The Experts below are selected from a list of 2850 Experts worldwide ranked by ideXlab platform
Yun Fang Tsai - One of the best experts on this subject based on the ideXlab platform.
-
Illness Trajectory of initial infection for patients with hepatitis c a qualitative study
Nursing & Health Sciences, 2019Co-Authors: Shu Mei Tsai, Yun Fang TsaiAbstract:: Little is known about how the initial infection and diagnosis of hepatitis C virus (HCV) impacts a patient's experience of living with and adjusting to the disease. In the present qualitative, descriptive study, we explored the initial experiences of patients in Taiwan diagnosed with HCV. Eighteen participants were recruited from hepatology clinics of a teaching hospital in Taichung, Taiwan by purposive sampling. Data were collected via in-depth face-to-face interviews and analyzed by conventional content analysis. The core theme describing the Illness Trajectory was "Oasis in the desert". Two main themes described the participants' experiences and adjustment to the diagnosis of hepatitis C: "Getting lost in the journey" and "The calm after the storm". Our findings highlight the need for health-care providers to coordinate interactions between patients and multi-disciplinary teams to manage the integration of different treatment options. There is a demand for educational interventions and online information for patients and the general population, which could improve knowledge of HCV.
-
From silence to storm - patient Illness Trajectory from diabetes diagnosis to haemodialysis in Taiwan: A qualitative study of patients' perceptions
Journal of Advanced Nursing, 2013Co-Authors: I. Chen Yu, Yun Fang TsaiAbstract:AIMS: This article is a report of a study that explored the perceptions of patients as they experienced their diabetes Illness Trajectory, and their initial decisions to undergo dialysis, in an effort to provide further complementary guidance for nurses and healthcare practitioners.\n\nBACKGROUND: Diabetes leads to higher morbidity and mortality when patients develop renal failure resulting from diabetic nephropathy. An effective self-care regimen and multidisciplinary team approach are required to avoid or delay the serious chronic complications of the disease. Patients and healthcare practitioners must be aware therefore of psycho-physiological adjustment when seeking to delay the onset of complications.\n\nDESIGN: A qualitative design was used for data collection through semi-structured interviews.\n\nMETHOD: Data were analysed using content analysis. Participants were 25 diabetes patients undergoing initial haemodialysis who were recruited from diabetes and nephrology wards at a medical centre in northern Taiwan. Data were collected from December 2010-August 2011.\n\nFINDINGS: The core theme describing the Illness Trajectory derived from face-to-face interviews with people undergoing hemodialysis was 'from silence to storm'. There emerged also five phases of patient experience that resulted from the development of diabetic nephropathy: (1) diabetes onset stage; (2) stable stage; (3) burden stage; (4) shock stage; and (5) coping stage.\n\nCONCLUSIONS: Patients suffer with diabetic nephropathy for a long-term period. Our findings may enhance the understanding of nurses regarding the experiences of patients with diabetic nephropathy, and will help them provide diabetes care that promotes healthy life for those individuals.
-
From silence to storm – patient Illness Trajectory from diabetes diagnosis to haemodialysis in Taiwan: a qualitative study of patients' perceptions
Journal of Advanced Nursing, 2012Co-Authors: I. Chen Yu, Yun Fang TsaiAbstract:AIMS: This article is a report of a study that explored the perceptions of patients as they experienced their diabetes Illness Trajectory, and their initial decisions to undergo dialysis, in an effort to provide further complementary guidance for nurses and healthcare practitioners. BACKGROUND: Diabetes leads to higher morbidity and mortality when patients develop renal failure resulting from diabetic nephropathy. An effective self-care regimen and multidisciplinary team approach are required to avoid or delay the serious chronic complications of the disease. Patients and healthcare practitioners must be aware therefore of psycho-physiological adjustment when seeking to delay the onset of complications. DESIGN: A qualitative design was used for data collection through semi-structured interviews. METHOD: Data were analysed using content analysis. Participants were 25 diabetes patients undergoing initial haemodialysis who were recruited from diabetes and nephrology wards at a medical centre in northern Taiwan. Data were collected from December 2010-August 2011. FINDINGS: The core theme describing the Illness Trajectory derived from face-to-face interviews with people undergoing hemodialysis was 'from silence to storm'. There emerged also five phases of patient experience that resulted from the development of diabetic nephropathy: (1) diabetes onset stage; (2) stable stage; (3) burden stage; (4) shock stage; and (5) coping stage. CONCLUSIONS: Patients suffer with diabetic nephropathy for a long-term period. Our findings may enhance the understanding of nurses regarding the experiences of patients with diabetic nephropathy, and will help them provide diabetes care that promotes healthy life for those individuals.
Marit Kirkevold - One of the best experts on this subject based on the ideXlab platform.
-
factors impacting the Illness Trajectory of post infectious fatigue syndrome a qualitative study of adults experiences
BMC Public Health, 2017Co-Authors: Eva Stormorken, Leonard A Jason, Marit KirkevoldAbstract:Post-infectious fatigue syndrome (PIFS), also known as post-viral fatigue syndrome, is a complex condition resulting in physical, cognitive, emotional, neurological, vocational and/or role performance disabilities in varying degrees that changes over time. The needs for health care resources are high, and costly, as is the economic burden on the affected individuals. Many factors may impact the Trajectory, and frequently PIFS develops into a chronic condition. Health professionals lack understanding and knowledge, which results in delayed diagnosis, lack of recognition, appropriate treatment, support and practical help. The aim of our study was to explore, from the perspective of persons who had lived with PIFS for four years following an outbreak of Giardia l. induced enteritis, factors that may have impacted their Illness Trajectory and how these factors had played a role during different phases. In this retrospective exploratory qualitative study a group of 26 affected adults between 26 and 59 years old were selected for in-depth interviews. A maximum variation sample was recruited from a physician-diagnosed cohort of persons with PIFS enrolled at a tertiary outpatient fatigue clinic. The interviews were audio-recorded, transcribed verbatim and subjected to qualitative content analysis. Unhelpful and helpful factors were associated with the healthcare system, health professionals and the affected persons were experienced as having an impact on the Trajectory. External impacting factors which are related to the health care system, providers and the social security system are misdiagnosis, trivialization of symptoms, unhelpful advice, delayed diagnosis and lack of appropriate help. Internal impacting factors related to the affected individuals were lack of knowledge, overestimating functional capacity, assuming the condition will pass, ignoring body signals and denial. A model of impacting factors in each phase of the Trajectory is presented. Unmet needs may result in unnecessary disability and high societal and personal costs. Enhanced knowledge of impacting factors in each phase of the Trajectory may contribute to more timely and tailored health care services and less use of health services. Increased functional capacity, improved health and ability to work or study may reduce the societal costs and the economic burden for the affected individuals.
-
from good health to Illness with post infectious fatigue syndrome a qualitative study of adults experiences of the Illness Trajectory
BMC Family Practice, 2017Co-Authors: Eva Stormorken, Leonard A Jason, Marit KirkevoldAbstract:Municipal drinking water contaminated with the parasite Giardia lamblia in Bergen, Norway, in 2004 caused an outbreak of gastrointestinal infection in 2500 people, according to the Norwegian Prescription Database. In the aftermath a minor group subsequently developed post-infectious fatigue syndrome (PIFS). Persons in this minor group had laboratory-confirmed parasites in their stool samples, and their enteritis had been cured by one or more courses of antibiotic treatment. The study’s purpose was to explore how the affected persons experienced the Illness Trajectory and various PIFS disabilities. A qualitative design with in-depth interviews was used to obtain first-hand experiences of PIFS. To get an overall understanding of their perceived Illness Trajectory, the participants were asked to retrospectively rate their functional level at different points in time. A maximum variation sample of adults diagnosed with PIFS according to the international 1994 criteria was recruited from a cohort of persons diagnosed with PIFS at a tertiary Neurology Outpatient Clinic in Western Norway. The sample comprised 19 women and seven men (mean age 41 years, range 26–59). The interviews were fully transcribed and subjected to a qualitative content analysis. All participants had been living healthy lives pre-Illness. The time to develop PIFS varied. Multiple disabilities in the physical, cognitive, emotional, neurological, sleep and intolerance domains were described. Everyone more or less dropped out from studies or work, and few needed to be taken care of during the worst period. The severity of these disabilities varied among the participants and during the Illness phases. Despite individual variations, an overall pattern of Illness Trajectory emerged. Five phases were identified: prodromal, downward, turning, upward and chronic phase. All reached a nadir followed by varying degrees of improvement in their functional ability. None regained pre-Illness health or personal and professional abilities. The needs of persons with this condition are not met. Early diagnosis and interdisciplinary rehabilitation could be beneficial in altering the downward Trajectory at an earlier stage, avoiding the most severe disability and optimising improvement. Enhanced knowledge among health professionals, tailored treatment, rest as needed, financial support and practical help would likely improve prognosis.
-
the unfolding Illness Trajectory of stroke
Disability and Rehabilitation, 2002Co-Authors: Marit KirkevoldAbstract:Purpose: To describe the characteristics of the Illness Trajectory of stroke during the first year. Method: A qualitative, prospective case study design; repeated in-depth semi-structured interviews with nine mild to moderately affected stroke patients during the course of the first year. A total of 63 interviews were conducted. The interview data were transcribed verbatim and analysed as a text, using a hermeneutic approach. Results: A stroke is not necessarily experienced as an abrupt psychosocial crisis by the stroke patient. The adjustment process seems to be gradually evolving and prolonged over most of the first year following the cerebro-vascular accident (CVA). The Illness Trajectory may be divided into four phases, each with characteristic tasks and focal points. The adjustment process involves hard physical and psychosocial work on the part of patient. A necessary pre-requisite for adjustment is a realistic conception of the Illness and its implications. This takes time and experience to achieve...
Dan Stark - One of the best experts on this subject based on the ideXlab platform.
-
identifying psychological distress at key stages of the cancer Illness Trajectory a systematic review of validated self report measures
Journal of Pain and Symptom Management, 2011Co-Authors: Lucy Ziegler, Liz Neilly, Scott A. Murray, Kate Hill, Michael I Bennett, Irene J Higginson, Dan StarkAbstract:Abstract Context To enable study of psychological distress along the cancer journey, we need to be able to select and map validated measures through the cancer Trajectory. Objectives To examine the performance of self-report measures for identifying clinically significant levels of psychological distress across the cancer patient Trajectory. Methods Electronic searches of Medline, PsychInfo, CINAHL, EmBase, The Cochrane Library, AMED, BNI, ASSIA, and Web of Science were undertaken. Only studies of self-report measures that used validated diagnostic tools for psychiatric diagnosis as the criterion measure were included. We then further limited our focus to those papers that specified a Trajectory stage. Results Forty-eight different self-report measures were reported in the 85 papers identified. The Hospital Anxiety and Depression Scale (HADS) was the most frequently reported measure (23 times). Several other measures were reported between two and four times, but most (37) measures were reported only once. Twenty-two of the 85 included papers reported measure performance by Trajectory stage. Best performing measures based on validation data available could be identified for each Trajectory stage: for pretreatment, the HADS for identifying depression; during treatment, the HADS and Mental Health Inventory-5 (MHI-5) together for identifying clinically significant distress; post-treatment, the HADS for identifying depression; and at recurrence and during the palliative phase, the Brief Edinburgh Depression Scale (BEDS) for identifying depression. Conclusion No single measure had evidence to support use throughout the Illness Trajectory in a longitudinal study, but the HADS, in combination with the MHI-5, was supported during the cancer treatment phase, and BEDS in the palliative care phase.
-
Identifying psychological distress at key stages of the cancer Illness Trajectory: A systematic review of validated self-report measures
Journal of Pain and Symptom Management, 2011Co-Authors: Lucy Ziegler, Liz Neilly, Scott A. Murray, Kate Hill, Michael I Bennett, Irene J Higginson, Dan StarkAbstract:Context: To enable study of psychological distress along the cancer journey, we need to be able to select and map validated measures through the cancer Trajectory. Objectives: To examine the performance of self-report measures for identifying clinically significant levels of psychological distress across the cancer patient Trajectory. Methods: Electronic searches of Medline, PsychInfo, CINAHL, EmBase, The Cochrane Library, AMED, BNI, ASSIA, and Web of Science were undertaken. Only studies of self-report measures that used validated diagnostic tools for psychiatric diagnosis as the criterion measure were included. We then further limited our focus to those papers that specified a Trajectory stage. Results: Forty-eight different self-report measures were reported in the 85 papers identified. The Hospital Anxiety and Depression Scale (HADS) was the most frequently reported measure (23 times). Several other measures were reported between two and four times, but most (37) measures were reported only once. Twenty-two of the 85 included papers reported measure performance by Trajectory stage. Best performing measures based on validation data available could be identified for each Trajectory stage: for pretreatment, the HADS for identifying depression; during treatment, the HADS and Mental Health Inventory-5 (MHI-5) together for identifying clinically significant distress; post-treatment, the HADS for identifying depression; and at recurrence and during the palliative phase, the Brief Edinburgh Depression Scale (BEDS) for identifying depression. Conclusion: No single measure had evidence to support use throughout the Illness Trajectory in a longitudinal study, but the HADS, in combination with the MHI-5, was supported during the cancer treatment phase, and BEDS in the palliative care phase. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Patricia M Davidson - One of the best experts on this subject based on the ideXlab platform.
-
Maintaining hope in transition: a theoretical framework to guide interventions for people with heart failure.
Journal of Cardiovascular Nursing, 2010Co-Authors: Patricia M Davidson, Kathleen Dracup, Jane Phillips, Geraldine Padilla, John DalyAbstract:: Theoretical frameworks provide a structure for the planning and delivery of nursing care and for research. Heart failure (HF), a condition of increasing prevalence in communities internationally, is responsible for high rates of morbidity, mortality, and great societal burden. The HF Illness Trajectory can be unpredictable and uncertain. Markers of transition, such as functional decline and increasing dependence, can signal the need for transition to a more palliative approach. This transition challenges clinicians to deliver information and interventions and to support patients and their families not only in relation to their physical status but also in the social, psychological, and existential dimensions. This article describes a theoretical framework, Maintaining Hope in Transition, informed by transition theory, to assist patients to cope with a diagnosis of HF and to guide development of nursing interventions. Transition theory provides a useful context to assist clinicians, patients, and their families adjust to the challenges inherent in a diagnosis of HF and negotiating the Illness Trajectory. Key factors acknowledged in the Maintaining Hope in Transition framework that determine its utility in models of care for HF patients are (1) acknowledging the changing of life circumstances, (2) restructuring reality, (3) dealing with vulnerability, (4) achieving normalization, and (5) resolving uncertainty. It is likely that incorporation of these factors in care planning, information, and interventions can facilitate patients' and their families' abilities to negotiate the HF Illness Trajectory, particularly in the advanced stages.
-
preparing for the worst while hoping for the best the relevance of hope in the heart failure Illness Trajectory
Journal of Cardiovascular Nursing, 2007Co-Authors: Patricia M Davidson, Kathleen Dracup, Jane Phillips, John Daly, Geraldine PadillaAbstract:BACKGROUND: Patients with heart failure have higher mortality rates than those with most malignant diseases. The heart failure Illness Trajectory is one of gradual decline characterized by unpredictable events such as acute decompensation of heart failure or a sudden cardiac death. Health professionals have an obligation to give patients and their families concise and honest information concerning their prognosis. The challenge exists to give what ostensibly may seem a bleak prognosis within a context of hope and optimism. AIM: To explore the role of hope in heart disease and the potential utility of this construct in the development of nursing interventions. METHODS: The electronic databases CINAHL, MEDLINE, EmBASE, and PSYCHlit were searched from 1982 to August 2004 using the key words "hope," "hopelessness," "heart disease," and "heart failure." Articles were subsequently sorted to meet the inclusion criteria of (1) a philosophical discussion of the construct of hope and/or (2) investigation of hope in heart disease. RESULTS: This search retrieved 768 articles, and 24 met the inclusion criteria. Key findings from the review indicate that "hope" and "hopelessness" are underdeveloped, yet important constructs and conceptually linked with depression and spirituality. Intriguing findings from descriptive, observational studies have demonstrated the positive impact of expression of hope on cardiovascular outcomes. These findings need to be validated in randomized controlled trials. CONCLUSIONS: This critical literature review has determined that "hope" is strongly associated with the individual's future orientation. Increased understanding of this concept may assist in refining patient-focused interventions and developing therapeutic strategies to enhance hope.
-
using the Illness Trajectory framework to describe recovery from traumatic injury
Contemporary Nurse, 2005Co-Authors: Elizabeth J Halcomb, Patricia M DavidsonAbstract:AbstractThis paper seeks to highlight the utility of the Corbin and Strauss Chronic Illness Trajectory Framework in describing recovery from traumatic injury and encourages consideration of its implementation into contemporary trauma nursing (Corbin and Strauss, 1991; 1992). To date, few such frameworks have been proposed to sensitize health professionals to the path of recovery following traumatic injury. Although this framework was initially conceived for use in the domain of chronic Illness, the lasting effects of severe traumatic injury have significant parallels to chronic conditions such as stroke (Burton, 2000) and multiple sclerosis (Miller, 1993) to which the framework has previously been applied. This paper demonstrates the Trajectory Framework as a useful structure to potentially enhance the development of post-discharge interventions for trauma survivors and encourages consideration of its implementation into the nursing management of this complex patient group.
Scott A. Murray - One of the best experts on this subject based on the ideXlab platform.
-
A better understanding of Illness trajectories after stroke may help clinicians identify patients for a palliative approach to care.
2020Co-Authors: Gillian Mead, Eileen Cowey, Scott A. MurrayAbstract:Only about 50% of people who have a stroke survive to fiveyears. Clinicians should identify those most at risk of dying, and gradually integrate palliative care. Such holistic and anticipatory care will be of benefit to patients and their family carers; should reduce futile treatments, medications, or unsuccessful resuscitation attempts; and help more people die how and where they choose. Research is exploring how best to provide palliative and end-of-life care in acute stroke units, but how best to improve holistic, ongoing care in the community is poorly understood. The concept of fluctuating Illness trajectories might help clinicians meet the multidimensional needs of stroke survivors at different time points. ‘Illness Trajectory’ research in cancer has suggested that social decline mirrors the physical decline, while psychological and existential distress tended to be most acute at diagnosis, returning home after treatment, disease recurrence, and in the last days. Further research is needed to explore how best to provide palliative care at different stages of the ‘stroke journey’, and the nature of Illness trajectories after stroke.
-
Gradual physical decline characterises the Illness trajectories of care home residents.
International Journal of Palliative Nursing, 2017Co-Authors: Anne Finucane, Barbara Stevenson, Scott A. MurrayAbstract:Background: Three archetypal trajectories of physical decline have been identified: a short period of rapid decline; long-term limitations with intermittent acute periods; and a prolonged gradual decline. An understanding of Illness trajectories can help clarify the evolving needs of people with progressive conditions, and inform the development of palliative care services to meet their needs. Many frail older people live and die in care homes; the present study is the first to explore the Illness trajectories of residents in care home settings. Aims: To determine the prevailing trajectories of physical decline in care home residents; and to identify the dominant Illness trajectories of residents in care homes in Lothian, Scotland. Method: Data were collected as part of a service development project to improve palliative care in eight care homes in south Edinburgh that provided 24-hour onsite nursing care. Results: Data on 120 residents were collected. The dominant Illness Trajectory, found in 78% of resi...
-
prolonged dwindling characterises the Illness Trajectory of nursing home residents at the end of life
BMJ, 2014Co-Authors: Anne Finucane, Barbara Stevenson, Scott A. MurrayAbstract:Introduction Three Illness trajectories have been identified: (i) a short period of evident decline typically experienced by patients with cancer; (ii) long term limitations with intermittent serious episodes typically experienced by patients with organ failure; and (iii) prolonged dwindling typically experienced by patients with frailty or dementia. An understanding of a patient9s Illness Trajectory facilitates anticipatory care planning and decision-making as end-of-life approaches. Aim(s) and method(s) To determine the dominant Illness trajectories of nursing care home residents. As a secondary aim we explored multimorbidity in this group. Data was collected by care home staff with support from community palliative care nurse specialists as part of a larger project to improve palliative care in South Edinburgh care homes. Results Data concerning 77 residents was collected. The dominant Illness Trajectory of 90% of residents was characterised by prolonged dwindling. Further analysis revealed that 30% of residents experienced mixed Illness trajectories. About half of those with mixed trajectories experienced dementia and cancer while half experienced dementia and organ failure. 67% of residents experienced two or more chronic morbidities. Overall, 78% of deceased residents had dementia. Conclusion(s) The vast majority of nursing home residents experienced prolonged dwindling prior to death. Most had multiple morbidities and high symptom burden. Interventions to improve palliative care in nursing homes need to be modelled on patients who experience prolonged dwindling characterised by dementia and multimorbidity.
-
Life after stroke - is palliative care relevant? A better understanding of Illness trajectories after stroke may help clinicians identify patients for a palliative approach to care.
International Journal of Stroke, 2013Co-Authors: Gillian Mead, Eileen Cowey, Scott A. MurrayAbstract:Only about 50% of people who have a stroke survive to five-years. Clinicians should identify those most at risk of dying, and gradually integrate palliative care. Such holistic and anticipatory care will be of benefit to patients and their family carers; should reduce futile treatments, medications, or unsuccessful resuscitation attempts; and help more people die how and where they choose. Research is exploring how best to provide palliative and end-of-life care in acute stroke units, but how best to improve holistic, ongoing care in the community is poorly understood. The concept of fluctuating Illness trajectories might help clinicians meet the multidimensional needs of stroke survivors at different time points. ‘Illness Trajectory’ research in cancer has suggested that social decline mirrors the physical decline, while psychological and existential distress tended to be most acute at diagnosis, returning home after treatment, disease recurrence, and in the last days. Further research is needed to explore how best to provide palliative care at different stages of the ‘stroke journey’, and the nature of Illness trajectories after stroke.
-
identifying psychological distress at key stages of the cancer Illness Trajectory a systematic review of validated self report measures
Journal of Pain and Symptom Management, 2011Co-Authors: Lucy Ziegler, Liz Neilly, Scott A. Murray, Kate Hill, Michael I Bennett, Irene J Higginson, Dan StarkAbstract:Abstract Context To enable study of psychological distress along the cancer journey, we need to be able to select and map validated measures through the cancer Trajectory. Objectives To examine the performance of self-report measures for identifying clinically significant levels of psychological distress across the cancer patient Trajectory. Methods Electronic searches of Medline, PsychInfo, CINAHL, EmBase, The Cochrane Library, AMED, BNI, ASSIA, and Web of Science were undertaken. Only studies of self-report measures that used validated diagnostic tools for psychiatric diagnosis as the criterion measure were included. We then further limited our focus to those papers that specified a Trajectory stage. Results Forty-eight different self-report measures were reported in the 85 papers identified. The Hospital Anxiety and Depression Scale (HADS) was the most frequently reported measure (23 times). Several other measures were reported between two and four times, but most (37) measures were reported only once. Twenty-two of the 85 included papers reported measure performance by Trajectory stage. Best performing measures based on validation data available could be identified for each Trajectory stage: for pretreatment, the HADS for identifying depression; during treatment, the HADS and Mental Health Inventory-5 (MHI-5) together for identifying clinically significant distress; post-treatment, the HADS for identifying depression; and at recurrence and during the palliative phase, the Brief Edinburgh Depression Scale (BEDS) for identifying depression. Conclusion No single measure had evidence to support use throughout the Illness Trajectory in a longitudinal study, but the HADS, in combination with the MHI-5, was supported during the cancer treatment phase, and BEDS in the palliative care phase.
