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Partner relationship in couples living with atrial fibrillation
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe and explore how the partner relationship of patient–partner dyads isaffected following cardiac disease and, in particular, atrial fibrillation (AF) in one of the spouses.

The thesis is based on four individual studies with different designs: descriptive (I), explorative (II, IV), and cross-sectional (III). Applied methods comprised a systematic review (I) and qualitative (II, IV) and quantitative methods (III). Participants in the studies were couples in which one of the spouses was afflicted with AF. Coherent with a systemic perspective, the research focused on the dyad as the unit of analysis. To identify and describe the current research position and knowledge base, the data for the systematic review were analyzed using an integrative approach. To explore couples’ main concern, interview data (n=12 couples) in study II were analyzed using classical grounded theory. Associations between patients and partners (n=91 couples) where analyzed through the Actor–Partner Interdependence Model using structural equation modelling (III). To explore couples’ illness beliefs, interview data (n=9 couples) in study IV were analyzed using Gadamerian hermeneutics.

Study I revealed five themes of how the partner relationship is affected following cardiac disease: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Study II showed that couples living with AF experienced uncertainty as the common main concern, rooted in causation of AF and apprehension about AF episodes. The theory of Managing Uncertainty revealed the strategies of explicit sharing (mutual collaboration and finding resemblance) and implicit sharing (keeping distance and tacit understanding). Patients and spouses showed significant differences in terms of self-reported physical and mental health where patients rated themselves lower than spouses did (III). Several actor effects were identified, suggesting that emotional distress affects and is associated with perceived health. Patient partner effects and spouse partner effects were observed for vitality, indicating that higher levels of symptoms of depression in patients and spouses were associated with lower vitality in their partners. In study IV, couples’ core and secondary illness beliefs were revealed. From the core illness belief that “the heart is a representation of life,” two secondary illness beliefs were derived: AF is a threat to life, and AF can and must be explained. From the core illness belief that “change is an integral part of life,” two secondary illness beliefs were derived: AF is a disruption in our lives, and AF will not interfere with our lives. Finally, from the core illness belief that “adaptation is fundamental in life,” two secondary illness beliefs were derived: AF entails adjustment in daily life, and AF entails confidence in and adherence to professional care.

In conclusion, the thesis result suggests that illness, in terms of cardiac disease and AF, affected and influenced the couple on aspects such as making sense of AF, responding to AF, and mutually incorporating and dealing with AF in their daily lives. In the light of this, the thesis results suggest that clinicians working with persons with AF and their partners should employ a systemic view with consideration of couple’s reciprocity and interdependence, but also have knowledge regarding AF, in terms of pathophysiology, the nature of AF (i.e., cause, consequences, and trajectory), and treatments. A possible approach to achieve this is a clinical utilization of an FSN based framework, such as the FamHC. Even if a formalized FSN framework is not utilized, partners should not be neglected but, rather, be considered a resource and be a part of clinical caring activities. This could be met by inviting partners to take part in rounds, treatment decisions, discharge calls or follow-up visits or other clinical caring activities. Likewise, interventional studies should include the couple as a unit of analysis as well as the target of interventions.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2016. , 96 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 75
Keyword [en]
Atrial fibrillation, cardiac disease, couples, partner-relationship
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-32272ISBN: 978-91-85835-74-4OAI: oai:DiVA.org:hj-32272DiVA: diva2:1046690
Public defence
2016-12-16, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-11-25 Created: 2016-11-14 Last updated: 2016-12-05Bibliographically approved
List of papers
1. Cardiac Disease and its Consequences on the Partner Relationship: a Systematic Review
Open this publication in new window or tab >>Cardiac Disease and its Consequences on the Partner Relationship: a Systematic Review
2011 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, 140-149 p.Article in journal (Refereed) Published
Abstract [en]

Introduction

Cardiac disease is a chronic illness that has extensive impact on patients and their partners. No previous review has been made on how the partner relationship is affected following cardiac disease. The review limited itself to the main cardiac disease of myocardial ischemia, arrhythmia and heart failure.

Aim

The aim of this review was to identify how the partner relationship is affected following cardiac disease after hospital discharge.

Method

CINAHL, PubMed and PsycINFO were searched from 1999 to 2009. Quality assessment of included articles was made using the Joanna Briggs Institute Reviewers' Manual. A total of 20 articles were included.

Results

Five themes identified how the partner relationship is affected following cardiac disease, namely: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Patients reported feeling overprotected by their spouses which occasionally served as a fertile ground for arguments or conflicts. Most couples experienced some implications concerning their sexual life following cardiac disease, though in various degrees. Both patients and partners seemed to experience communication deficiency concerning emotions within their relationship following the event. Most couples experienced a shift in roles and responsibilities within their partner relationship. Even though most couples experienced great distress following being afflicted with cardiac disease they reported that the disease had brought them closer together.

Conclusion

The review found that though couples found the cardiac event distressful they conformed and adjusted their relationship to the new situation.

Keyword
Arrhythmia, Couple, Heart failure, Myocardial ischemia, Partner relationship, Systematic review
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-14149 (URN)10.1016/j.ejcnurse.2011.01.006 (DOI)21345737 (PubMedID)
Projects
Bridging the Gap II
Available from: 2010-12-28 Created: 2010-12-28 Last updated: 2016-11-14Bibliographically approved
2. Managing uncertainty in couples living with atrial fibrillation
Open this publication in new window or tab >>Managing uncertainty in couples living with atrial fibrillation
Show others...
2014 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, E1-E10 p.Article in journal (Refereed) Published
Abstract [en]

Background: Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

Objective: The aim of this study was to explore couples’ main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

Methods: Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

Results: Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples’ shifting between implicit and explicit sharing.

Conclusions: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples’ daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

Keyword
atrial fibrillation, couples, grounded theory, qualitative research, uncertainty
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:hj:diva-23464 (URN)10.1097/JCN.0b013e3182a180da (DOI)000337681400001 ()24108265 (PubMedID)2-s2.0-84899480539 (ScopusID)
Available from: 2014-02-12 Created: 2014-02-12 Last updated: 2016-11-14Bibliographically approved
3. Associations of emotional distress and perceived health in persons with atrial fibrillation and their partners using the Actor–Partner Interdependence Model
Open this publication in new window or tab >>Associations of emotional distress and perceived health in persons with atrial fibrillation and their partners using the Actor–Partner Interdependence Model
Show others...
2016 (English)In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 22, no 3, 368-391 p.Article in journal (Refereed) Published
Abstract [en]

Individual behavior affects and is affected by other people. The aim of this study was to examine if emotional distress in patients with atrial fibrillation (AF) and their spouses was associated with their own and their partner’s perceived health. Participants included 91 dyads of patients and their spouses. Emotional distress was measured using the Hospital Anxiety and Depression Scale and perceived health was measured with the Short Form 36 Health Survey. The Actor–Partner Interdependence Model was used for dyad-level analyses of associations, using structural equation modeling. Higher levels of anxiety and depression were associated with lower levels of perceived health in patients and spouses. Higher levels of depression in patients were associated with lower levels of vitality in spouses and vice versa. As AF patients and their spouses influence each other, health-care interventions should consider the dyad to address dyadic dynamics. This may benefit the health of the individual patient and of the couple.

Keyword
Actor–Partner Interdependence Model, atrial fibrillation, couples, dyads, emotional distress, health, partner relationship
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-31510 (URN)10.1177/1074840716656815 (DOI)27385260 (PubMedID)2-s2.0-84980615387 (ScopusID)
Available from: 2016-08-25 Created: 2016-08-25 Last updated: 2016-12-02Bibliographically approved
4. "The heart is a representation of life" – An exploration of illness beliefs in couples living with atrial fibrillation
Open this publication in new window or tab >>"The heart is a representation of life" – An exploration of illness beliefs in couples living with atrial fibrillation
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-32270 (URN)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2016-11-14

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