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BackgroundThe COVID-19 pandemic continues to pose significant challenges to the welfare system by stress-related ill health and increased turnover rates among nurses.AimThe aim of this study was to explore nurses' lived experiences of stress in the transformed caring reality during the COVID-19 pandemic.Methodological Design and JustificationCaring theory and phenomenological hermeneutical philosophy guided this interpretative study. Findings comprise a broadened understanding of stress experienced by nurses.Ethical Issues and ApprovalEthical approval was granted from the Swedish Ethical Review Authority. All participants provided informed consent to participate beforehand.Research MethodIn-depth audio recorded interviews with 13 nurses were performed and transcribed verbatim. Analysis was guided by the three steps of Lindseth and Norberg: naïve understanding, structural thematic analysis and comprehensive understanding.ResultsIn this study, one main theme Enduring the unbearable emerged, and was illuminated in the major themes: Being deprived of the caring self; Seeing self-neglect as the way forward and Feeling vulnerable and unsupported. The interpreted meaning of nurses' lived experiences of stress during the COVID-19 pandemic accommodates the dilemma of enduring the unbearable whilst being subjected to silencing one's inner ethical, caring compass.ConclusionsThe results underscore the substantial and persistent stress related health risks nurses faced during the COVID-19 pandemic and emphasise the necessity of integrating ethical considerations into policies designed to support nurses' health in future emergencies.

Aim: To explore healthcare workers' experiences of the changed caring reality during the COVID‐19 pandemic in Sweden.

Design: An online fully mixed‐methods design.

Methods: A web‐based self‐reported questionnaire with fixed and open‐ended answers collected data from March to April 2021, analysed in three steps. First, free‐text questions were analysed by qualitative content analysis. Then quantitative linear regression analyses using models covering stress and coping mechanisms were conducted. Finally, a meta‐inference of qualitative and quantitative data emerged a new comprehensive understanding. The COREQ guidelines were used for reporting.

Results: Meta‐inferenced results of quantitative and qualitative findings show the pandemic was a traumatic experience for healthcare workers. Main theme; When work became a frightening experience in a dehumanized reality , comprised four themes: Entering unprepared into a frightful, incomprehensible world; Sacrificing moral values and harbouring dilemmas in isolation; Lack of clear management; and Reorient in togetherness and find meaning in a changed reality. Qualitative results comprised four categories; Working in a dehumanized world; Living in betrayal of ones' own conscience; Lack of structure in a chaotic time and Regaining vitality together. Subdimensions comprehensibility and meaningfulness were associated significantly with post‐traumatic stress disorder in multiple regression analysis. In multiple regression analysis, sense of coherence was the most prominent coping strategy.

Conclusions: Forcing oneself to perform beyond one's limit, sacrificing moral values and lacking management was a traumatic experience to healthcare workers during the pandemic. Reorienting as a way of coping was possible in togetherness with colleagues. There is an urgency of interventions to meet the needs among healthcare workers who took on a frontline role during the COVID‐19 pandemic and to prevent mental health illness in future crisis.

Patient or Public Contribution: No patient or public contribution.

Summary: The pandemic outbreak exposed frontline healthcare workers to unparallelled stress shown as negative for their mental health in several meta‐analyses and systematic reviews. In‐depth understanding on experiences and how symptoms of post‐traumatic stress disorder relate to coping mechanisms have been scarcely explored. This study contributes to understanding on healthcare workers' experiences and the relation between lower sense of coherence and increased risk of developing symptoms of post‐traumatic stress disorder.

Implications for Practice/Policy: This study might guide how to prepare for resilience in future emergencies.

Objectives: To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD).

Design: A prospective, randomised, parallel single centre trial.

Settings: Primary care settings in Sweden.

Participants: 157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded.

Intervention: Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years.

Primary and secondary outcomes: Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors.

Results: The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group.

Conclusion: One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors.

Background: The COVID-19 pandemic continues to impact health care workers’ (HCWs’) mental health. Research show that psychological distress and hard challenges abide with strong commitment to contribute. Yet, in-depth understanding of HCWs’ experiences of the changed caring reality during the pandemic is missing. Mixed methods research (MMR) accommodates several features apart from employing either quantitative or qualitative methods. This presentation focuses on examples from the 13-step mixed method by Leech and Onwuegbuzie.

Methods: 97 HCWs in one hard-hit region in Sweden answered a web-based questionnaire measuring symptoms of stress (using DSM-5 criteria for post-traumatic stress syndrome, PTSD) in relation to perceived sense of coherence (SOC-scale) and self-compassion (SCS) as well as HCWs’ experiences. First, qualitative data (experiences of the pandemic) was analyzed by qualitative content analysis, then quantitative data (associations between PTSD and SOC/SCS) were analyzed with linear regression adjusted for covariates. Thirdly, a synthesis, the meta-inference of qualitative and quantitative data, explained a new comprehensive understanding. 

Results: By analyzing the categories and subcategories from the qualitative analysis in relation to symtoms of stress and SOC/SCS, a synthesis emerged. This was undertaken by merging and comparing the findings and discussing the new comprehensive understanding. Finally, to fully outline the mixed methods approach, qualitative and quantitative data were synthesized into a new comprehensive whole, a meta inference. 

Conclusion: This study moves away from dichotomic traditions between qualitative or quantitative approaches. By broadening the methodological departure this study may provide a new comprehensive understanding and contribute to enhance quality in MMR. 

Aims Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease the desire to eat a varied dietleading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrientintake have not been investigated in patients with heart failure (HF). The purpose of the study was to determine whether therelationship between appetite and micronutrient insufficiency was mediated through diet variety.

Methodsand results A total of 238 patients with HF, mean age 61 ± 12.1; 68% male, and 45% NYHA class III/IV were included in this secondaryanalysis. Data collection consisted of a 4-day food diary and self-reported appetite on a 10-point visual analogue scale.Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet.Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for cov-ariates age, gender, NYHA class, and body mass index showed that diet variety mediated the relationship between appetiteand micronutrient insufficiencies [indirect effect = −0.0828, 95% confidence interval (CI): −0.1585 to −0.0150]. There was nodirect effect of appetite on micronutrient insufficiency (c ́ = −0.1802; 95% CI = −0.3715 to.0111).

Conclusions Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake inpatients with HF. More research is needed to validate these associations in patients with HF.

BACKGROUND: Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital. OBJECTIVE: The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite. METHODS: Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life. RESULTS: A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates. CONCLUSIONS: Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.

Cardiac and stroke conditions often coexist because of common risk factors. The occurrence of stroke may have significant consequences for patients with cardiac conditions and their caregivers and poses a major burden on their lives. Although both cardiac and stroke conditions are highly prevalent, primary stroke prevention in cardiac patients is crucial to avert disabling limitations or even mortality. In addition, specific interventions may be needed in the rehabilitation and follow-up of these patients. However, healthcare systems are often fragmented and are not integrated enough to provide specifically structured and individualised management for the cardiac-stroke patient. Cardiac rehabilitation or secondary prevention services are crucial from this perspective, although referral and attendance rates are often suboptimal. This state of the art review outlines the significance of primary stroke prevention in cardiac patients, highlights specific challenges that cardiac-stroke patients and their caregivers may experience, examines the availability of and need for structured, personalised care, and describes potential implications for consideration in daily practice.

AbstractAims Patient-centred care (PCC) is the cornerstone for healthcare professionals to promote high quality care for patients with cardiovascular conditions. It is defined as ’Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions’. PCC can improve patient outcomes and allow patients and healthcare professionals to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC). Methods and results Using a narrative literature review and expert consensus, the Science Committee within the Association of Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed, with committee members independently evaluating five PCC aspects: patient voice and involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients’ needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared. The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the ’multidisciplinary involvement’ category. Conclusion Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing, or formulating recommendations. Future development of guidelines should ensure better incorporation of patients’ perspective, in particular, and other PCC aspects highlighted in this study.

Aims and objectives: The objective in our study was to explore chronic heart failure patients’ perceived control over their heart disease. Background: Higher levels of perceived control over one’s chronic heart disease are associated with lower levels of psychological distress and a higher quality of life. Design: The study has an explorative and descriptive design using a directed manifest qualitative content analysis according to Marring. Methods: The analysis was based on nine interviews with four men and five women aged between 62-85 years, diagnosed with chronic heart failure. The study followed consolidated criteria for reporting qualitative research (COREQ). Results: Five categories emerged in the analysis, mirroring a step-by-step process. The first step, insecurity, was followed by evaluation, management and adjustment. The patients finally reached a higher level of perceived control over their lives in relation to their heart disease. Conclusions: Most of the patients stated that they could assess and manage symptoms and had adapted to their condition, which increased their level of perceived control. Relevance to clinical practice: These findings suggest that managing symptoms is important for strengthen the patients with chronic heart failure. The findings can help health care professionals in communication with the patient planning for self-care actions.