Experiences of participating in an eHealth intervention for patients with abdominal aortic aneurysm: A qualitative study.

AIMS: To explore patients' experiences of an eHealth tool and tailored psychosocial support throughout the care trajectory of AAA repair. DESIGN: A qualitative interview study. METHODS: Individual in-depth interviews were performed with twelve patients participating in an intervention study in conjunction with AAA surgery. Data were collected from March to December 2019. The interviews were analysed using qualitative content analysis with an inductive approach. RESULTS: The patients' familiarity with and attitude to eHealth influenced their use of the eHealth tool. The interpersonal relationship with health care staff affected patients' ability to submit themselves. The preoperative information, including the eHealth tool, may result in an overwhelming amount of information, causing anxiety and leading patients to refrain from information, partly due to the timing of the information. Psychosocial support offered continuity and reassurance, and enabled the patients to elaborate on existential matters. CONCLUSION: The design of eHealth services in AAA care would benefit from a consideration of patients' attitude to eHealth and familiarity with modern technology. To increase patients' accessibility to health care services, their preference for technology use and type of contact should be verified and respected. Psychosocial support should be offered with continuity to alleviate patients' emotional burden. Adjustment to patients' mental state and learning needs may forestall anxiety. IMPACT: This study highlights factors that affect the acceptability of eHealth services in AAA patients. These findings can guide future design and implementation of mobile health interventions in surgical care.

When caring becomes an art - how clinical gaze are perceived to be developed.

PURPOSE: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence.

BACKGROUND: Nursing faculties' perceptions influence nursing education. This article describes how nursing faculty perceive nursing students' development of professional competence by integrating theory and practice, and by examining how this context influences this integration. METHOD: With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description. RESULTS: The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses' competence and expectations in health care. CONCLUSION: If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.].

Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study.

AIM AND OBJECTIVES: To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1-year residency programme. BACKGROUND: In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses' transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied. DESIGN/METHODS: Qualitative, descriptive study with a data-driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see File S1). RESULTS: Three themes emerged: (a) the nurses' relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme. CONCLUSIONS: There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence. RELEVANCE TO CLINICAL PRACTICE: To overcome the gap between the university and the healthcare settings, the managers can facilitate nurses' continued learning by creating structures for reflection.

Newly Graduated Swedish Nurses' Inadequacy in Developing Professional Competence.

BACKGROUND: The learning process for student and recently graduated nurses during their transition to professional nursing is stressful and challenging. The aim of this study was to describe recent graduates' experiences of developing professional competence in their basic nursing program and during their first year. METHOD: A qualitative descriptive design with an inductive approach based on interviews with 11 nurses, with a qualitative content analysis. RESULTS: Recently graduated nurses experience shortages and struggle to develop their professional competence. They find that reflection is a fundamental tool in the process of professional competence development. The competence gap is not between theoretical and practical knowledge, but rather between the university and health care organizations. CONCLUSION: Focusing on the intertwining of theoretical and practical knowledge can bridge the gap between these two organizations and create a foundation for lifelong learning of professional competence. Creating opportunities for reflection is central to the learning process. [J Contin Educ Nurs. 2020;51(2):65-74.].

eHealth tool for patients with abdominal aortic aneurysm: development and initial evaluation.

RATIONALE: Abdominal aortic aneurysm (AAA) is a prevalent condition among elderly men and may require surgical repair. Recent technical advances offer new opportunities to provide patients and next of kin with tailored and individualised information. eHealth tools have proven useful in other patient cohorts, but there are currently no validated educational eHealth tools for patients with AAA. AIM: Our aim was to develop and evaluate an eHealth tool for patients with abdominal aortic aneurysm using a participatory design process. METHOD: Patients, healthcare professionals and a technical team were involved in the development of the eHealth tool. The tool was assessed for content and usability through questionnaires, validated instruments and focus group interviews. Readability was assessed using Flesch Reading Ease Score (FRE) and Flesch-Kincaid Grade Level (FKGL). Interview data were analysed using thematic content analysis. RESULTS: Factual content and illustrations were accurate and in line with current information routine. Readability assessments produced a mean FRE score of 42.2 (±3,7) and mean FKGL of 10 (±1), implying that the eHealth tool may be difficult to comprehend for certain users. However, participants in the focus group interviews found the tool to be understandable, relevant and easy to use. CONCLUSION: The developed eHealth tool is acceptable, understandable and usable for the potential end-users. Further evaluation of the usability of the tool and effect on outcome in clinical care is warranted. This is the first educational eHealth tool for patients with AAA and has potential to contribute to improved communication and quality of care for AAA patients.

Perceived learning needs of patients with abdominal aortic aneurysm.

BACKGROUND: Patients undergoing surgical treatment of abdominal aortic aneurysm (AAA) should receive adequate information about the disease, treatment options, and self-care. Patients' learning needs should be acknowledged. The aim was to describe the perceived learning needs in patients with AAA. A secondary aim was to explore their experience of methods for patient education. METHODS: Three focus group interviews were conducted with 14 patients treated with open or endovascular repair of AAA. The interviews embraced initial diagnosis, surgical treatment, and follow-up from a learning perspective and were analyzed using qualitative content analysis. RESULTS: Three categories and 10 subcategories emerged. The health care staff failed to meet the participants' individual learning needs. Participants relied on other pathways to obtain knowledge, such as the internet or anecdotal information from friends and family. Learning needs pertained to risks and complications with surgery, self-care, and rupture risk. The participants were reluctant to ask questions due to a stressful environment. They requested accessible written information, along with a professional contact person for coordination and support during the care pathway. CONCLUSIONS: Patients with AAA describe unmet learning needs in regard to risks and complications with the disease and surgical treatment but also disease management and lifestyle factors. Education material should be consistent, individualized and easily accessible for patients and next of kin. Additional psychosocial support is warranted. Adjusting information to patients' needs may improve patient satisfaction.

The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study.

BACKGROUND: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. METHODS: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. RESULTS: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. CONCLUSION: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

Risk attitude and preferences in person's hypothetically facing open repair of abdominal aortic aneurysm.

The aim of this study was to describe risk attitude and preference for treatment using a proxy measurement of a general population sample hypothetically facing treatment for open repair (OR) of abdominal aortic aneurysm (AAA). In a telephone interview, a standard gamble (SG) and a time trade-off (TTO) question were asked to elicit risk attitude and preference for treatment in a general population sample of 200 persons, stratified in four age groups. When facing the two questions of (1) either live a shorter life without an AAA compared to a longer life with an AAA (TTO) or (2) taking a risk of living with AAA compared to taking the risk with surgical treatment (SG), the oldest age group was neither willing to live a shorter life without AAA, nor willing to take a risk with surgical treatment to the same extent as the younger age groups: age 50-59 (TTO P = 0.03, SG P = < 0.001), age 60-69 (TTO P = 0.01, SG P = < 0.001), age 70-79 (TTO P = 0.02, SG P = 0.002). These results suggest that persons in the age groups over 80 years old in the general population sample are more inclined to go on living with an AAA without taking the immediate risk associated with OR as well as the postoperatively impaired health-related quality of life (HRQL). Preference for treatment in different age groups is important to consider during the decision-making process, especially for patients over 80 years old. Patient education about treatment options, specific risks as well as postoperative impairment of HRQL is necessary in this process.

Patient throughput times and inflow patterns in Swedish emergency departments. A basis for ANSWER, A National SWedish Emergency Registry.

OBJECTIVE: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns. METHOD: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital. RESULTS: All EDs provided throughput times and patient presentation data without significant problems. In all EDs, Monday was the busiest day and the fewest patients presented on Saturday. All EDs had a large increase in patient inflow before noon with a slow decline over the rest of the 24 h, and this peak and decline was especially pronounced in elderly patients. The average LOS was 4 h of which 2 h was spent waiting for the first physician. These throughput times showed a considerable diurnal variation in all EDs, with the longest times occurring 6-7 am and in the late afternoon. CONCLUSION: These results demonstrate the feasibility of collecting benchmarking data on quality of care targets within Swedish EM, and form the basis for ANSWER, A National SWedish Emergency Registry.

Patients' experience of open repair of abdominal aortic aneurysm--preoperative information, hospital care and recovery.

AIMS AND OBJECTIVES: The aim was to elucidate patients' lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm. BACKGROUND: Open surgical treatment has a great impact on patients' health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients' needs must be better understood. DESIGN: An exploratory descriptive design was chosen to describe and understand patients' lived experience. METHOD: Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis. RESULTS: The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff. CONCLUSIONS: To facilitate the transition process, health care staff should consider patients' unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery. RELEVANCE TO CLINICAL PRACTICE: Throughout the care pathway, patients' need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.

Risk attitudes to treatment among patients with severe intermittent claudication.

OBJECTIVES: To determine claudication patients' risk attitude to invasive treatment and whether this treatment is cost effective. METHODS: Quality of life and health state utility status of 50 consecutive patients with severe intermittent claudication was assessed and compared with ankle-brachial pressure index values (ABPI) and results from treadmill tests before and after endovascular or open revascularization. Health utility scores were then calculated and used in a cost-utility analysis. RESULTS: Before surgery, patients were assigned a utility score of 0.51 (EQ-5D index) for their disease, and the standard gamble (SG) and time trade-off (TTO) median scores were 0.88 and 0.70, respectively. Before treatment, a weak correlation (r = 0.43, P < .001) between having a high risk perception of treatment and patients' walking distance were observed, where patients able to walk short distances accepted a higher risk. After treatment, ABI (P = .003) and walking distance (P = .002) improved significantly as well the physical components of the quality of life instruments (P < .001). The surgical treatment generated an improvement in quality of life expressed in QALYs equivalent to 0.17. With an estimated survival of 5 years, it adds up to a value of 0.85, corresponding to a sum of 51,000 US dollars gained. CONCLUSIONS: Patients with severe intermittent claudication are risk-seeking when it comes to surgical treatment and their risk attitude is correlated to their walking ability and quality of life. The incremental QALYs gained by treatment are achieved at a reasonable cost and revascularization appears to be cost effective.

Postoperative mobilization of patients with abdominal aortic aneurysm.

AIM: This paper reports on a study which aimed to evaluate the effects of structured written preoperative information on patients' postoperative psychological and physical wellbeing after surgery for abdominal aortic aneurysm (AAA). BACKGROUND: The possible benefits of current booklets written by professionals on postoperative psychological and physical wellbeing in patients with AAA are unknown. Previous studies have shown that preoperative information has a favourable effect on both mood state and physical mobilization. METHOD: Fifty-two patients admitted for elective repair of AAA were selected consecutively and randomized to receive only verbal (control group), or verbal and written information in booklet form (experimental group). The booklet contained procedural and sensory information about the disease and its treatment. Two questionnaires were used to establish whether the booklet had any effect on perceived health, psychological and physical wellbeing postoperatively. RESULTS: The two groups were similar regarding their perceived health but differed significantly regarding psychological wellbeing pre- and postoperatively. Patients in the experimental group were significantly sadder both pre- and postoperatively compared with those in the control group. Both groups were similar in postoperative physical wellbeing. CONCLUSION: This group of patients often has asymptomatic disease, with a short interval between diagnosis and major surgery. When patients receive an information booklet during this period, this seems to cause more worries than anticipated. Hence, a more supportive educational programme might benefit this patient group, both pre- and postoperatively.