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Background

The longitudinal effects of educational interventions in people with abdominal aortic aneurysm are largely unexplored. This prospective study investigated whether the anxiety-lowering effect of an eHealth intervention observed at the 1-month follow-up is maintained 1 year after abdominal aortic aneurysm surgery.

Methods

Those scheduled for surgical repair of abdominal aortic aneurysm were recruited in a single-centre randomized clinical trial. The control group received care and follow-up per the institution's standard. The intervention group received an eHealth tool along with psychosocial support. The 1-month results have been reported. The primary outcome measure was the anxiety mean score (HADS-A).

Results

Of 120 included participants, 96 completed the 1-year follow-up (48 in each treatment group). The mean age was 73 years, a majority (86%) were male and 73% were current or previous smokers. Anxiety symptoms measured with the HADS-A decreased over time in both the intervention group (-0.33) and the control group (-0.35, P = 0.868). The improvements in anxiety symptoms seen in the short-term follow-up were not sustained at the 1-year follow-up. No significant mean score differences were found in the intention-to-treat or per-protocol analyses.

Conclusion

In this randomized clinical trial, an eHealth intervention did not result in a sustained reduction in anxiety symptoms compared with standard care in the same cohort. The study provides an insight into the limited acceptability of an eHealth tool in people with abdominal aortic aneurysm and valuable data on the recovery trajectory following open and endovascular abdominal aortic aneurysm surgery. Further research is warranted to evaluate the relevance and long-term effectiveness of eHealth interventions in abdominal aortic aneurysm care. Registration number NCT03157973 (http://www.clinicaltrials.gov). In a randomized clinical trial evaluating the effect of an eHealth intervention on anxiety in patients undergoing surgical treatment of abdominal aortic aneurysm, the positive short-term results of the intervention were not sustained at the 1-year follow-up. The study provides data on the natural trajectory of physical and psychological symptoms following abdominal aortic aneurysm repair, and can serve as a basis for future interventions to improve abdominal aortic aneurysm care.

Aims: To explore patients’ experiences of an eHealth tool and tailored psychosocial support throughout the care trajectory of AAA repair. Design: A qualitative interview study.

Methods: Individual in-depth interviews were performed with twelve patients participating in an intervention study in conjunction with AAA surgery. Data were collected from March to December 2019. The interviews were analysed using qualitative content analysis with an inductive approach.

Results: The patients’ familiarity with and attitude to eHealth influenced their use of the eHealth tool. The interpersonal relationship with health care staff affected patients’ ability to submit themselves. The preoperative information, including the eHealth tool, may result in an overwhelming amount of information, causing anxiety and leading patients to refrain from information, partly due to the timing of the information. Psychosocial support offered continuity and reassurance, and enabled the patients to elaborate on existential matters.

Conclusion: The design of eHealth services in AAA care would benefit from a consideration of patients’ attitude to eHealth and familiarity with modern technology. To increase patients’ accessibility to health care services, their preference for technology use and type of contact should be verified and respected. Psychosocial support should be offered with continuity to alleviate patients’ emotional burden. Adjustment to patients’ mental state and learning needs may forestall anxiety. Impact: This study highlights factors that affect the acceptability of eHealth services in AAA patients. These findings can guide future design and implementation of mobile health interventions in surgical care.

PURPOSE: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Background: Nursing faculties??? perceptions influence nursing education. This article describes how nursing faculty perceive nursing students??? development of professional competence by integrating theory and practice, and by examining how this context influences this integration. Method: With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description. Results: The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses??? competence and expectations in health care. Conclusion: If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.]

Background: The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. Methods: A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. Results: Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P=0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P=0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P=0.042) but mental-component HRQoL and depressive symptoms were unchanged. Conclusions: Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it.

Background: The learning process for student and recently graduated nurses during their transition to professional nursing is stressful and challenging. The aim of this study was to describe recent graduates’ experiences of developing professional competence in their basic nursing program and during their first year. Method: A qualitative descriptive design with an inductive approach based on interviews with 11 nurses, with a qualitative content analysis. Results: Recently graduated nurses experience shortages and struggle to develop their professional competence. They find that reflection is a fundamental tool in the process of professional competence development. The competence gap is not between theoretical and practical knowledge, but rather between the university and health care organizations. Conclusion: Focusing on the intertwining of theoretical and practical knowledge can bridge the gap between these two organizations and create a foundation for lifelong learning of professional competence. Creating opportunities for reflection is central to the learning process. 

Aim and objectives To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1-year residency programme. Background In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses' transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied. Design/Methods Qualitative, descriptive study with a data-driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see FileS1). Results Three themes emerged: (a) the nurses' relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme. Conclusions There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence. Relevance to clinical practice To overcome the gap between the university and the healthcare settings, the managers can facilitate nurses' continued learning by creating structures for reflection.

Ofrivillig ensamhet och social isolering är ett allvarligt folkhälsoproblem och bör hanteras med forskningsbaserade åtgärder. Det menar experter från Mälardalens högskola och ger konkreta förslag på vad som bör göras. 

Rationale Abdominal aortic aneurysm (AAA) is a prevalent condition among elderly men and may require surgical repair. Recent technical advances offer new opportunities to provide patients and next of kin with tailored and individualised information. eHealth tools have proven useful in other patient cohorts, but there are currently no validated educational eHealth tools for patients with AAA. Aim Our aim was to develop and evaluate an eHealth tool for patients with abdominal aortic aneurysm using a participatory design process. Method Patients, healthcare professionals and a technical team were involved in the development of the eHealth tool. The tool was assessed for content and usability through questionnaires, validated instruments and focus group interviews. Readability was assessed using Flesch Reading Ease Score (FRE) and Flesch-Kincaid Grade Level (FKGL). Interview data were analysed using thematic content analysis. Results Factual content and illustrations were accurate and in line with current information routine. Readability assessments produced a mean FRE score of 42.2 (+/- 3,7) and mean FKGL of 10 (+/- 1), implying that the eHealth tool may be difficult to comprehend for certain users. However, participants in the focus group interviews found the tool to be understandable, relevant and easy to use. Conclusion The developed eHealth tool is acceptable, understandable and usable for the potential end-users. Further evaluation of the usability of the tool and effect on outcome in clinical care is warranted. This is the first educational eHealth tool for patients with AAA and has potential to contribute to improved communication and quality of care for AAA patients.

Background: Patients undergoing surgical treatment of abdominal aortic aneurysm (AAA) should receive adequate information about the disease, treatment options, and self-care. Patients' learning needs should be acknowledged. The aim was to describe the perceived learning needs in patients with AAA. A secondary aim was to explore their experience of methods for patient education. Methods: Three focus group interviews were conducted with 14 patients treated with open or endovascular repair of AAA. The interviews embraced initial diagnosis, surgical treatment, and follow-up from a learning perspective and were analyzed using qualitative content analysis. Results: Three categories and 10 subcategories emerged. The health care staff failed to meet the participants' individual learning needs. Participants relied on other pathways to obtain knowledge, such as the internet or anecdotal information from friends and family. Learning needs pertained to risks and complications with surgery, self-care, and rupture risk. The participants were reluctant to ask questions due to a stressful environment. They requested accessible written information, along with a professional contact person for coordination and support during the care pathway. Conclusions: Patients with AAA describe unmet learning needs in regard to risks and complications with the disease and surgical treatment but also disease management and lifestyle factors. Education material should be consistent, individualized and easily accessible for patients and next of kin. Additional psychosocial support is warranted. Adjusting information to patients' needs may improve patient satisfaction.