Læknablaðið : fylgirit - 01.05.2002, Blaðsíða 31

ABSTRACTS / 33RD SNC & 2ND SCNN
tably high risk of stroke or death and the procedure was largely
abandoned. However, recent advances in microcatheter and
balloon technology have led to renewed interest in intracranial
angioplasty and stenting. Several recent studies have shown that
intracranial angioplasty and stenting are technically feasible and
have been associated with stroke rates of 4%^t0%. More data on
safety, long-term outcome, and re-stenosis rates in patients under-
going intracranial angioplasty or stenting are needed before this
therapy should be evaluated in a randomized, multi-center clinical
trial. Moreover, best medical therapy for intracranial stenosis,
which will serve as the proven control group in such a trial, has yet
to be determined.
In this regards, the ongoing Warfarin-Aspirin Symptomatic
Intracranial Disease (WASID) trial is an ongoing randomized,
double blind clinical trial in which 806 patients with TIA or minor
stroke related to angiographically proven stenosis (50 to 99%) of a
major intracranial artery will be randomized to warfarin (INR 2-3)
or aspirin (1300 mg per day). This study, which is funded by the
National Institutes of Health (USA) will 1) determine whether
warfarin or aspirin is more effective for preventing stroke and
vascular death in these patients; and 2) identify subgroups of
patients whose rate of ischemic stroke in the territory of the
stenotic intracranial artery is sufficiently high to justify a subse-
quent trial comparing intracranial angioplasty/stenting with best
medical therapy in these patients.
L41 - Vascular testing in patients with stroke and TIA
Feldmann E
Brown University, Rhode Island, USA
Abstract not received.
42 - Supporting People With Chronic Disesaes to Live With Their
Disease
Jónsdóttir H
Associate Professor, Faculty of Nursing University of Iceland and Project
Manager, National University Hospital
Life with a chronic disease may be the single biggest challenge in
life for people living with a variety of diseases. The impact these
diseases may have upon people and their loved ones are frequently
underestimated by nurses and other health care professionals and
health service is commonly limited to instrumental treatments of
the patho-physiological manifestations of diseases.
Nursing practice is no exemption to this. Immediate physical
needs have the priority: To take care of personal hygiene, mobility,
communication, nutrition, elimination and physical comfort. Other
needs, commonly phrased as psychological, social, spiritual, and
existential, are not considered immediate and are frequently
postponed-often indefinitely.
The limitations of focusing nursing care on meeting physical
needs become clear when attention is paid to the turmoil that
diseases may cause. The literature demonstrates vast changes that
take place in relation to the chronic disease experience. Some of
these amendments are alterations in relating to oneself and to
others, inability to be employed, lack of meaningful social inter-
actions, pain, fatigue, and uncertainty. The ways a disease creeps
into people’s lives are numerous, depending on the nature of the
disease, prior life experiences, age, gender, social circumstances,
and culture, to name a few.
The chronic illness experience is very personal and needs to be
explored in the light of the uniqueness of each individual with
his/her hopes, wishes, desires and goals in life. It is to this multi-
faceted picture, which a chronic disease creates in an individual’s
life that nursing practice needs to attend. Nursing practice should
be concerned with what matters to people, and accordingly, support
them in meeting their aims and aspirations life.
Fundamental to supporting people to live life with a chronic
disease is to make efforts to understand what it is like to live in
particular health circumstances; to relate to clients; and to attend to
what is of importance in their life. Based on these premises a
nursing practice named ‘partnership’ is being developed (Jons-
dottir, Litchfield & Pharris, 2002; Litchfield, 1999). Partnership has
been articulated as nursing practice as it unfolds. The nurse is
present to clients in a “fully open caring attentiveness to whatever
emerg[es]” in the nurse-client relationship (Litchfield, 1999 p. 65).
The nurse focuses on that which is meaningful in the life of the
client and embraces and responds to whatever emerges about that
experience. This interaction is on a form of natural conversations. It
is open and creative and a sense of a connection and mutual trust
evolves. Through the conversations, insight into life may develop
and possibilities for action may be identified. The nurse does not
seek it. Rather, the nurse attempts to let go of controlling the
clients’ behaviours and thoughts and attempts to accept people’s
own capacity to find their way in life.
The benefits of participating in partnership can only be illumi-
nated retrospectively. Litchfield (1999) described the benefits for
families living with complex health circumstances from participating
in partnership in terms of “insight as the potential for action”,
expanding horizon reflected in a movement from “being trapped in
the present without vision to seeing the presence of past and future”
and “increasing connectedness” reflected in “inclusion” with others,
“interdependence in health care” and “transformation” of living.
References
Jonsdottir, H., Litchfield, M., & Pharris, M.D. (2002). Partnership as an expression
of caring in the human health experience. Submitted for publication.
Litchfield, M. (1999). Practice wisdom. Adv Nurs Sci, 22(2), 62-73.
43 - A study on bowel and bladder management of spinal cord
injured individuals in lceland
Kjartansdóttir M
Department of Rehabilitation, Landspítali Grensás, University Hospital, Iceland
This is a report on a descriptive study on bowel and bladder
management of spinal cord injured individuals in Iceland after
discharge from hospital from 1973 to 1996.
Objective: The purpose of this study was to see what method spinal
cord injured individuals (discharged from hospital 1973-96) are
using regarding bowel- and bladder management in home environ-
ment. Is what we teach them in the rehabilitation unit relevant to
home environment? Are spinal cord injured individuals satisfied
with the method they are using as bladder and bowel management?
Problem: Spinal cord injury produces a wave of repercussions that
affect many organ systems and subsequently the live activities of
the affected person. What general population less appreciates is the
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