND: Paroxysmal atrial fibrillation is associated with impaired health-related quality of life. Yoga has been suggested to improve health-related quality of life among patients with heart failure and hypertension. AIM: The aim of the study was to evaluate the effects of MediYoga, in respect of health-related quality of life, blood pressure, heart rate, as well as N-terminal pro b-type natriuretic peptide, among patients with symptomatic paroxysmal atrial fibrillation, compared with standard therapy or relaxation. METHODS: Patients with symptomatic paroxysmal atrial fibrillation, n=132, were stratified for gender and randomised to MediYoga, a relaxation group or a control group, 44 patients per group with a 12-week follow-up. Health-related quality of life, blood pressure, heart rate and N-terminal pro b-type natriuretic peptide were assessed. RESULTS: After 12 weeks, there were no differences in health-related quality of life between the groups. There were improvements in Short-Form Health Survey bodily pain, general health, social function, mental health and mental component summary scores within the MediYoga group (p=0.014, p=0.037, p=0.029, p=0.030, p=0.019, respectively). No change was seen in the relaxation and control groups. Systolic blood pressure decreased in the MediYoga group (134±18 to 127±13) compared with the control group (126±17 to 127±15, p=0.041); no difference compared with the relaxation group (131±17 to 125±12). Diastolic blood pressure decreased in the MediYoga group (79±9 to 74 ±9) compared with the control group (76±9 to 79±8, p=0.005); no difference compared with the relaxation group (76±9 to 77±8). There were no differences in heart rate and N-terminal pro b-type natriuretic peptide between the groups after 12 weeks. CONCLUSIONS: MediYoga improves health-related quality of life and decreases blood pressure in patients with paroxysmal atrial fibrillation. MediYoga may be used as a part of a self-management programme among patients with paroxysmal atrial fibrillation.

Sleep as a topic in nursing education programs? A mixed method study of syllabuses and nursing students' perceptions.

BACKGROUND: Sleep is a basic human need and is considered important for maintaining health. It is even more important during illness due to its impact for example on our immune system. Nurses have an important role in identifying sleep deprivation. They are also in a unique position to promote and address sleep among patients. However, it is essential that they are provided with the appropriate knowledge during training. AIM: To explore and describe nursing students' perceptions of preparedness to adress and support patients' sleep during hospitalization and to apply sleep-promoting interventions in a clinical context. Furthermore, the aim was to investigate if, and how, the topic of sleep is explicitly incorporated in nursing education programs. DESIGN: A descriptive study based on a mixed method approach. METHODS: Quantitative and qualitative data were collected from program and course syllabuses and intended learning outcomes from three universities. Twenty-one nursing students from the same universities were interviewed during their final year of education. RESULTS: The results of both quantitative and qualitative data consistently show that education regarding sleep and patients' sleep is limited and, in some respects, absent in the Bachelor of Science Nursing programs investigated. CONCLUSION: This study indicates that education about sleep and patients' sleep in the nursing programs studied is insufficient and limited. This gap in knowledge may lead to prospective registered nurses using their own experiences instead of evidence-based knowledge when assessing, supporting and applying sleep-promoting interventions.

Experiences from individuals with increased cardiovascular risk participating in a one-year lifestyle program.

OBJECTIVE: The purpose of the current study was to describe the participants' experiences of a structured lifestyle program for persons with high cardiovascular risk. METHOD: Sixteen participants with high cardiovascular risk participating in a one-year structured lifestyle intervention program were interviewed regarding their experiences of the program. The interviews were analyzed using content analyses. RESULTS: The participants' (mean age 58 ± 9) experiences were categorized into three categories: "How to know," based on the participants' experience from both individual counselling and group sessions with tools to strengthen self-care; "Staff who know how," based on experience from the meeting with, and the importance of, competent health professionals; "Why feedback is essential," based on the participants' experience and effects of person-centered feedback. Several factors were deemed important in the structure of the program: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful health professional who gives continuous feedback, and the right tools to support self-care at home between visits. CONCLUSION: Individuals participating in a structured lifestyle program experienced several factors as important: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful healthcare professional who gives continuous feedback, and the right tools to support self-care at home between visits.

Perceptions and experiences of MediYoga among patients with paroxysmal atrial fibrillation-An interview study.

OBJECTIVES: We investigated the perceptions and experiences of a therapeutic yoga form, MediYoga, which is evolved from Kundaliniyoga among patients with symptomatic paroxysmal atrial fibrillation (PAF). DESIGN AND SETTING: an inductive exploratory design was chosen with individual semi-structured interviews. The study was conducted with 12 participants (7 men and 5 women, average age 63.5) at a university hospital, Sweden. Informed consent was obtained from all participants. The data were analyzed using a qualitative content analysis with an inductive method and a manifest approach. RESULTS: Three categories were found in the analysis. In the category "A time for a sense of existence and presence", the patients described an increased thoughtfulness and experiences of gaining access to an inner self. The category "A way of gaining well-being and increased consciousness" describes patients` feelings of relaxation and feeling of comfort, with components of mental and physical well-being. Furthermore, "Access to a tool to gain willpower and relieve symptoms" describes the perceptions from patients to obtained access to a tool for handling the emotions, such as fear and anxiety, as well as symptoms that they could struggling with between, and during, their episodes of atrial fibrillation. No adverse events were reported by the yoga group, during the study. CONCLUSIONS: Patients with PAF described MediYoga as an accessible tool to manage emotions and symptoms related to episodes of AF. MediYoga may also assist in enhancing body awareness, whereby physical, mental and spiritual components are integrated. MediYoga may strengthen self-management among patients with PAF.

Effects of yoga in patients with paroxysmal atrial fibrillation - a randomized controlled study.

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.

A nurse-based management program in heart failure patients affects females and persons with cognitive dysfunction most.

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.

A group-based multi-professional education programme for family members of patients with chronic heart failure: effects on knowledge and patients' health care utilization.

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.

Effects of expanded cardiac rehabilitation on psychosocial status in coronary artery disease with focus on type D characteristics.

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.