To Örebro University

In this study, a nurse-led supportive family health conversation intervention delivered through one to three video-conferencing sessions was evaluated for patients undergoing open-heart surgery and their self-selected family members. Based on the Family Systems Nursing framework, the intervention aimed to improve family well-being, functioning, and involvement by fostering shared understanding and challenging limiting beliefs. Patients and family members were randomized into two groups. Both received usual surgical care, while the intervention group also participated in digital family health conversations before and after surgery. Participants completed questionnaires at baseline and at 30 and 90 days after discharge. The analysis included 101 patients (control = 54, intervention = 47) and 99 family members (control = 52, intervention = 47). The intervention was not superior to usual care for the primary outcome, family well-being. Most secondary outcomes showed no effect, although some aspects of quality of life improved. Further research should examine long-term effects, feasibility, and appropriate outcome measures.

Clinical trials register number and URL: NCT05045196, https://clinicaltrials.gov/study/NCT05045196?cond=NCT05045196 & rank=1;

BACKGROUND: As open-heart surgery can be stressful for the patient and their family, the objective of this study was to generate knowledge on how to support families in relation to open-heart surgery based on important situations.

AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement as expressed by family members of patients who underwent elective open-heart surgery in Sweden.

METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique used is a qualitative method appropriate for identifying issues relating to clinical problems.

ETHICAL ISSUES AND APPROVAL: Ethical approval was obtained from the Swedish Ethical Review Authority. Allowance was made for the unexpected presence of the patient.

RESEARCH METHODS: Individual interviews with 29 family members of patients who underwent open-heart surgery in Sweden in 2023 were analysed using the critical incidence technique, as applied in nursing and healthcare sciences.

RESULTS: The family members experienced being-or not being-seen as significant and were fearing the loss of normal life in relation to open-heart surgery. Actions taken during important situations were building confidence to relinquish control and relieving burdens to improve well-being.

CONCLUSIONS: Family involvement, in terms of being informed and welcomed, led to an improved ability to care for their loved ones. Emotionally supportive interventions targeting families should be considered in relation to a loved one's open-heart surgery.

BACKGROUND: As family members affect patient outcomes following open-heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open-heart surgery in Sweden.

METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not.

ETHICAL ISSUES AND APPROVAL: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps.

RESEARCH METHODS: Individual interviews were conducted with 35 patients who underwent open-heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method.

RESULTS: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk-taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support.

CONCLUSIONS: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open-heart surgery.

OBJECTIVE: The primary aim of this study was to describe the current practice regarding pain management in relation to tonsil surgery among Ear Nose and Throat (ENT) clinics in Sweden. The secondary aim was to determine the impact of the provider's regime of rescue analgesics on the pain related Patient Reported Outcome Measures (pain-PROMs) from the Swedish Quality Register for Tonsil Surgery (SQTS).

MATERIALS & METHODS: A descriptive cross-sectional study originating from a validated web-based questionnaire. The survey enrolled one respondent from each ENT clinic (47/48 participated) nationally. Pain-PROMs from the SQTS, recorded from October 2019 to October 2022, were included (8163 tonsil surgeries).

RESULTS: Paracetamol was used by all enrolled ENT clinics as preemptive analgesia. The addition of COX inhibitors was used in 40% of the clinics. Betamethasone was usually administered, to prevent pain and nausea (92%). All clinics gave postdischarge instructions on multimodal analgesia with COX inhibitors and paracetamol. Rescue analgesics were prescribed after tonsillectomy for 77% of adults, 62% of older children, 43% of young children and less often after tonsillotomy. The most frequently prescribed rescue analgesic was clonidine in children (55%) and oxycodone in adults (72%). A high proportion of patients reported contact with health care services due to postoperative pain (pain-PROMs/ SQTS). Tonsillectomy procedures were associated with the highest rates of contacts (children/adolescents 13-15%; adults 26%), while tonsillotomy were associated with lower rates, (5-7% of children/adolescents). There was no significant difference in the frequency of health care contacts due to pain regarding whether clinics routinely prescribed rescue analgesics or not after tonsillectomy.

CONCLUSION: The Swedish analgesic regimen after tonsil surgery is good overall. Nevertheless, there is a need for increased awareness and knowledge to achieve optimal patient recovery. Pain-PROM data demonstrate the call for improvement in pain management after tonsil surgery.

Background

Family involvement affects the whole family´s well-being in relation to major surgery. There are reasons to explore if the involvement of family has changed with new technical solutions for communication and altered visitation policies in the aftermath of the Covid 19 pandemic. 

Aim

To explore experiences and actions of family involvement narrated by Swedish patients who have undergone elective open-heart surgery

Methods

The critical incident technique was used, a qualitative research method suitable for describing crucial aspects of clinical problems. Important situations of family involvement were collected in 2023 through interviews with 35 patients who had undergone open-heart surgery in Sweden. The important situations were analyzed by separating the patients’ experiences of the situations from the actions of patients, family members and healthcare professionals. 

Results

The analysis resulted in 87 important situations of family involvement in relation to open-heart surgery described by patients. By separating experiences and actions it became evident that, in addition to the patients themselves, family members and healthcare professionals were actors when the patients were describing important situations of family involvement. Positive and negative experiences were at times described as shared by their family members, and actions of family involvement led to improved recovery and burdening communications for the patients. 

Conclusion

The separating of experiences and actions of patients’ descriptions was challenging and beneficial for the understanding of the patients’ perspective on clinical consequences of family involvement. While preserving health beneficial aspects of family involvement, social support interventions should be considered to support families in relation to open-heart surgery.  

Background: The perioperative period can be stressful for children and families. Minimizing child distress and investigating the quality of anesthetic care is important. There is a paucity of assessment tools available to assess perioperative anxiety in children.

Aim: To determine the validity and reliability of the modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale in a perioperative setting for children.

Methods: Children (n=189, 3–12 years old) scheduled for ear, nose, and throat surgery had their anxiety rated at induction by a registered nurse anesthetist. Two observers individually evaluated video recordings of the perioperative period. The Verbal-Numeric-Anxiety-Fear-Rating-Scale was used to assess the children's preoperative anxiety and fear, and the modified-Distraction-Short-Scale was used to evaluate coping behavior. The modified-Yale-Preoperative-Anxiety-Scale was used to measure preoperative anxiety and behavioral compliance during anesthesia induction.

Results: Interrater reliability, showed excellent agreement between observers on modified-Distraction-Short-Scale scores (weighted kappa (Kw)=0.91) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (Kw=0.84). The agreements between the registered nurse anesthetist and observers were moderate too good for modified-Distraction-Short-Scale (Kw=0.65-0.80) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (Kw=0.65-0.75). The intraclass correlation coefficient (ICC) for the registered nurse anesthetist and two observers was excellent for modified-Distraction-Short-Scale scores (ICC=0.96) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (ICC=0.90). Regarding concurrent validity, modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores were strongly correlated among all three observers (Spearman’s correlation coefficient [rs]=0.75-0.82). The modified-Yale-Preoperative-Anxiety-Scale scores were moderately correlated with modified-Distraction-Short-Scale (rs=0.57-0.66) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (rs=0.54-0.67). Construct validity was tested by using age as a discriminating variable, and Verbal-Numeric-Anxiety-Fear-Rating-Scale , modified-Distraction-Short-Scale , and modified-Yale Preoperative-Anxiety-Scale scores were lower for the older age group; however, only modified-Distraction-Short-Scale (Observer 1: p= 0.035, Observer 2: p=0.022), and modified-Yale-Preoperative-Anxiety-Scale scores were significantly lower (p<0.001).

Conclusions: The modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale are simple and valid tools for assessing children’s perioperative anxiety or fear and evaluating coping behavior. These results suggest that both scales are useful tools for routine clinical practice and research.

Objectives: The primary aim of this study was to describe pain treatment in relation to surgery of the tonsils in Sweden. The secondary aim was to determine the impact of the provider’s regimens of analgesic treatment on the patient reported pain-related outcome measures (pain-PROMs) from National Tonsil surgery Register in Sweden (NTSRS).

Methods: A descriptive cross-sectional study based on a web-questionary enrolled one respondent from 47 out of 48 invited ENT-clinics in Sweden. Pain-PROMs from the NTSRS were included.

Results: Pre-emptive analgesia pre- and intraoperatively was paracetamol (100%), normally administered iv, and cox-inhibitors iv (74%). To prevent pain and nausea, betamethasone iv (92%/n=43) was administered. Paracetamol combined with cox-inhibitors (Ibuprofen) were recommended by all clinic as a basic analgesic regime postoperatively. The clinics usually prescribed (66%) higher dose of paracetamol day 1-3, followed by a reduced dose days 4-8. Additional rescue analgesics were prescribed after tonsillectomy to older children (62%/n=29), and to young children by 43%/n=20. The most common rescue analgesic was clonidine (55%), followed by oxicodon (34%), morphine (4%), and ketobemidone (2%). Pain-PROMs (NTSRS) showed the frequency of contacts with healthcare due to pain in children (15%). There was no significant difference in percentage of contacts due to pain regarding if clinics routinely prescribed rescue analgesics after tonsillectomy or not.

Conclusions: The national analgesic regime after tonsil surgery is overall good. Despite this, there is a need for rise in awareness and knowledge to achieve optimal patient recovery. Pain-PROM data demonstrate the complexity of pain management after tonsil surgery. 

Background

Family involvement in in-patient care enhances patient safety and quality of care by reducing complications and hospital length of stay. A valid measurement of family involvement in care is needed when implementing and evaluating family involvement-promoting activities. 

Methods

The design of this study was inspired by the guidelines for best practices for developing and validating measurement scales. The steps used were: identifying domains and generating items, assessing content validity, and pre-testing items with the target population. An expert group rated item relevance and the content validity index was calculated. Nineteen online Think-aloud interviews were conducted with family members of former in-patient surgical patients.

Results 

The domains of family involvement and item selection from two preexisting questionnaires were grounded in scholarly literature. Items were adapted for family members in the in-patient care setting. Item content validity varied between 0.71–1.00, scale content validity/averaging was 0.90. After adjustments, the items were pretested through on-line cognitive interviews with family members. Three main problem areas were found: defining family involvement, misinterpretation of different terms, and underuse of one response option. These problems were adjusted for. The Family Involvement in Care Questionnaire consists of 16 items with a four-point Likert scale and two open-ended items.

Conclusion

On-line think aloud interviews are a feasible method when evaluating new questionnaires. Problems experienced by the target population were identified prior to a large quantitative psychometric evaluation of the questionnaire. 

Background

Family involvement improves patient outcomes after surgery and is important for the family´s well-being. Attitudes to family involvement in care among health care professionals influence how families are treated and cared for. We therefore aimed to describe these attitudes, held by nurses and medical doctors, working in the open-heart surgical care context.

Methods

A mixed-methods convergent parallel design was applied. A questionnaire with scaled and open-ended questions generated a qualitative (n=206) and a quantitative (n=267) dataset from nurses. In parallel with this data collection, qualitative interviews with medical doctors (n=20) generated a second qualitative dataset. Data were analyzed separately and thereafter merged into mixed-methods concepts using a side-by-side joint display. Meta-inferences of the concepts convergence and divergence were discussed and presented in a visual side-by-side joint display.

Results

Seven categories from the qualitative results were merged with the inference of statistical results into four mixed-methods concepts: Supporting, informing and improving care, Caring for the family, Impairing care and Depending on the situation. Out of these concepts, presenting interprofessional attitudes to family involvement in open-heart surgical care, two were convergent and two divergent. 

Conclusion

The side-by-side joint display was useful in both the integration and presentation of meta-inference. Even though attitudes, as described by nurses and medical doctors, are foremost positive, the importance of family involvement in open-heart surgical care depends on the situation. 

BACKGROUND: Family involvement in care can be seen as a prerequisite for high-quality family-centered care. It has been identified to improve both patient safety and the quality of care by reducing patient complications and hospital length of stay.

OBJECTIVE: To develop and evaluate the content validity of a questionnaire measuring family involvement in inpatient care.

METHODS: The study followed a systematic approach in building a rigorous questionnaire: identification of domain, item generation, and assessment of content validity. The content validity index was calculated based on ratings of item relevance by an expert group consisting of seven senior nurses. Subsequently, 19 online cognitive interviews using the Think-aloud method were conducted with family members of former patients who had undergone open-heart surgery.

RESULTS: Five aspects of family involvement were identified, and the initial pool of items were selected from two preexisting questionnaires. The experts' ratings resulted in item content validity of 0.71-1.00, and the scale content validity/averaging was 0.90, leading to rewording, exclusion, and addition of items. The pretesting of items through two rounds of cognitive interviews with family members resulted in the identification of three main problem areas: defining family involvement, misinterpretation of different terms, and underuse of the not relevant response option. The problems were adjusted in the final version of the questionnaire, which consists of 16 items with a four-point Likert scale and two open-ended items.

CONCLUSIONS: The Family Involvement in Care Questionnaire has demonstrated potential in evaluating family involvement in inpatient care. Further psychometric properties regarding reliability and validity need to be established.