Clinical outcomes of a short-term family-focused intervention for patients with atrial fibrillation-A randomised clinical trial.

AIMS: To evaluate a family-focused intervention for patients with atrial fibrillation (AF) in addition to conventional care and to establish its effect on health-related quality of life (HRQoL), anxiety, depression, AF symptoms, and family support. BACKGROUND: AF is a widespread heart disease affecting the well-being of patients and their family members physically and psychologically. Supporting patients and their family members could potentially facilitate regaining family strength and improve HRQoL. METHODS: Patients with newly diagnosed AF were randomised to standard care or additional family-focused intervention with change in global score of the Atrial Fibrillation Quality of Life Questionnaire (AFEQT) as primary outcome after six months' follow-up. Secondary outcomes included the Hospital Anxiety and Depression Score, the European Heart Rhythm Association score, the Ice Expressive Family Functioning Questionnaire, and the Ice Family-Perceived Support Questionnaire (ICE-FPSQ). RESULTS: Sixty-eight patients received standard care (n = 35) or family focused intervention (n = 33). The median change at the six-month follow-up on the global AFEQT score was 4.17 (-1.46-9.17) in the control group and 5.83 (-2.5-30) in the intervention group, yielding a median difference of -1.67 (p = 0.500). Change in ICE-FPSQ showed significant positive scores in favour of intervention (p < 0.001); other secondary outcome changes were non-significant. CONCLUSION: The family-focused intervention had a small positive but non-significant effect on HRQoL compared to standard care. To address the impact of AF on the patients and family members seems to improve anxiety and depression scores and perceived family support.

Barriers and Facilitators Influencing Nurses' Confidence in Managing Family Nursing Conversations in the Treatment of Chronic Noncancer Pain: A Longitudinal Qualitative Study.

This mixed-methods research examined the translation of a family nursing conversation intervention to the multidisciplinary treatment of patients experiencing chronic noncancer pain. The intervention required educating nurses who offered family nursing interventions to these families. The research uncovered barriers and facilitators influencing the nurses' perceived self-efficacy related to the process of incorporating family nursing conversations in their nursing care. A qualitative, descriptive, longitudinal design with three focus group interviews was implemented. A template analysis, using a priori themes based on Bandura's self-efficacy theory, illuminated a process initially predominated by barriers. Learning how to offer family nursing conversations was initially overwhelming for nurses because they were concerned about harming the family. Over time, the nurses came to understand the usefulness of the therapeutic conversation with families. Significant facilitators were the project manager's role, a strong nursing community, and the positive influence of the family intervention on the nurses' professional identity.

Experiences from COVID-19-driven use of telephone consultations in a cardiology clinic-The CoviTel study.

INTRODUCTION: The COVID-19 pandemic triggered a rapid shift towards telephone consultations (TC) in the out-patient clinic setting with little knowledge of the consequences. The aims of this study were to evaluate patient-centred experiences with TC, to describe patterns in clinical outcomes from TC and to pinpoint benefits and drawbacks associated with this type of consultations. METHODS: This mixed methods study combined an analysis of quantitative and qualitative data. A quantitative, retrospective observational study was conducted employing data from all 248 patients who received TC at an out-patient cardiology clinic during April 2020 with a one-month follow-up. Semi-structured interviews were conducted; Ten eligible patients were recruited from the outpatient clinic by purposive sampling. RESULTS: Within the follow-up period, no patients died or were acutely hospitalised. Approximately one in every four patients was transferred to their general practitioner, while the remaining three-quarter of the patients had a new examination or a new consultation planned. The cardiologist failed to establish contact with more than a fifth of the patients, often due to missing phone numbers. Ten patients were interviewed. Five themes emerged from the interviews: 1) Knowing an estimated time of the consultation is essential for patient satisfaction, 2) TC are well perceived when individually adapted, 3) TC can be a barrier to patient questions, 4) Video consultations should only be offered to patients who request it, and 5) Prescriptions or instructions made via TC do not cause uncertainty in patients. CONCLUSIONS: The TC program was overall safe and the patients felt comfortable. Crucial issues include precise time planning, the patient's availability on the phone and a correct phone number. Patients stressed that TC are unsuitable when addressing sensitive topics. A proposed visitation tool is presented.

How Family Members Experienced a Family-Focused Atrial Fibrillation Intervention in an Outpatient Setting-A Qualitative Study.

Introduction: Family-focused nursing has gained ground worldwide, and a range of healthcare systems are now practicing family-focused nursing, which has been shown to increase the quality of care. Even so, a lack of research remains into family-focused nursing for various groups of patients in clinical practice. Objectives: The purpose of this study was to explore how family members (FMs) of patients with atrial fibrillation (AF) experienced a family-focused nursing intervention in a clinical outpatient setting. Methods: This was a qualitative phenomenological interview study employing Reflective Lifeworld Research (RLR) to explore humans' lived experiences. The data reported herein were derived from semi-structured interviews with seven FMs of patients with AF who participated in a clinical trial which tested a family-focused intervention in a Cardiology outpatient clinic treating patients with AF. The transcribed interviews were analyzed in four phases which is an iterative process as proposed by Dahlberg and Dahlberg. Findings: The essence of the phenomenon was experiencing less panic and finding peace, which emerged from the following four patterns. (1) The FMs' post-AF experience, (2) Enhanced understanding and knowledge of AF, (3) Personal interaction with a nurse specialist and (4) AF becomes manageable. A space facilitating reflection upon the disease and daily life with the disease was established through group sessions and family conversations. Conclusion: A family-focused nursing intervention facilitated by specialized nurses with extensive communication skills filled a knowledge gap related to AF thereby reducing panic and increasing peace among FMs. Furthermore, the intervention facilitated family awareness of their resources to bring about change, regain balance, and enhance well-being in their everyday lives and initiated a healing process in the families. Future interventions for patients with AF should consider FMs as well as patients as an entity of care.

Engaging in partnerships is the key to preserving and creating a trustful collaboration with vulnerable families: A focus group study.

OBJECTIVE: Maternal vulnerability challenges parenthood and represents a critical task for health professionals working in postnatal care. Being born to a vulnerable mother may have wide-ranging effects on child development and carry the risks of impairment in cognitive performance, behavioural disturbances and mental problems which may persist into late childhood and adolescence. It is vital to explore the perspectives of healthcare professionals who have experience of caring for vulnerable families at the obstetric department and in the transition to the primary healthcare sector to identify and describe potential barriers, challenges and the potential for any improvements in postnatal care. The aim of this study was to describe healthcare professionals' experience of vulnerable families and their extended stay at the obstetric department, and to describe the collaboration between the primary and the secondary healthcare sectors concerning postnatal care. DESIGN AND SETTING: A qualitative inductive descriptive design with focus group interviews was used for data collection. Two two-hour focus group interviews were conducted at a university hospital in the Capital Region of Denmark in February 2019. PARTICIPANTS AND RESULTS: In total, 16 health professionals from the obstetric department and primary healthcare sectors participated. The overall theme found was Engaging in partnership across sectors and with families can improve postnatal care for vulnerable families. It emerged from three categories: 1) vulnerability as an individual perception, 2) communication and trust as essential competencies and 3) collaboration in a partnership. CONCLUSION AND IMPLICATIONS FOR PRACTICE: This study demonstrates the complexity and challenges of postnatal care provided to vulnerable families. It highlights the possibilities and benefits of engaging in partnership across sectors and families to improve postnatal care for vulnerable families. Engaging in partnerships improves the quality of the extended stay at the obstetric department and the transition to the primary healthcare sector.

Living with Atrial Fibrillation: A Family Perspective.

Aim: The aim of this study was to obtain insights from patients and their family members on how families are living with atrial fibrillation. Background: Atrial fibrillation is the most common cardiac arrhythmia and is often described as an emerging global epidemic affecting an estimated 33.5 million people worldwide. Living with atrial fibrillation not only affects the patient but also may negatively influence family members' perceived health. The perspective of the family has previously been understudied, and more knowledge on how patients and their family members cope and adjust to life with atrial fibrillation may be helpful when developing future support for patients and their family members when coping with atrial fibrillation. Methods: A qualitative phenomenological study with an inductive, descriptive research approach based on Giorgi's descriptive method was used. Data were gathered through 12 dyadic family interviews. The COnsolidated criteria for REporting Qualitative research checklist was followed while conducting the study. Results: Three major themes emerged: emotional differences, changes in family life, and uncertainty about the future. Atrial fibrillation had multiple effects on the family. Frequently, several adjustments and adaptations had to be made to accommodate life with atrial fibrillation. Conclusion: Patients with atrial fibrillation and their family members feel a need to talk about their emotions and worries. They required support and guidance to manage the challenges of living with atrial fibrillation. These results will be used in a family-focused intervention designed to support families in adjusting and managing their everyday lives with atrial fibrillation.

Dancing with atrial fibrillation - How arrhythmia affects everyday life of family members: A qualitative study.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Patients with AF often experience debilitating symptoms, stress and reduced health-related quality of life. Previous qualitative research on AF has primarily focused on the patient. AF, however, can also be burdensome for the patient's family. AIM: The aim of this study was to explore how family members experience life when a close member in the family has AF. METHOD: Transcribed focus group interviews were analysed using content analysis approach inspired by Graneheim and Lundman. RESULTS: Two focus group interviews were conducted with 11 family members. The overall theme was Dancing with AF. The theme emerged from three categories: 1) Handling AF as a living condition, 2) Influencing the roles of family members, 3) Fear of AF attack. AF had a very significant impact on the patients' family members, forcing them to reconstruct their daily lives. CONCLUSIONS: AF has multiple consequences for family members and can give rise to conflicts concerning family roles. Family members have a lack of knowledge of AF and fear of how AF can cause changes in the family members' everyday lives. This study demonstrates that there is a need for further research of ways to support the family members of patients with AF.