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From monitoring physiological functions to using psychological strategies: Nurses' view of caring for the aneurysmal subarachnoid haemorrhage patient
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 3, 403-411 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: The aims of this study were: (1) to describe nurses' views of the physical and supportive needs of patients who have suffered a subarachnoid haemorrhage (SAH), (2) to describe nurses' views of changes in social circumstances and (3) changes in the mental condition of patients after SAH. BACKGROUND: As patients with SAH are generally younger and predominantly female compared with other stroke groups they may have different needs of nursing support to facilitate adaptation. Caring for persons surviving stroke involves advanced nursing skills such as monitoring neurological functions in neurointensive care and providing physical care during rehabilitation. DESIGN: Explorative descriptive design. METHOD: Semi-structured interviews were performed with 18 nurses in neurointensive and rehabilitation care. A qualitative latent content analysis was conducted. RESULTS: Nurses viewed patients' need for support as a process ranging from highly advanced technological care to 'softer' more emotional care. However, shortages in the communication between neurointesive and rehabilitation nurses regarding this support were acknowledged. Changes in social circumstances and mental conditions were viewed both as obstacles and advantages regarding return to everyday life. Nurses also viewed that the characteristics of the group with SAH was not particularly different from the group with other types of stroke. CONCLUSIONS: Support to patients with SAH is viewed as a process carried out by nurses at neurointensive care units and rehabilitation units. Shortages in communication, regarding this support, were acknowledged. Obstacles and advantages with respect to returning to everyday life could apply to any stroke group, which could make it more difficult for nurses to detect the specific needs of patients with SAH. RELEVANCE TO CLINICAL PRACTICE: The communication between neurointensive nurses and rehabilitation nurses regarding support to patients with SAH is not satisfactory. Occasionally the specific needs of patients with SAH are not recognized.

Place, publisher, year, edition, pages
2008. Vol. 17, no 3, 403-411 p.
Keyword [en]
Care, Neurosurgery, Nurse roles, Nurses, Nursing, Subarachnoid haemorrhage
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-17712DOI: 10.1111/j.1365-2702.2006.01878.xISI: 000252397000015PubMedID: 17419788OAI: oai:DiVA.org:uu-17712DiVA: diva2:45483
Available from: 2008-08-18 Created: 2008-08-18 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Coping, Psychiatric Morbidity and Perceived Care in Patients with Aneurysmal Subarachnoid Haemorrhage
Open this publication in new window or tab >>Coping, Psychiatric Morbidity and Perceived Care in Patients with Aneurysmal Subarachnoid Haemorrhage
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Many patients with an aneurysmal subarachnoid haemorrhage (SAH) exhibit difficulties in rehabilitation, even in cases of a good prognosis. The present project investigates this using qualitative methods and standardised outcome measures.

Patients with SAH treated at Uppsala University Hospital between 2002 and 2005 with an expected good prognosis were consecutively included. In addition, nurses working with such patients were interviewed.

Outcome was assessed in terms of perception of care, psychiatric health, coping and health related quality of life (HRQoL).

Qualitative content analyses revealed eight categories, which were divided into two patterns, Confident or Pessimistic perception of recovery, largely on the basis of the presence or absence of depression.

Eighty-three patients were assessed by The Structured Clinical Interview for DSM-IV, Axis I (SCID-I). Forty-one percent fulfilled criteria for any psychiatric disorder seven months after SAH and 45 % presented with a history of lifetime psychiatric morbidity. Logistic regressions indicated that a psychiatric history was related to a higher risk of psychiatric problems seven months after SAH, as well as a lower return to work.

SAH patients had lower HRQoL than the general Swedish population; almost entirely in the subgroup with a psychiatric history prior to the SAH. Those with a psychiatric history used more evasive, fatalistic, emotive and palliative coping strategies associated with inability to handle illness. Multiple regressions revealed that a psychiatric history and use of coping were independently associated with HRQoL, albeit more in the mental than the physical domains.

Qualitative content analyses revealed that nurses viewed patients’ support needs as a process ranging from technological to emotional care. Shortcomings in the communication between nurses in acute and rehabilitation settings on the subject of support were acknowledged.

The results underline the importance of early diagnosis of coexisting psychiatric illness and the need for an intact health care chain.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 53 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 496
Keyword
subarachnoid haemorrhage, health related quality of life, depression, nursing care, post traumatic stress disorder, psychiatric disorders, coping
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-109761 (URN)978-91-554-7653-3 (ISBN)
Public defence
2009-12-12, Enghoffsalen, Entrance 50, Akademiska sjukhuset, 751 85, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-11-19 Created: 2009-10-26 Last updated: 2009-11-19Bibliographically approved

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Hedlund, MathildeCarlsson, Marianne

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