Patients with HF have a reduced HRQOL especially if difficulties maintaining sleep, initiating sleep, and early morning awakenings are involved.

Equipment and procedures developed during the past several decades have made the modern intensive care unit (ICU) the hospital's most technologically advanced environment. In terms of patient care, are these advances unmitigated gains? This study aimed to develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments. A lifeworld perspective guided the investigation. Nine unstructured interviews with intensive care patients comprise its data. The qualitative picture uncovered by a phenomenological analysis shows that contradiction and ambivalence characterized the entire care episode. The threat of death overshadows everything and perforates the patient's existence. Four inter-related constituents further elucidated the patients' experiences: the confrontation with death, the encounter with forced dependency, an incomprehensible environment and the ambiguity of being an object of clinical vigilance but invisible at the personal level. Neglect of these issues lead to alienating 'moments' that compromised care. Fixed at the end of a one-eyed clinical gaze, patients described feeling marginalized, subjected to rituals of power, a stranger cared for by a stranger. The roar of technology silences the shifting needs of ill people, muffles the whispers of death and compromises the competence of the caregivers. This study challenges today's caregiving system to develop double vision that would balance clinical competence with a holistic, integrated and comprehensive approach to care. Under such vision, subjectivity and objectivity would be equally honoured, and the broken bonds re-forged between techne, 'the act of nursing', and poesis, 'the art of nursing'.

Background: Cardiac patients may experience problems with sexual activity as a result of their disease, medications or anxiety and nurses play an important role in sexual counselling. We studied the practice, responsibility and confidence of cardiac nurses in the sexual counselling of these patients. Method: An adapted version of the nurses' survey of sexual counselling of MI patients was administered during a scientific meeting of the Council on Cardiovascular Nursing and Allied Professionals within the European Society of Cardiology. Results: Most of the 157 cardiovascular nurses (87%) who completed the survey felt responsible to discuss sexual concerns with their clients, especially when patients initiated a discussion. However in practice, most respondents rarely addressed sexual issues. The items that nurses reported to counsel patients were closely related to the cardiac disease, symptoms and medications and seldom more sensitive subjects (e.g. foreplay, positions). Nurses estimated that their patients could be upset (67%), embarrassed (72%) or anxious (68%) if they were asked about sexual concerns. One-fifth of the nurses felt they had insufficient knowledge and 40% sometimes hesitated to discuss sexual concerns with clients because they might not know how to answer questions. Additional education on sexuality was significantly related to being more comfortable and active in sexual counselling. Conclusion: Although cardiac nurses feel responsible and not anxious discussing patients' sexual concerns, these issues are not often discussed in daily practice. Nurses might need more knowledge and specific practical training in providing information on sexual concerns and sexual counselling to cardiac patients.

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The experiences emphasized the need for a holistic approach to care. In this process, the organization of care and the role and skills of the nurse should be focused on the individual's needs and perspectives. The social environment, professional approach and value-adding measures are particularly relevant for optimal care at nurse-led rheumatology outpatient clinics.

Postoperative delirium (PD) after transcatheter aortic valve implantation (TAVI) remains to be explored. We sought to (1) determine the incidence of PD in octogenarians who underwent TAVI or surgical aortic valve replacement (SAVR), (2) identify its risk factors, and (3) describe possible differences in the onset and course of PD between treatment groups. A prospective cohort study of consecutive patients aged ≥80 years with severe aortic stenosis who underwent elective TAVI or SAVR (N = 143) was conducted. The incidence of PD was assessed for 5 days using the Confusion Assessment Method (CAM). Risk factors for PD were studied with logistic regression. Patients treated with TAVI were older (p ≤0.001), had lower cognitive scores (p = 0.007), and more co-morbidities (p = 0.003). Despite this, significantly fewer (p = 0.013) patients treated with TAVI (44%) experienced PD compared to patients treated with SAVR (66%). Undergoing SAVR (p = 0.02) and having lower cognitive function (p = 0.03) emerged as risk factors for PD, whereas gender, activities of daily living, frailty, atrial fibrillation, and postoperative use of opioids and anxiolytics did not. Patients treated with TAVI and without PD during the first 2 postoperative days were unlikely to experience PD on subsequent days. The onset of PD after SAVR could occur at any time during the postoperative evaluation. In conclusion, SAVR in octogenarian patients with aortic stenosis might be considered as a predisposing factor for PD. Our data also suggest that the onset of PD was more unpredictable after SAVR.

In this study, patients' experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme "the nurse-led rheumatology clinic provided added value to patient care". The participants' experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care, making it more complete. Nurses and rheumatologists complemented each other, as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients in rheumatology units.

the development and current status of the CIT, with focus on its fundamental definitions, guidelines, and pros and cons when applied in nursing and healthcare sciences. BackgroundLike all qualitative methods, CIT has an established history, which in this case goes back to World War II. The psychologist John Flanagan was the head of the military aviation psychology programmer and studied pilot behavior in connection with critical incidents that arose in aviation missions during training or battle against the enemy. An unacceptably large number of pilots failed in their missions, which is why his interest was partly directed at studying the pilots' experiences of critical incidents (descriptions) and partly at observing what steps they took to handle them (actions). Flanagan analyzed the critical incident after success or failure by "working backwards" -retrospectively, which means studying what has already happened afterwards -to thereby identify the specific behavior that led to a positive or negative result (outcome or consequence). In terms of data collection, it is a matter of supporting or getting the participant to remember and describe real incidents, and not how things could have been or turned out. In other words, it is about the participant's "real" and experienced world. There are accordingly two focuses behind CIT: the researcher intends to identify the participant's capacity based on his/her actions in the critical incident and to determine whether the consequence of the actions constitute a significantpositive or negative -contribution [8,9]. MethodA theoretical reasoning based on the original literature and with the support of updated literature relevant to the CIT was used in order to describe, explain, compare, reflect and implicate the development of CIT. Concepts and terminology developmentFlanagan established the concept of CIT, but over the years, several other terms have been used both in and outside of nursing, such as "Critical Incident Analysis", "Critical Incident Reflection", "Critical Incident Exercise" and "Significant Event Technique" [3,10,11]. There are probably many reasons why the terminology has changed over the years, but one crucial reason AbstractPurpose: The aim of this study was to elucidate the development and current status of the critical incident technique (CIT), with focus on its fundamental definitions, guidelines, and pros and cons when applied in nursing and healthcare sciences. Method:A theoretical reasoning based on the original literature and with the support of updated literature relevant to the CIT was used. Results:A critical incident is a retrospective story generating an activity, a behaviour which, due to its retrospective perspective, can only be deemed critical in hindsight. The incident is critical if there is a major human activity which is sufficient to allow conclusions and predictions. The story has a clear beginning and a clear end, and its impact needs to be clear with a significant outcome, either positively or negatively. The CIT-procedure, still...