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  • 1.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences.
    Theander, K.
    Arne, M.
    Lisspers, K.
    Lundh, L.
    Sandelowsky, H.
    Ställberg, B.
    Thors Adolfsson, E.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    A descriptive study of incorrect inhalation technique in patients with COPD in primary care2018Conference paper (Refereed)
  • 2.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences.
    Theander, Kersti
    Arne, Mats
    Lisspers, Karin
    Lundh, Lena
    Sandelowsky, Hanna
    Ställberg, Björn
    Thors Adolfsson, Eva
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Incorrect inhalation technique is common in patients with COPD in primary care2018Conference paper (Refereed)
    Abstract [en]

    The results show that many patients don’t use the inhaler correctly. Errors related to inhalation technique were twice as common as those related to devices. When teaching patients to use the inhalers it seems like there is a need to focus more on the inhalation technique itself. The checklist used in this study needs to be further improved.

  • 3.
    Bove, Dorthe Gaby
    et al.
    Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark.
    Zakrisson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Midtgaard, Julie
    Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; The University Hospital Centre for Health Research, Copenhagen University Hospital, Rigshospitalet, København, Denmark.
    Lomborg, Kirsten
    Section for Nursing, Department of Clinical Medicine and Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
    Overgaard, Dorthe
    Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
    Undefined and unpredictable responsibility: a focus group study of the experiences of informal caregiver spouses of patients with severe COPD2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 3-4, p. 483-493Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore how spouses of patients with severe chronic obstructive pulmonary disease experience their role as informal caregiver.

    Background: Informal caregiver spouses are of pivotal importance in the way that patients with chronic obstructive pulmonary disease cope with their daily life, including their opportunity to stay at home and avoid hospitalisations in the last stages of the disease. However, caregiving is associated with increased morbidity and mortality among caregivers. Further understanding of the role as an informal caregiver spouse of patients with severe chronic obstructive pulmonary disease is needed to develop supportive interventions aimed at reducing the caregiver burden.

    Design: The study had a qualitative exploratory design. The data collection and analysis were based on framework method. Framework method is a thematic methodology and consists of five key stages: familiarisation, identifying a thematic framework, indexing, charting and mapping & interpretation.

    Methods: Three focus groups were conducted in November 2013 with 22 spouses of patients with severe chronic obstructive pulmonary disease.

    Results: Undefined and unpredictable responsibility was found to be the overarching theme describing the informal caregiver role. Underlying themes were: being constantly in a state of alertness, social life modified, maintaining normality, ambivalence in the relationship and a willingness to be involved.

    Conclusions: The informal caregiver spouses experienced ambiguity about expectations from their private and the health professionals' surroundings. The informal caregiver spouses wanted to provide meaningful care for their partners, but sought knowledge and support from the health professionals.

    Relevance to clinical practice: We recommend that nurses take on the responsibility for including the informal caregiver spouses in those aspects of decision-making that involve the common life of the patients and their spouses.

  • 4.
    Eliason, Gabriella
    et al.
    Örebro University, School of Health and Medical Sciences.
    Zakrisson, Ann-Britt
    Örebro University, School of Health and Medical Sciences.
    Piehl-Aulin, Karin
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences.
    Physical activity patterns in patients in different stages of chronic obstructive pulmonary disease2011In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 8, no 5, p. 369-374Article in journal (Refereed)
    Abstract [en]

    It has previously been suggested that exercise capacity is decreased in COPD and that it is associated with degree of disease. The reduced exercise capacity may plausibly be due to low levels of physical activity in this patient group. The aim of the present study was to assess exercise capacity and physical activity in different stages of COPD and to examine the associations between exercise capacity, pulmonary function and degree of physical activity. A total of 44 COPD patients and 17 healthy subjects participated in the study. Exercise capacity was assessed using the 6-minute walking test and physical activity was assessed using an accelerometer worn all waking hours during 7 days. Mean exercise capacity was significantly lower in COPD patients compared with healthy subjects. Mean physical activity level and time spent at least moderately active were significantly lower in patients with moderate and severe COPD compared with healthy subjects while no differences in time spent sedentary were observed between the study groups. Pulmonary function, mean physical activity level and time spent at least moderately physically active were significantly associated with exercise capacity in the patients. We conclude that patients with moderate and severe COPD are less physically active compared with healthy subjects. Furthermore, mean physical activity level and physical activity of at least moderate intensity are positively associated with exercise capacity in COPD, while time spent sedentary is not, which stresses an important role of physical activity on exercise capacity in these patients.

  • 5.
    Eliason, Gabriella
    et al.
    Örebro University, School of Health and Medical Sciences.
    Zakrisson, Ann-Britt
    Örebro University, School of Health and Medical Sciences.
    Piehl-Aulin, Karin
    Department of pheumatology, danderyds hospital, Stockholm, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences.
    Physical activity patterns in patients with different degrees of chronic obstructive pulmonary diseaseManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: It has previously been suggested that exercise capacity is decreased in COPD patients and that it is associated with degree of disease. The reduced exercise capacity may plausibly be due to low levels of physical activity in this patient group. In the present study we aimed to assess exercise capacity and physical activity in different stages of COPD and to examine the associations between exercise capacity, pulmonary function and degree of physical activity.

    Methods: 44 COPD patients and 17 healthy subjects participated in the study. Exercise capacity was assessed using the 6 minute walking test and physical activity was assessed using a uniaxial accelerometer worn all waking hours during seven days.

    Results: Mean exercise capacity was significantly lower in COPD patients compared to healthy subjects. Mean physical activity level and time spent at least moderately active were significantly lower in patients with moderate and severe COPD compared to healthy subjects while no differences in time spent sedentary were observed between the study groups. Pulmonary function, mean physical activity level and time spent at least moderately physically active were significantly associated with exercise capacity in the patients.

    Conclusions: Patients with moderate and severe COPD are significantly less physically active compared to healthy subjects. Furthermore, mean physical activity level as well as physical activity of at least moderate intensity are positively associated with exercise capacity in COPD patients while time spent sedentary is not which stresses an important role of physical activity on exercise capacity in this patient group. 

  • 6.
    Zakrisson, Ann-Britt
    Örebro University, School of Health and Medical Sciences.
    Management of patients with chronic obstructive pulmonary disease in primary health care: a study of a nurse-led multidisciplinary programme of pulmonary rehabilitation2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to modify and evaluate effects, as well as todescribe experiences of a nurse-led multidisciplinary programme of pulmonaryrehabilitation in primary health care for patients with chronicobstructive pulmonary disease (COPD) and their next of kin.Interviews were performed with 12 COPD nurses about their experiencesof patient education (I). Forty-nine patients participated in the interventiongroup and 54 in the control group in a quasi-experimentalstudy which investigated the effects of the programme on functional capacity,quality of life and exacerbation frequency during one year (II).Interviews were performed related to the experiences of 20 patients whohad participated in the six-week programme (III) and the experiences of20 next of kin to the patients that had participated (IV).The results showed that COPD nurses fluctuated between security andinsecurity in patient education and were in need of support, time, structureand collaboration to develop their patient education (I). In Study IIthere were no differences between the groups with regard to functionalcapacity and quality of life, but the number of exacerbations decreased inthe intervention group and increased in the control group (II). The patientsin study III had allowed themselves to live at their own pace followingthe programme but a constant fear was present in spite of the programme(III). Next of kin in Study IV had a life that remained overshadowedby illness but there were positive outcomes of the programme aslong as two years afterwards. The next of kin also had constant fear,however (IV).In conclusion, the six week programme brought about results in changingeveryday life. Nevertheless, all lived in the shadow of fear and uncertaintyin spite of the programme. More research is needed to address therequirements of COPD nurses, patients and next of kin.

    List of papers
    1. The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care
    Open this publication in new window or tab >>The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care
    2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 147-155Article in journal (Refereed) Published
    Abstract [en]

    The number of patients with chronic obstructive pulmonary disease (COPD) is increasing. These patients need nursing care, including education in self-care, which has a positive effect on their physical and psychoemotional well-being. The aim of this study was to describe the experiences of asthma/COPD nurses' in primary health care (PHC) of educating patients with COPD. A descriptive, qualitative study was conducted, with interviews of 12 asthma/COPD nurses. The data were analysed using qualitative content analysis. The findings are presented in two themes: Theme 1, receiving support results in a feeling of security, which enables the development of patient education; and Theme 2, a lack of support results in a feeling of insecurity, which makes it difficult to develop patient education. The asthma/COPD nurses were individual orientated with individualization of care, but the patient's mood, the varying support of those around and the nurses' varying degrees of security affected the education. The conclusion is that the asthma/COPD nurses' experience of patient education fluctuated between insecurity and security. The nurses' feeling of insecurity in their patient education can be strengthened through support from colleagues and by increased knowledge in promoting the learning of others. Collaborative teamwork with a well-functioning asthma/COPD clinic in PHC can facilitate and improve patient services; these initiatives can enable the asthma/COPD nurses to reach their full potential.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2010
    Keywords
    chronic obstructive pulmonary disease, district nurse, nursing, patient education, primary health care, self-care
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-20123 (URN)10.1111/j.1471-6712.2009.00698.x (DOI)000274389900019 ()
    Available from: 2011-10-19 Created: 2011-10-19 Last updated: 2017-12-08Bibliographically approved
    2. Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial
    Open this publication in new window or tab >>Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial
    Show others...
    2011 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed) Published
    Abstract [en]

    AIM:To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    METHOD:A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    RESULTS:No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    CONCLUSIONS:The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

    Place, publisher, year, edition, pages
    The Primary Care Respiratory Society U K, 2011
    Keywords
    COPD, management, exacerbations, nurse, primary care, rehabilitation, pulmonary, quantitative
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-20124 (URN)10.4104/pcrj.2011.00060 (DOI)000304279300021 ()21687920 (PubMedID)
    Note

    The authors are also affiliated to Family Medicine Research Centre, Örebro University, Sweden • Centre for Assessment of Medical Technology in Örebro, Sweden.

    Tidskriften har upphört 2014

    Available from: 2011-10-19 Created: 2011-10-19 Last updated: 2018-03-26Bibliographically approved
    3. Experiences among patients with COPD one year after attending a primary care nurse-led multidisciplinary programme
    Open this publication in new window or tab >>Experiences among patients with COPD one year after attending a primary care nurse-led multidisciplinary programme
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-20125 (URN)
    Available from: 2011-10-19 Created: 2011-10-19 Last updated: 2017-10-17Bibliographically approved
    4. Next of kin’s experience of living with a patient suffering from COPD two years after a nurse-led multidisciplinary programme of pulmonary rehabilitation in primary health care settings
    Open this publication in new window or tab >>Next of kin’s experience of living with a patient suffering from COPD two years after a nurse-led multidisciplinary programme of pulmonary rehabilitation in primary health care settings
    (English)Manuscript (preprint) (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-20126 (URN)
    Available from: 2011-10-19 Created: 2011-10-19 Last updated: 2017-10-17Bibliographically approved
  • 7.
    Zakrisson, Ann-Britt
    Örebro University, School of Health and Medical Sciences.
    Nurse-led multidisciplinary COPD-rehabilitation in primary health care2009Conference paper (Refereed)
  • 8.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital. University Healthcare Research Centre, Region Örebro County, Örebro, Sweden.
    Symptom-reducing actions: a concept analysis in the context of chronic obstructive pulmonary disease2017In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, no 1, article id 1387452Article, review/survey (Refereed)
    Abstract [en]

    Patients with Chronic Obstructive Pulmonary Disease (COPD) have multiple symptoms. Nursing care is based on six core competencies and one of them is person-centred care that includes the aspect of professional symptom relief. The aim was to clarify a meaning of the concept of Symptom-reducing actions in the context of COPD. Databases MEDLINE and CINAHL were searched between 1982 and February 2016 and 26 publications were found. Two dictionaries and three books were investigated. The method of Walker & Avant was followed. The use of the concept of Symptom-reducing actions may be categorized by the sub-concepts of supervision, information, and patient education. Exploration of defining attributes was symptom management, instructions, support, motivation, explanation, advice, teaching, and learning. Antecedent occurrences were related to factors that affect the patient's level of function such as physical performance and cognitive function. Symptom-reducing actions offer a way to support patients with COPD in self-management. Symptom-reducing actions can mediate facts in a purposeful process performed by the nurse to enable the patient to take control over and manage unpleasant symptoms by a person-centred, planned process. The nurse can achieve this via supervision, information, and patient education with an integrated emotional component. Evaluating the outcomes is needed.

  • 9.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Arne, M.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, K.
    Sandelowsky, H.
    Ställberg, B.
    Thors Adolfsson, E.
    Theander, K.
    A description of requests for self-management support among patients with COPD in Primary Health Care2017In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 50, no Sup. 61, article id PA1605Article in journal (Refereed)
  • 10.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Arne, Mats
    Centre for Clinical Research, County Council of Värmland, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Uppsala University, Uppsala, Sweden.
    Lundh, Lena
    Division of Family Medicine and Priamry Care, Stockholm, Sweden.
    Sandelowsky, Hanna
    Division of Family Medicine and Priamry Care, Stockholm, Sweden.
    Ställberg, Björn
    Uppsala University, Uppsala, Sweden.
    Thors Adolfsson, Eva
    Primary Health Care, Region Västmanland, Västerås, Sweden.
    Theander, Kersti
    Karlstad University, Karlstad, Sweden.
    Improved quality of care by the PRISMS form in supporting self-management in patients with COPD: A Randomized Controlled Trial (RCT)2017Conference paper (Refereed)
    Abstract [en]

    Patient Report Informing Self-Management Support (PRISMS) could be a useful tool to improve quality of care in supporting self-management. Personal attention is an important part of a person-centered approach.

  • 11.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of University Healthcare Research Centre.
    Arne, Mats
    Centre for clinical research, County Council of Värmland, Sweden; Department of Medical Sciences, Lung allergy and sleep research, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Theander, Kersti
    Centre for clinical research, County Council of Värmland, Sweden.
    A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities: a longitudinal follow-up2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    AIM: To test a self-management intervention in primary health care for patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure on self-efficacy, symptoms, functioning and health.

    BACKGROUND: Patients with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.

    DESIGN: A multicentre randomized control trial.

    METHOD: The trial was conducted with one intervention group (n=73) and one control group (n=77). The trial was performed from September 2013 - September 2015 at nine primary health care centres in three county councils in Sweden. At baseline patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure experienced any symptom. Follow-ups were performed after three months and one year. The intervention was structured on Bandura's theory of self-efficacy in six meetings and individual action plans based on personal problems were performed and discussed.

    RESULTS: At baseline, there were no differences between the groups except for SF-36 social function. After three months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found.

    CONCLUSION: When designing a program, the patient's own difficulties must be taken into consideration if person-centered care is to be established. It is feasible to include both patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure in the same group in primary health care. Health care professionals need supervision in pedagogics during intervention in self-management.

  • 12.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences.
    A nurse-led multidisciplinary COPD programme: potential flaws in the results? reply2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 357-358Article in journal (Refereed)
  • 13.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences.
    Hägglund, Doris
    Örebro University, School of Health and Medical Sciences.
    Odencrants, Sigrid
    Örebro University, School of Health and Medical Sciences.
    Hasselgren, Mikael
    Arne, Mats
    Theander, Kersti
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed)
    Abstract [en]

    AIM:To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    METHOD:A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    RESULTS:No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    CONCLUSIONS:The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 14.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center (UFC), Region Örebro County, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences.
    Theander, Kersti
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden; Department of Nursing, Karlstad University, Karlstad, Sweden.
    A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 962-971Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To investigate the effects of a nurse-led multidisciplinary pulmonary rehabilitation programme conducted in primary health care on functional capacity, quality of life and exacerbation frequency over three years among patients with Chronic Obstructive Pulmonary Disease.

    Background: Although Chronic Obstructive Pulmonary Disease is a chronic respiratory disease, it has been established that pulmonary rehabilitation has positive effects on patients' everyday functioning. However, the duration of these functional improvements, especially when the rehabilitation programmes are provided in primary health care settings, remains to be established.

    Design: A quasi-experimental design.

    Method: Primary health care patients with Chronic Obstructive Pulmonary Disease (GOLD stages II and III) were included; 49 in the intervention group and 54 in the control group. The intervention comprised a six-week pulmonary rehabilitation programme. Functional capacity was assessed using a six-minute walking test and quality of life by the Clinical COPD Questionnaire at baseline, after one year and three years. Exacerbation frequency was calculated from one year before to three years after the programme.

    Results: No significant differences between the groups were observed in the six-minute walking-test or the Clinical COPD Questionnaire after one year and three years. On average, there were significant improvements in the six-minute walking-test and the Clinical COPD Questionnaire from baseline to the one-year follow-up. Exacerbation frequency tended to decrease in the intervention group and increase in the control group (interaction test was p = 0·091) but increased again in both groups after three years.

    Conclusion: There was no evidence of the benefit of the nurse-led multidisciplinary pulmonary rehabilitation programme, although the exacerbation frequency tended to decrease in the intervention group after one year. There is a need for support and coaching at regular follow-ups in primary health care.

    Relevance to clinical practice: There is a need to support and coach patients with Chronic Obstructive Pulmonary Disease in primary health care by means of regular follow-ups.

  • 15.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hägglund, Doris
    Örebro University, School of Health and Medical Sciences.
    The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 147-155Article in journal (Refereed)
    Abstract [en]

    The number of patients with chronic obstructive pulmonary disease (COPD) is increasing. These patients need nursing care, including education in self-care, which has a positive effect on their physical and psychoemotional well-being. The aim of this study was to describe the experiences of asthma/COPD nurses' in primary health care (PHC) of educating patients with COPD. A descriptive, qualitative study was conducted, with interviews of 12 asthma/COPD nurses. The data were analysed using qualitative content analysis. The findings are presented in two themes: Theme 1, receiving support results in a feeling of security, which enables the development of patient education; and Theme 2, a lack of support results in a feeling of insecurity, which makes it difficult to develop patient education. The asthma/COPD nurses were individual orientated with individualization of care, but the patient's mood, the varying support of those around and the nurses' varying degrees of security affected the education. The conclusion is that the asthma/COPD nurses' experience of patient education fluctuated between insecurity and security. The nurses' feeling of insecurity in their patient education can be strengthened through support from colleagues and by increased knowledge in promoting the learning of others. Collaborative teamwork with a well-functioning asthma/COPD clinic in PHC can facilitate and improve patient services; these initiatives can enable the asthma/COPD nurses to reach their full potential.

  • 16.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Örebro University Hospital, Region Örebro County, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Theander, K.
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden; Department of Nursing, Karlstad University, Karlstad, Sweden.
    Anderzén-Carlsson, Agneta
    Örebro University Hospital. Centre for Health Care Sciences.
    The experience of a multidisciplinary programme of pulmonary rehabilitation in primary health care from the next of kin's perspective: a qualitative study2013In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 22, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary rehabilitation increases functional capacity and quality of life and decrease exacerbations in patients with chronic obstructive pulmonary disease (COPD), but there is little knowledge of how it influences their next of kin.

    Aims: To describe the experience of a multidisciplinary programme of pulmonary rehabilitation in primary health care from the perspective of the next of kin.

    Methods: A descriptive qualitative study was undertaken as part of a longitudinal study comprising a multidisciplinary programme for patients with COPD where the next of kin were invited to one session. Semi-structured interviews were conducted with 20 next of kin and analysed by qualitative content analysis.

    Results: One main theme emerged — Life still remains overshadowed by illness. There were three sub-themes: a sense of deepened understanding; a sense of personal vulerability; and a sense of relief of burden.

    Conclusions: The next of kin's life was still overshadowed by illness, despite the multidisciplinary programme. Although experiencing positive outcomes two years after the programme, the next of kin expressed a need for more support. This study has shown that next of kin could benefit from their own participation and/or that of the patient in a multidisciplinary programme of pulmonary rehabilitation. We believe that next of kin should be offered primary health care support for the sake of their own health, but also in order to manage their informal caregiver role. The experiences described here could form a basis for further development of interventions for next of kin of patients with COPD.

  • 17.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Theander, Kersti
    Anderzén Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences.
    Experiences among patients with COPD one year after attending a primary care nurse-led multidisciplinary programmeManuscript (preprint) (Other academic)
  • 18.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Theander, Kersti
    Anderzén Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences.
    Next of kin’s experience of living with a patient suffering from COPD two years after a nurse-led multidisciplinary programme of pulmonary rehabilitation in primary health care settingsManuscript (preprint) (Other academic)
  • 19.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Region Örebro County, Örebro, Sweden.
    Theander, Kersti
    Department of Nursing, Karlstad University, Karlstad, Sweden; Primary Care Research Unity, VÄrmland County Council, Karlstad, Sweden.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.
    How life turned out one year after attending a multidisciplinary pulmaonary rehabilitation programme in primary health care2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 3, p. 302-311Article in journal (Refereed)
    Abstract [en]

    Aim: To describe experiences among patients with chronic obstructive pulmonary disease (COPD) of the lasting usefulness one year after participating in a multidisciplinary pulmonary rehabilitation (PR) programme in a primary health care (PHC)setting.

    Background: COPD affects patients’ functioning in daily life. In a previous study, the patients participated in a programme for PR and were found to increase their functional capacity, quality of life and decrease exacerbations. The present study aims to provide a deeper understanding of the experience of participating in the programme.

    Design: The study has a descriptive, qualitative design and is part of a longitudinal study on a multidisciplinary programme for PR of patients with COPD.

    Method: Semi-structured interviews with 20 participants were performed and data analysed by qualitative content analysis. Findings: The findings are presented in one theme that illustrates the participants’ experience of their current situation; I live life at my own pace, and three sub-themes illustrating this experience related to the participation in the programme; Awareness of limitations in my life; Regained control over my life; and No change in my life.

    Conclusion: Irrespective of whether the patients had already found their own strategies for managing the disease or whether the programme changed their lives, they lived their lives at their own pace. However, their lives were shadowed by worry.

    Relevance to clinical practice: A multidisciplinary programme for PR in PHC could be an alternative for patients suffering from COPD, in order to facilitate for them in their daily life. It is suggested that the inclusion of patients in such groups should be based on each individual’s need based on symptoms or functional capacity in everyday life, not based on spirometry values.

  • 20.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Theander, Kersti
    Primary Care Res Unity, City Council Värmland, Karlstad, Sweden..
    Anerös, Terese
    Örebro University, School of Health Sciences.
    Longitudinal effects of a multidisciplinary programme of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in primary health care2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 42, no 57, article id 994Article in journal (Other academic)
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