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Transitional experiences in patients following intracranial aneurysm rupture
Red Cross University College of Nursing. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 9-10, 1263-1273 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To describe changes and transitions in everyday life in the first two years following an intracranial aneurysm rupture.

Background

An intracranial aneurysm rupture causes a haemorrhagic stroke, and the physical and mental consequences of this condition are numerous and complex. In Sweden, some, but not all, patients receive rehabilitation for this condition. Patients with this type of stroke are not included in the national stroke registry; thus, information on the recovery period for these particular patients is lacking.

Design

A longitudinal mixed methods study design was used.

Methods

The sample was consecutive and consisted of 88 patients (84·6% of 104 eligible), acutely admitted to a neurosurgical clinic in Stockholm for intracranial aneurysm rupture. Data were collected through a postal study-specific questionnaire at 6 months, 1 year and 2 years postaneurysm rupture. Intramethod mixing was used in the data collection, and quantitative and qualitative data were analysed parallel with statistical and qualitative content analysis.

Results

A majority of participants perceived changes in their everyday lives during the first two years following aneurysm rupture, and the changes were ongoing with little differences reported between 6 months and 2 years after the onset. Internal changes, or transitions, were revealed within changes in personality, changed social roles and relationships and changed abilities and behaviour.

Conclusions

Recovering from an intracranial aneurysm rupture involves a period of intense changes and transitions, a vulnerable period for many people that may be made easier to manage by the intervention of nurses.

Relevance to clinical practice

Patients experiencing transitions in the recovery period after intracranial aneurysm rupture may benefit from nursing interventions that support them through the transitional process. Nurse-led follow-up care by a specialist nurse from the neurosurgical clinic may be a possible way to provide support.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014. Vol. 23, no 9-10, 1263-1273 p.
Keyword [en]
everyday life, multifaceted approach to change, neurosurgery, nursing, patients' experience, stroke
National Category
Nursing
Identifiers
URN: urn:nbn:se:rkh:diva-711DOI: 10.1111/jocn.12317PubMedID: 23957605OAI: oai:DiVA.org:rkh-711DiVA: diva2:643107
Note

Som manuskript i avhandling. As manuscript in dissertation.

Available from: 2013-08-26 Created: 2013-08-26 Last updated: 2014-11-07Bibliographically approved
In thesis
1. Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes
Open this publication in new window or tab >>Impact on life after intracranial aneurysm rupture: health-related quality of life and epidemiologic outcomes
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe impact on life up to ten years after intracranial aneurysm rupture in terms of health-related quality of life, changes in everyday life and descriptive epidemiology with the intention to contribute to an increased understanding of the long-term perceived consequences of that impact.

Study I aimed to describe changes and transitions in everyday life during the first two years following an intracranial aneurysm rupture. A consecutive sample of 88 patients was followed-up at three time points. A majority of respondents perceived changes in their everyday life during the first two years following aneurysm rupture. Transitions were revealed within changes in personality, changed social roles and relationships, and changed abilities and behavior.

In Study II epidemiology in relation to gender differences and treatment modalities ten years after aneurysm rupture was investigated. Ten years after the onset, 63.9% of the 468 admitted patients were still alive. The incidence in women was higher than that of men; they were older at onset and were diagnosed with more aneurysms. There were no significant differences in survival times between patients treated with different active aneurysm treatments, or between men and women.

In Study III survivors from study II (n=217) were followed-up with questionnaires and telephone interviews, aiming to describe psychological, physical and cognitive functions ten years after intracranial aneurysm rupture. Compared to reference groups, the aneurysm respondents scored higher levels of anxiety and depression. Respondents with ruptured aneurysms in the posterior circulation of the brain scored significantly more symptoms of anxiety and depression. A small proportion, 2.8%, scored for severe physical disability and 21.7% scored below the cut-off value, indicating cognitive impairments.

Study IV used the same sample as study III (n=217), and a general population sample (n=434) from the Stockholm Public Health Survey, matched by age and sex. The aim was to measure health-related quality of life (HRQoL), and to explore factors affecting HRQoL, ten years after intracranial aneurysm rupture. Compared to general population, the aneurysm sample reported significantly more problems with mobility, self-care, usual activities and anxiety/depression and had significantly lower overall HRQoL values. HRQoL in the aneurysm sample was most affected in respondents with worse neurological outcome, respondents with comorbidities, and respondents with low perceived recovery.

In conclusion, intracranial aneurysm ruptures impacts upon life in several ways for an extensive period of time after the onset. The results indicate a need for follow-up and support, and to identify subgroups of aneurysm patients who might benefit from support: patients with ruptured aneurysms in the posterior circulation of the brain; patients with worse neurological outcome at hospital discharge; patients with comorbidities; and patients with low perceived recovery. Ten years after the onset of aneurysm rupture the majority of patients were still alive. Differences between men and women were apparent in incidence and clinical presentation at the onset of aneurysm rupture, not in survival times. Survival time was equal between patients within active treatment modalities.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2012. 70 p.
Keyword
intracranial aneurysm rupture, quality of life
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-701 (URN)978-91-7457-927-7 (ISBN)
Public defence
2012-12-14, Kugelbergsalen, Karolinska Universitetssjukhuset, Solna, 14:00
Opponent
Supervisors
Available from: 2014-09-17 Created: 2013-08-01 Last updated: 2014-09-17Bibliographically approved

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