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Brännström, Margareta
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Publications (10 of 44) Show all publications
Markgren, R., Brännström, M., Lundgren, C. & Boman, K. (2019). Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial. BMJ Supportive & Palliative Care, 9(1), Article ID e10.
Open this publication in new window or tab >>Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial
2019 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 9, no 1, article id e10Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Patients with chronic heart failure (CHF) may be insufficiently treated pharmacologically. Recently, we presented a person-centred integrated Palliative advanced homecaRE and heart FailurE caRe (PREFER) strategy and compared it with usual care (control). Patients managed according to PREFER had improved health-related quality of life and markedly reduced hospitalisations compared with the control group. We hypothesised that these improvements may have been partly due to better drug treatments within the PREFER strategy. Thus, our aim in this study was to explore the management of drug treatments in the PREFER group compared with the control group.

METHODS: Doses and numbers of drugs and the number of patients receiving the target doses based on current guidelines were measured and compared between the groups at the start and finish of the study.

RESULTS: The percentages of ACE inhibitors (ACEIs) or mineralocorticoid receptor antagonists (MRAs) increased, while loop diuretics decreased in the PREFER arm during the study, although the differences were not significant. Beta-receptor blockers (BBs) decreased somewhat in both groups. The number of patients treated with MRAs differed the most between groups, and increased from 10 (28%) to 15 (48%) in the PREFER arm compared with 13 (35%) vs 13 (39%) in the control group. The change in patients receiving full target doses (+8 vs. +1) of the ACEIs/angiotensin receptor blockers, BBs and MRAs were significantly higher (p=0009) in the PREFER arm than in the control arm.

CONCLUSIONS: Person-centred integrated care of patients with severe CHF was associated with increased evidence-based drug treatments, especially MRAs.

CLINICAL TRIAL NUMBER: NCT01304381.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2019
Keywords
Chronic heart failure, Palliative care, Person-centred, Pharmacology
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-115214 (URN)10.1136/bmjspcare-2015-000894 (DOI)000471863100010 ()26792391 (PubMedID)2-s2.0-85061865428 (Scopus ID)
Funder
Swedish Heart Lung Foundation
Available from: 2016-02-01 Created: 2016-02-01 Last updated: 2019-07-10Bibliographically approved
Ericsson, M., Ängerud, K. H., Brännström, M., Lawesson, S. S., Strömberg, A. & Thylén, I. (2019). Interaction between tele-nurses and callers with an evolving myocardial infarction: Consequences for level of directed care. European Journal of Cardiovascular Nursing
Open this publication in new window or tab >>Interaction between tele-nurses and callers with an evolving myocardial infarction: Consequences for level of directed care
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2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Rapid contact with emergency medical services is imperative to save the lives of acute myocardial infarction patients. However, many patients turn to a telehealth advisory nurse instead, where the delivery of urgent and safe care largely depends on how the interaction in the call is established.

Purpose: The purpose of this study was to explore the interaction between tele-nurses and callers with an evolving myocardial infarction after contacting a national telehealth advisory service number as their first medical contact.

Method: Twenty men and 10 women (aged 46–89 years) were included. Authentic calls were analysed using inductive content analysis.

Findings: One overall category, Movement towards directed level of care, labelled the whole interaction between the tele-nurse and the caller. Four categories conceptualised the different interactions: a distinct, reasoning, indecisive or irrational interaction. The interactions described how tele-nurses and callers assessed and elaborated on symptoms, context and actions. The interaction was pivotal for progress in the dialogue and affected the achievement of mutual understanding in the communicative process. An indecisive or irrational interaction could increase the risk of failing to recommend or call for acute care.

Conclusion: The interaction in the communication could either lead or mislead the level of care directed in the call. This study adds new perspectives to the communicative process in the acute setting in order to identify a myocardial infarction and the level of urgency from both individuals experiencing myocardial infarction and professionals in the health system.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Pre-hospital care-seeking, interaction, level of care, myocardial infarction, tele-nursing
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158815 (URN)10.1177/1474515119848195 (DOI)31067981 (PubMedID)
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2019-05-13
Brännström, M., Fischer Grönlund, C., Zingmark, K. & Söderberg, A. (2019). Meeting in a ‘free-zone’: Clinical ethical support in integrated heart-failure and palliative care. European Journal of Cardiovascular Nursing
Open this publication in new window or tab >>Meeting in a ‘free-zone’: Clinical ethical support in integrated heart-failure and palliative care
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.

Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.

Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.

Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.

Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Clinical ethical support, PREFER study, RiFECC, heart failure, implementation, palliative care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-159012 (URN)10.1177/1474515119851621 (DOI)31088300 (PubMedID)
Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2019-05-17
Hägglund, L., Boman, K. & Brännström, M. (2018). A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older. Nursing Open, 5(2), 176-185
Open this publication in new window or tab >>A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 2, p. 176-185Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

This study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older.

Background

Physical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF.

Design

A mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (= 25) or control (= 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self-rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (= 10) in the Tai Chi training group.

Results

No statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow-up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort.

Conclusion

Tai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
chronic heart failure, elderly, group training, mixed methods, Tai Chi
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145128 (URN)10.1002/nop2.127 (DOI)000428455600009 ()29599993 (PubMedID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2019-05-16Bibliographically approved
Hellström Ängerud, K., Boman, K. & Brännström, M. (2018). Areas for quality improvements in heart failure care: quality of care from the family members' perspective. Scandinavian Journal of Caring Sciences, 32(1), 346-353
Open this publication in new window or tab >>Areas for quality improvements in heart failure care: quality of care from the family members' perspective
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 346-353Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care.

OBJECTIVE: To describe family members' perceptions of quality of HF care in an outpatient setting.

METHODS: A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV.

RESULTS: Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members.

CONCLUSION: Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
heart failure, Quality from patients' Perspective questionnaire, family members' perspective, quality of care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-139041 (URN)10.1111/scs.12468 (DOI)000426524200035 ()28543624 (PubMedID)
Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-06-09Bibliographically approved
Blanck, E., Fors, A., Ali, L., Brännström, M. & Ekman, I. (2018). Being support for patients with chronic heart failure and/or chronic obstructive pulmonary disease - the relatives perspective. European Journal of Cardiovascular Nursing, 17, 98-99
Open this publication in new window or tab >>Being support for patients with chronic heart failure and/or chronic obstructive pulmonary disease - the relatives perspective
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2018 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 98-99Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-150819 (URN)10.1177/1474515118787764 (DOI)000440339600165 ()
Note

Special Issue

Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20Bibliographically approved
Andersson, S., Lindqvist, O., Fürst, C.-J. & Brännström, M. (2018). Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes. Scandinavian Journal of Caring Sciences, 32(1), 299-308
Open this publication in new window or tab >>Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 299-308Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Residential care homes (RCHs) play an important role in end-of-life care, being the most common place of death for elderly people in several European countries. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve and ensure quality care at the end of life. There is a lack of scientific evidence supporting the use of care pathways.

DESIGN: A descriptive qualitative study.

OBJECTIVE: The aim was to describe care professionals' experiences of using the Liverpool Care Pathway for the Dying Patient in the care of dying residents in residential care homes.

METHODS: Five focus group interviews and two individual interviews with enrolled nurses (n = 10), Registered Nurses (n = 9) and general practitioners (n = 5) were carried out and analysed using qualitative content analysis.

RESULTS: Care professionals expressed that they became confident through a shared approach to care, were supported to tailor the care according to the residents' individual needs, were supported to involve family members in decision-making and care and became more aware of the care environment.

CONCLUSION: The results of this study indicate that the LCP might be a useful tool for care professionals in improving end-of-life care in RCHs through increased attention to the goals of care, the individual needs of residents and family involvement.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
Liverpool Care Pathway, care pathway, care professionals, clinical intervention, elderly, end of life, nursing home, palliative care, qualitative content analysis, residential care homes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-137440 (URN)10.1111/scs.12462 (DOI)000426524200030 ()28664584 (PubMedID)
Available from: 2017-07-03 Created: 2017-07-03 Last updated: 2018-06-09Bibliographically approved
Brännström, M., Niederbach, C. & Rödin, A.-C. (2018). Experiences of surviving a cardiac arrest after therapeutic hypothermia treatment: an interview study. International Emergency Nursing, 36, 34-38
Open this publication in new window or tab >>Experiences of surviving a cardiac arrest after therapeutic hypothermia treatment: an interview study
2018 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 36, p. 34-38Article in journal (Refereed) Published
Abstract [en]

Background: Cardiac arrest (CA) is often associated with high mortality. In Sweden, it is reported that 13–52 per 100,000 people suffer out-of-hospital CA, and survival to one month is 2–14%.

Objective: This study aimed to describe people’s experiences of surviving a CA after therapeutic hypothermia treatment.

Method: A descriptive qualitative design was used. Data were collected through individual interviews with seven CA survivors. The collected data were analyzed using qualitative content analysis.

Results: The analysis resulted in six subthemes and three emerging themes. The themes were “Dealing with issues of mortality”, “Living a changed life”, and “Being confident with health care and family members”.

Conclusion: Surviving a CA after therapeutic hypothermia treatment means having to deal with issues of mortality, and these patients face a turning point in life. The near-death event can create regression or progression in ethos among these patients.

Relevance to clinical practice: This study implies that persons who have survived a CA need support to cope. One way to provide support might be to initially establish an individualized health care plan, including bringing up existential issues and involving family members in such conversations.

Place, publisher, year, edition, pages
Oxford: Elsevier, 2018
Keywords
Cardiac arrest, Sudden cardiac death, Cardiopulmonary resuscitation, Experience, Limit situation, Survivor
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-139873 (URN)10.1016/j.ienj.2017.09.003 (DOI)000426153100006 ()28988657 (PubMedID)
Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2018-09-28Bibliographically approved
Andersson, S., Årestedt, K., Lindqvist, O., Fürst, C. J. & Brännström, M. (2018). Factors associated with symptom relief in end-of-life care in residential care homes: a national register-based study. Journal of Pain and Symptom Management, 55(5), 1304-1312
Open this publication in new window or tab >>Factors associated with symptom relief in end-of-life care in residential care homes: a national register-based study
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2018 (English)In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 55, no 5, p. 1304-1312Article in journal (Refereed) Published
Abstract [en]

Context: Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life.

Objectives: The aim of the study was to explore the presence of symptoms and symptom relief and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care.

Methods: The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (N = 22,855). Univariate and multiple logistic regression analyses were conducted.

Results: Pain was reported as the most frequent symptom of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were gender; age; time in the RCH; use of a validated pain or symptom assessment scale; documented end-of-life discussions with physicians for both the residents and family members; consultations with other units; diseases other than cancer as cause of death; presence of ulcers; assessment of oral health; and prescribed pro re nata injections for pain, nausea, and anxiety.

Conclusion: Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Nursing homes, older persons, palliative care, quality of care, register study, symptom relief
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-142748 (URN)10.1016/j.jpainsymman.2017.12.489 (DOI)000430180700012 ()29305321 (PubMedID)2-s2.0-85042660407 (Scopus ID)
Note

Originally included in thesis in manuscript form.

Available from: 2017-12-11 Created: 2017-12-11 Last updated: 2018-06-13Bibliographically approved
Andersson, S., Lindqvist, O., Fürst, C.-J. & Brännström, M. (2018). Family members' experiences of care of the dying in residential care homes where the Liverpool Care Pathway was used. International Journal of Palliative Nursing, 24(4), 194-202
Open this publication in new window or tab >>Family members' experiences of care of the dying in residential care homes where the Liverpool Care Pathway was used
2018 (English)In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 24, no 4, p. 194-202Article in journal (Refereed) Published
Abstract [en]

Background: Residential care homes (RCHs) are increasingly becoming a common place of death for older people.

Aim: The aim of this study was to describe family members' experiences of care of the dying in RCHs where the Liverpool care pathway for the dying patient was used.

Methods: This study had a descriptive qualitative study design. Fifteen (n=15) individual interviews were analysed using qualitative content analysis.

Results: The analysis resulted in three themes: being confident in a familiar and warm atmosphere, being involved vs not being involved in end-of-life (EoL) care, and being consoled by witnessing the health professional's endeavour to relieve suffering.

Significance of results: The results indicated that taking part in a care plan seems to increase family members' feelings of involvement in EoL care. This study also highlights the family members' needs for increased possibilities for EoL discussions with the GP.

Place, publisher, year, edition, pages
London: Mark Allen Group, 2018
Keywords
Clinical intervention, End of life, Family members, Liverpool care pathway, Nursing home
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-142741 (URN)10.12968/ijpn.2018.24.4.194 (DOI)000430497200007 ()29703112 (PubMedID)2-s2.0-85046245868 (Scopus ID)
Note

Originally included in thesis in manuscript form.

Available from: 2017-12-11 Created: 2017-12-11 Last updated: 2018-09-25Bibliographically approved
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