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  • 1.
    Bäckström, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Family Members of Patients with Burns: Experiences of a Distressful Episode2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods.

    The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms.

    Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms.

    Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character.  Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved.

    Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge.

    In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.

    List of papers
    1. Prediction of psychological symptoms in family members of patients with burns 1 year after injury
    Open this publication in new window or tab >>Prediction of psychological symptoms in family members of patients with burns 1 year after injury
    2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 2, p. 384-393Article in journal (Refereed) Published
    Abstract [en]

    Aim

    To report a study of predictors of psychological symptoms in family members of patients with burns.

    Background

    Family members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term.

    Design

    The design of the study was prospective and longitudinal.

    Methods

    Forty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses.

    Results

    The mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance.

    Conclusion

    Family members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.

    Keywords
    burns, family members, injury, nursing, psychological symptoms, rehabilitation
    National Category
    Psychiatry Nursing Surgery
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-190020 (URN)10.1111/j.1365-2648.2012.06017.x (DOI)000313722600014 ()22509932 (PubMedID)
    Available from: 2013-01-07 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
    2. Health-related quality of life in family members of patients with burns
    Open this publication in new window or tab >>Health-related quality of life in family members of patients with burns
    Show others...
    2014 (English)In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 35, no 3, p. 243-250Article in journal (Refereed) Published
    Abstract [en]

    A severe burn not only affects the patients, but may also have a great impact on the lives of family members. It is known that family members of patients with burns experience psychological distress, but health-related quality of life (HRQoL) has not been studied in this group. The aim was to study predictors of HRQoL in family members of patients with burns. Forty-four family members of adult patients treated in a burn center, between 2000 and 2007, completed questionnaires during care, and at 3, 6, and 12 months after injury. HRQoL was assessed with the EuroQol 5D (EQ-5D), which consists of the dimensions: mobility, self-care, usual activities, pain, and anxiety/depression. The questionnaire generates an EQ-5D index and a visual analog scale (VAS) score. Overall, the EQ-5D index was similar to that of the general population. A slight improvement in HRQoL was found in the VAS scores and in the anxiety/depression dimension over time. In regression models, HRQoL was primarily predicted by earlier life events, symptoms of post-traumatic stress disorder, and HRQoL, assessed during the patients’ hospitalization. In summary, HRQoL assessed with VAS scores increased slightly during the first year postburn, and early screening for life events and psychological symptoms, and HRQoL might be useful in identifying family members in need of support.

    Keywords
    burns, family members, injury, health related quality of life, rehabilitation
    National Category
    Psychiatry Surgery Nursing
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-208623 (URN)10.1097/BCR.0b013e318295744e (DOI)000335394600015 ()
    Available from: 2013-10-06 Created: 2013-10-06 Last updated: 2017-12-06Bibliographically approved
    3. Family members of patients with severe burns: Experiences during care and rehabilitation
    Open this publication in new window or tab >>Family members of patients with severe burns: Experiences during care and rehabilitation
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim was to explore experiences of care and rehabilitation in family members of patients with burns. Ten semi-structured interviews analyzed using qualitative content analysis resulted in seven categories related to the care: Feeling distress, Receiving excellent care, Being treated in an insensitive way, Reluctance towards giving care, Being the hub of the family network, Feeling hope, and Being thankful. Six categories were related to rehabilitation: Ambiguous feelings, Difficulties after discharge, Being forced to take responsibility, Handling the situation, Gaining support and Being thankful. Although there are positive experiences during care, family members experience the time in hospital and after discharge as distressful and could benefit from being cared for in a more individualized way. Improved communication between caregivers and the family member may be important. Family members need to be included in the planning of care and support offered at discharge could ease the burden on these individuals.

    Keywords
    burns, experience, family members, nursing, recovery
    National Category
    Nursing Psychiatry Surgery
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-208624 (URN)
    Available from: 2013-10-07 Created: 2013-10-06 Last updated: 2014-01-23
    4. Family members’ experiences of support during care and rehabilitation of patients with severe burns
    Open this publication in new window or tab >>Family members’ experiences of support during care and rehabilitation of patients with severe burns
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to explore family members’ experiences of support during burn care and during the rehabilitation phase after hospital discharge.

    Background: Family members are important in the recovery process of patients with severe burns; however, few previous studies have focused on how this group experiences and values support during care and rehabilitation.

    Methods: Ten semi-structured interviews with family members of patients treated at the national burn centres were recorded digitally, transcribed verbatim, and analysed using content analysis. The informants were included nationwide, most were females, and different socioeconomic groups were represented.

    Results: Categories related to experiences during care were: Nonsupport, Professional support, Support from family and friends, A wish for support, and That little something extra. Categories related to experiences during rehabilitation were: Nonsupport, Professional support, Support from family and friends, Support from the injured person and Religion. Support from other family members and friends was generally considered the most important source of support, and there was a wish for more proactive support from care professionals.

    Conclusion: The experience of support is individual, which makes supporting family members a complex task. Individualized treatment of family members and their inclusion in the care process are of central importance, as is identifying specific needs for support both during the time in hospital and during rehabilitation. It is important to be proactive and offer support.

    Keywords
    burns, experience, family members, nursing, recovery, support
    National Category
    Nursing Surgery Psychiatry
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-208625 (URN)
    Available from: 2013-10-07 Created: 2013-10-06 Last updated: 2014-01-23
  • 2.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Gerdin, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Prediction of psychological symptoms in family members of patients with burns 1 year after injury2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 2, p. 384-393Article in journal (Refereed)
    Abstract [en]

    Aim

    To report a study of predictors of psychological symptoms in family members of patients with burns.

    Background

    Family members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term.

    Design

    The design of the study was prospective and longitudinal.

    Methods

    Forty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses.

    Results

    The mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance.

    Conclusion

    Family members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.

  • 3.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Kristina, Haglund
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Family members’ experiences of support during care and rehabilitation of patients with severe burnsManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to explore family members’ experiences of support during burn care and during the rehabilitation phase after hospital discharge.

    Background: Family members are important in the recovery process of patients with severe burns; however, few previous studies have focused on how this group experiences and values support during care and rehabilitation.

    Methods: Ten semi-structured interviews with family members of patients treated at the national burn centres were recorded digitally, transcribed verbatim, and analysed using content analysis. The informants were included nationwide, most were females, and different socioeconomic groups were represented.

    Results: Categories related to experiences during care were: Nonsupport, Professional support, Support from family and friends, A wish for support, and That little something extra. Categories related to experiences during rehabilitation were: Nonsupport, Professional support, Support from family and friends, Support from the injured person and Religion. Support from other family members and friends was generally considered the most important source of support, and there was a wish for more proactive support from care professionals.

    Conclusion: The experience of support is individual, which makes supporting family members a complex task. Individualized treatment of family members and their inclusion in the care process are of central importance, as is identifying specific needs for support both during the time in hospital and during rehabilitation. It is important to be proactive and offer support.

  • 4.
    Bäckström, Josefin
    et al.
    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.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sjöberg, Folke
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden The Burn Center, Department of Hand and Plastic Surgery, Linköping University Hospital, Linköping, Sweden.
    Haglund, Kristina
    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.
    Being a family member of a burn survivor –: Experiences and needs2018In: Burns Open, ISSN 2468-9122, Vol. 2, no 4, p. 193-198Article in journal (Refereed)
    Abstract [en]

    Background

    Family members are important in the recovery process of persons with severe burns; however, few previous studies have focused on how this group experiences care and rehabilitation.

    Objective

    To explore family members’ experiences and needs, during the time in hospital and after discharge.

    Methodology

    Explorative study with a qualitative descriptive design. Ten semi-structured interviews with family members of injured persons treated at the national burn centres were recorded digitally, transcribed verbatim, and analysed using content analysis.

    Findings

    Five categories were related to experiences during care: Experiencing excellent treatment and support, Experiencing mistrust and a rejecting attitude, Feelings of chaos and shock, Being the hub of the family network, Feeling hope and thankfulness. Three categories were related to experiences during rehabilitation: Ambiguous feelings, Multifaceted support and Handling the situation.

    Conclusion

    The experiences of the time in hospital and during rehabilitation are individual and comprise a mixture of positive and negative experiences and a diversity of needs. The results suggest that healthcare professionals should be proactive and identify specific needs for support as well as provide individualized treatment of family members.

  • 5.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin.
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Family members of patients with severe burns: Experiences during care and rehabilitationManuscript (preprint) (Other academic)
    Abstract [en]

    The aim was to explore experiences of care and rehabilitation in family members of patients with burns. Ten semi-structured interviews analyzed using qualitative content analysis resulted in seven categories related to the care: Feeling distress, Receiving excellent care, Being treated in an insensitive way, Reluctance towards giving care, Being the hub of the family network, Feeling hope, and Being thankful. Six categories were related to rehabilitation: Ambiguous feelings, Difficulties after discharge, Being forced to take responsibility, Handling the situation, Gaining support and Being thankful. Although there are positive experiences during care, family members experience the time in hospital and after discharge as distressful and could benefit from being cared for in a more individualized way. Improved communication between caregivers and the family member may be important. Family members need to be included in the planning of care and support offered at discharge could ease the burden on these individuals.

  • 6.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Gerdin, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Health-related quality of life in family members of patients with burns2014In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 35, no 3, p. 243-250Article in journal (Refereed)
    Abstract [en]

    A severe burn not only affects the patients, but may also have a great impact on the lives of family members. It is known that family members of patients with burns experience psychological distress, but health-related quality of life (HRQoL) has not been studied in this group. The aim was to study predictors of HRQoL in family members of patients with burns. Forty-four family members of adult patients treated in a burn center, between 2000 and 2007, completed questionnaires during care, and at 3, 6, and 12 months after injury. HRQoL was assessed with the EuroQol 5D (EQ-5D), which consists of the dimensions: mobility, self-care, usual activities, pain, and anxiety/depression. The questionnaire generates an EQ-5D index and a visual analog scale (VAS) score. Overall, the EQ-5D index was similar to that of the general population. A slight improvement in HRQoL was found in the VAS scores and in the anxiety/depression dimension over time. In regression models, HRQoL was primarily predicted by earlier life events, symptoms of post-traumatic stress disorder, and HRQoL, assessed during the patients’ hospitalization. In summary, HRQoL assessed with VAS scores increased slightly during the first year postburn, and early screening for life events and psychological symptoms, and HRQoL might be useful in identifying family members in need of support.

  • 7.
    Hasselberg, Marie
    et al.
    Karolinska Institutet.
    Kirsebom, Marie
    Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Bäckström, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Berg, Hans-Yngve
    Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Rissanen, Ritva
    Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
    I did NOT feel like this at all before the accident: do men and women report different health and life consequences of a road traffic injury?2018In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Worldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives.

    OBJECTIVE: To describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives.

    METHODS: The study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation.

    PARTICIPANTS: A total of 692 respondents with a minor or a moderate injury were included.

    RESULTS: The respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing.

    CONCLUSION: These differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

  • 8.
    Lundberg, Pranee C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Bäckström, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Widén, Sarah
    Caregiving to patients who are culturally diverse by Swedish last-year nursing students.2005In: Journal of Transcultural Nursing, ISSN 1043-6596, E-ISSN 1552-7832, Vol. 16, no 3, p. 255-262Article in journal (Refereed)
    Abstract [en]

    With Leininger’s theory of cultural care diversity and universality as a framework, the aim of this study was to describe Swedish last-year nursing students’ experiences of caregiving to patients who are culturally diverse. The students participated voluntarily, 107 by completing a questionnaire with open-ended questions and 15 by participating in in-depth semistructured interviews. Three categories of experience were identified by use of qualitative method, namely, cultural awareness, cultural insufficiency, and cultural curiosity. The students were found to be on the level of Leininger’s first phase of transcultural knowledge. It is concluded that cultural sensitivity should be promoted by integrating transcultural concepts into the curricula on all levels of nursing education and by offering special courses on transcultural nursing to nursing students and health care providers.

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