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  • 1.
    Ahlander, Britt-Marie
    et al.
    Department of Radiology, Ryhov County Hosptial, Jönköping, Sweden.
    Engvall, Jan
    Department of Clinical Physiology, Linköping University, Linköping, Sweden; Center of Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Maret, Eva
    Department of Clinical Physiology, Karolinska Institutet, stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Ericsson, Elisabeth
    Örebro University, School of Health Sciences.
    Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 1250-1261Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate whether additional information has an impact on motion artefacts.

    Background: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment.

    Design: A prospective randomised intervention study, not registered.

    Methods: The sample (n = 148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomised to receive either video information in addition to standard text-information (CMR-video/n = 49) or standard text-information alone (CMR-standard/n = 48). A third group undergoing myocardial perfusion scintigraphy (n = 51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and 1 week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression scale, MRI Fear Survey Schedule and the MRI-Anxiety Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015–April 2016. The study followed the CONSORT guidelines.

    Result: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p =.039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p <.001). No difference was found regarding motion artefacts between CMR-video and CMR-standard.

    Conclusion: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts.

    Relevance to clinical practice: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

  • 2.
    Algilani, Samal
    et al.
    Örebro University, School of Health Sciences.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    An interactive ICT-platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing: development and feasibility2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 11-12, p. 1575-1583Article in journal (Refereed)
    Abstract [en]

    Aim and objectives: To develop and test feasibility and acceptability of an interactive ICT-platform integrated in a tablet for collecting and managing patient reported concerns of older adults in home care.

    Background: Using different ICT-applications, e.g. interactive tablets for self-assessment of health and health issues, based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesize that introduction of ICT-applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce.

    Design: The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data.

    Methods: In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data was extracted as a coded file.

    Results: The older adults reported as instructed, in total 107 reports (mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved.

    Conclusions The overall findings in this study indicated high feasibility among older adults using the ICT-platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations.

    Relevance to practice: An ICT-platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses.

  • 3.
    Andershed, Birgitta
    Örebro University, Department of Health Sciences.
    Relatives in end-of-life care--part 1: a systematic review of the literature the five last years, January 1999-February 20042006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 9, p. 1158-1169Article in journal (Refereed)
    Abstract [en]

    AIM:

    To review systematically research conducted during the past five years focusing on the relatives' situation and needs in end-of-life care.

    BACKGROUND AND AIM:

    That relatives make a large contribution in the care of the dying is well-known. In this situation, relatives often have to solve many new practical problems in the care as well as dealing with the sorrow of both themselves and the dying person. In recent years, palliative care has been developed in many countries and many new studies have been carried out.

    METHODS:

    A systematic search of the literature was performed in the CINAHL and Medline databases. Of the 94 papers analysed, there were 59 qualitative and 35 quantitative studies with differing designs. The studies were carried out in 11 countries and were published in 34 different journals.

    RESULTS:

    The results were categorized in two main themes with several subthemes: (1) being a close relative--the situation: (i) exposed position--new responsibility, (ii) balance between burden and capacity and (iii) positive values; (2) being a close relative--needs: (i) good patient care, (ii) being present, (iii) knowing and communicating and (iv) support from and trusting relationship with the professional. The relative's feelings of security and trust in the professional were found to be of great importance.

    CONCLUSION:

    More than twice as many studies had a descriptive/explorative design, which is of importance in the assessment of evidence. However, different studies complement one another and in summary, it can be said that analytic evidence is unequivocal: good patient care, communication, information and the attitude of the professional are of decisive importance regarding relatives' situation. These results are also in accord with earlier review studies.

    RELEVANCE TO CLINICAL PRACTICE:

    Staff members have a great deal of responsibility for assuring that the patient feels as good as possible, facilitating relatives' involvement based on the family's wishes and limiting the stress and difficulties experienced by the family. The results showed that the relative's satisfaction could depend on the attitude of the professional as well as on good communication, good listening and good information. This can also be viewed as a prerequisite for the professional to get to know the family and to provide 'care in the light'.

  • 4.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Faculty of Health, Science, and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
    Gillå, Cristina
    Central Child Health Unit, County Council of Varmland, Karlstad, Sweden.
    Lind, Maria
    Central Child Health Unit, Örebro County Region, Örebro, Sweden.
    Almqvist, Kjerstin
    Department of Social and Psychological studies, Karlstad University, Karlstad, Sweden.
    Fändriks, Anna Lindgren
    Central Child Health Unit, County Council of Varmland, Karlstad, Sweden.
    Källström, Åsa
    Örebro University, School of Law, Psychology and Social Work.
    Child healthcare nurses' experiences of asking new mothers about intimate partner violence2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 13-14, p. 2752-2762Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim of this study was to investigate child health care nurses' experiences of asking mothers of 8-month-old children about intimate partner violence using a two-step questionnaire.

    Background: Exposure to intimate partner violence is detrimental to women and to their children, and its early detection is vital. Child health care is a promising setting for detecting intimate partner violence.

    Design: The overall project had a quasi-experimental design, and was employed in 2015 at 12 child health care centers in Sweden. The project aimed to test a two-step method for talking about intimate partner violence with mothers (n = 198) at the child health care center. In this paper we disclose the experiences of the intervention from the perspective of the nurses (n = 13) who were educated and involved in the intervention.

    Methods: Data were collected by semi-structured interviews, analyzed by thematic analysis.

    Results: Five categories emerged: Using the two-step questionnaire method, Asking about IPV as an important issue, Being comfortable in the professional role and with asking about IPV, The importance of time and place in asking about IPV, and Spill-over effects.

    Conclusions: Asking mothers visiting the child health clinic about their experiences of intimate partner violence was seen as an important task. Using a questionnaire could facilitate asking, but the questionnaire must be short and easy to use. Furthermore, the time and place for initiating a talk about this sensitive topic must be carefully chosen.

    Relevance to clinical practice: The Violence in Families questionnaire was regarded as a useful tool and could thus be implemented in practice. However, it is important to offer education to the nurses prior to implementing a routine of asking about intimate partner violence in the child healthcare setting.

  • 5.
    Arenhall, Eva
    et al.
    Örebro University, School of Health and Medical Sciences. Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Kristofferzon, Marja-Leena
    Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Fridlund, Bengt
    School of Health Sciences, Jönköpings University, Jönköping, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences. Department of Anaesthesia and Intensive Care, Örebro University Hospital,Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    The female partners' experiences of intimate relationship after a first myocardial infarction2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11-12, p. 1677-1684Article in journal (Refereed)
    Abstract [en]

    Aim. This study aimed to explore and describe women's experience of intimate relationships in connection to and after their partner's first myocardial infarction. Background. Support from partners is important for recovery, but little is known about partners' experience of intimate relationships after myocardial infarction. Design. The study used an explorative, qualitative design. Methods. The first author interviewed 20 women having a partner who had suffered a first myocardial infarction during the preceding year. Qualitative content analysis was used to analyse the data. Findings. Three themes emerged: 'limited life space', 'sense of life lost' and 'another dimension of life'. The women described how their self-assumed responsibility led to a more stifling and limited life. Their sense of life lost was described in terms of deficits and feeling the loss. The women also described experiencing another dimension of life characterised by three subthemes: 'uncertainty of life', 'certain of relationship' and 'share life more'. Conclusions. The partners' myocardial infarction had an impact on the interviewees' intimate relationships; they suffered a major loss and missed their 'former' partner, both emotionally and sexually. They struggled with the new asymmetry in their intimate relationship and felt compelled to adapt to their partners' lack of sexual desire or function. Also, their partner controlled them, which lead towards a stifling, more limited life space. Relevance to clinical practice. Caregivers in hospital and primary care settings could apply the findings in their efforts to help couples recover or maintain intimate relationships following myocardial infarction. 

  • 6.
    Arving, Cecilia
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Creating a new profession in cancer nursing?: Experiences of working as a psychosocial nurse in cancer care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2939-2947Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe the nature of being a psychosocial nurse in cancer care.

    BACKGROUND: Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

    DESIGN: A qualitative inductive interview approach was used.

    METHODS: A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

    RESULTS: The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

    CONCLUSIONS: This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. RELEVANCE TO CLINICAL PRACTICES: The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

  • 7.
    Bergdahl, Elisabeth
    et al.
    Dalens Hospital, Unit of Palliative Care, Enskededalen, Sweden.
    Wikström, Britt-Maj
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Andershed, Birgitta
    Örebro University, Department of Health Sciences. Ersta Sköndal University College, Stockholm, Sweden.
    Esthetic abilities: a way to describe abilities of expert nurses in palliative home care2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 4, p. 752-760Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this paper is to focus on the abilities needed to create the caring relation in palliative home care and to find ways to describe these abilities and skills from an esthetic perspective.

    BACKGROUND: Nurses in Palliative home care have to create a functioning relationship between themselves the patient and the patient's next of kin, this puts special demands on the nurse. A number of abilities, such as creativity, intuition, empathy and self-knowledge are mentioned in literature related to the caring relation. Many nursing theorists have referred to the art and esthetic of nursing when trying to describe these abilities.

    METHODS: Data were collected using semi-structured interviews with eight expert nurses in palliative home care. The transcribed interviews were analysed using qualitative content analyses.

    FINDINGS: Three main categories where found: The will to do good, Knowledge and Perceptiveness. Subcategories that can be seen as abilities where found in the main categories knowledge and perceptiveness.

    CONCLUSIONS: The main categories can be seen as expressions for abilities, personal qualities and skills needed to create the caring relation in palliative home care. We found interesting connections between the three main categories and the concepts of esthetics, ethics and science. We also found that nurses develop in a way, i.e. similar to an artist.

    RELEVANCE TO CLINICAL PRACTICE: The concepts brought forward in this paper could be used in clinical supervision and education as well as in clinical practice. If nurses think about the three aspects: Knowledge, the will to do good and perceptiveness, the chance for a positive relation between the nurse and the patient, and the patient's next of kin might increase. One could speculate that perceptiveness is a vital ability in order to achieve the expert level of nursing and that this perspective should be taken in consideration when recruiting nurses and in curriculum development.

  • 8.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bisholt, Birgitta
    Dept Nursing, Karlstad university, Karlstad, Sweden.
    Engström, Agneta Kullén
    Sch Hlth, Högskolan i Borås, Borås, Sweden.
    Ohlsson, Ulla
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sundler, Annelie Johansson
    Sch Life Sci, Högskolan i Skövde, Skövde, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Swedish nursing students' experience of stress during clinical practice in relation to clinical setting characteristics and the organisation of the clinical education2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, p. 2264-2271Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe nursing students' experience of stress during clinical practice and evaluate the risk of stress in relation to the clinical setting characteristics and the organisation of the clinical education.

    BACKGROUND: Stress during clinical practice is well documented, but there is a lack of knowledge concerning whether the clinical setting characteristics and the organisation of the education make a difference.

    DESIGN: A cross-sectional study with evaluative design.

    METHODS: Data were collected by means of a numerical rating scale for the assessment of stress and questions about the clinical setting characteristics and the organisation of the education. One hundred and eighty-four students who had completed their final year on the nursing programme at three universities in Sweden were included.

    RESULTS: Nearly half of the students (43%) experienced high level of stress during clinical practice. Measured by decision in the tree analysis, the absolute risk of stress was 57% in students with placements in hospital departments, as compared to 13% in students with placements in other clinical settings. The risk of stress increased to 71% if the students with placement in a hospital took the national clinical final examination. Performance of practice in a hospital department overcrowded with patients was also associated with increased risk of stress. The organisation of supervision and number of students at the clinical placement had an effect on the experience of stress, but did not prove to be risk factors in the analysis.

    CONCLUSIONS: The risk of stress in nursing students during their clinical practice differs depending on clinical setting characteristics. The taking of the national clinical final examination could be a source of stress, but this requires further investigation.

    RELEVANCE TO CLINICAL PRACTICE: It is important that supervisors are aware that students in hospital departments overcrowded with patients are at risk of stress and may have increased need of support.

  • 9.
    Blomberg, Karin
    et al.
    Örebro University, Department of Health Sciences.
    Sahlberg-Blom, Eva
    Örebro University, Department of Health Sciences.
    Closeness and distance: a way of handling difficult situations in daily care2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 2, p. 244-254Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The aim of this study was to describe how care team members caring for patients with advanced cancer describe how they handle difficult situations in daily care. In this paper 'difficult situations' refers to those situations team members themselves describe as difficult. Background. Serious illness and impending death involve great changes in a person's life. The care of patients with advanced cancer is complex and many different factors influence each care situation. This places demands on the way care team members handle problems and difficulties in daily care. Design. Qualitative descriptive study. Methods. The study is based on 16 focus group discussions with care team members who were caring for patients with advanced cancer at three different care units in two Swedish cities. The focus group discussions included 77 participants. The procedure for data analysis was inspired by the phenomenological method. Findings. The results show that care team members handled difficult situations by balancing between being close and distancing themselves. In most situations their choice of strategy seemed spontaneous rather than being a conscious decision, although it was sometimes described as a more conscious approach. Variations of closeness and distance that were identified were Identity, Meaning, Limit-setting and touching, Prioritization, the Team and the Organization. These could also be seen as tools that could facilitate or impede the use of closeness and distance. Conclusions. The results show that care team members have a need to reflect over daily care and to become aware of what governs different care actions. Relevance to clinical practice. If the experienced difficult situation is not handled in a way that is beneficial to the care team member, patient and relatives, it is assumed that this can result in stress, burnout and, above all, non-optimal care.

  • 10.
    Bosse, Ek
    et al.
    Mid Sweden University, Östersund, Sweden.
    Svedlund, Marianne
    Mid Sweden University, Östersund, Sweden.
    Registered nurses’ experiences of their decision-making at an Emergency Medical Dispatch Centre2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 7-8, p. 1122-1131Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe registered nurses experiences at an Emergency Medical Dispatch Centre.

    Background: It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patients arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses.

    Design: A qualitative design was used for this study.

    Methods: Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used.

    Results: Two themes emerged during the analysis: ‘Having a profession with opportunities and obstacles’ and ‘Meeting serious and difficult situations’, with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned.

    Conclusions: Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses.

    Relevance to clinical practice: Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame-free culture are important factors to attract and retain employees.

  • 11.
    Boström, Katrin
    et al.
    Department of Health and Medical Services, Örebro County Council, University Health Care Center, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences.
    A family matter: when a parent is diagnosed with multiple sclerosis. A qualitative study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 1053-1061Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim was to explore and describe from a triple perspective - that of the ill parent, the healthy parent and the children - experienced issues that are important to acknowledge and act upon to make it easier for a child to cope when a parent is diagnosed with multiple sclerosis.

    Background: A chronic disease affects the whole family and has a substantial impact on the children. Traditionally, the focus is on the patient, and communication with other family members is not generally integrated into health care. Health care professionals need to be aware of a child's needs when a parent is diagnosed with multiple sclerosis.

    Design: A qualitative design using content analysis with an inductive approach was used.

    Methods: Nine focus group interviews were conducted with the ill parents, the healthy parents and the children separately.

    Results: Participants jointly indicated that family members need to be recognised, both initially and onwards in their everyday lives. Seven categories were defined: Prerequisites within the families, Initial reactions, Trying to adapt and manage, Developing strategies, Everyday life, Thoughts about the future and Support from health care providers. Together they constituted the theme that multiple sclerosis is a family matter. Both ill and healthy parents wished for support from health care professionals in addressing their children's needs.

    Conclusions: Health care professionals need to pay attention to children as a parent's illness affects them. Not only the children would benefit, but so would their parents, as their worries for their children would be reduced.

    Relevance to clinical practice: Staff can be advised to pay attention to the parenting role, how the parenting role and parent-child relationship may change as a result of a chronic disease. Parents may need reassurance and benefit from advice about how to talk to their children about their condition and its impact.

  • 12.
    Bove, Dorthe Gaby
    et al.
    Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark.
    Zakrisson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Midtgaard, Julie
    Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; The University Hospital Centre for Health Research, Copenhagen University Hospital, Rigshospitalet, København, Denmark.
    Lomborg, Kirsten
    Section for Nursing, Department of Clinical Medicine and Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
    Overgaard, Dorthe
    Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
    Undefined and unpredictable responsibility: a focus group study of the experiences of informal caregiver spouses of patients with severe COPD2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 3-4, p. 483-493Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To explore how spouses of patients with severe chronic obstructive pulmonary disease experience their role as informal caregiver.

    Background: Informal caregiver spouses are of pivotal importance in the way that patients with chronic obstructive pulmonary disease cope with their daily life, including their opportunity to stay at home and avoid hospitalisations in the last stages of the disease. However, caregiving is associated with increased morbidity and mortality among caregivers. Further understanding of the role as an informal caregiver spouse of patients with severe chronic obstructive pulmonary disease is needed to develop supportive interventions aimed at reducing the caregiver burden.

    Design: The study had a qualitative exploratory design. The data collection and analysis were based on framework method. Framework method is a thematic methodology and consists of five key stages: familiarisation, identifying a thematic framework, indexing, charting and mapping & interpretation.

    Methods: Three focus groups were conducted in November 2013 with 22 spouses of patients with severe chronic obstructive pulmonary disease.

    Results: Undefined and unpredictable responsibility was found to be the overarching theme describing the informal caregiver role. Underlying themes were: being constantly in a state of alertness, social life modified, maintaining normality, ambivalence in the relationship and a willingness to be involved.

    Conclusions: The informal caregiver spouses experienced ambiguity about expectations from their private and the health professionals' surroundings. The informal caregiver spouses wanted to provide meaningful care for their partners, but sought knowledge and support from the health professionals.

    Relevance to clinical practice: We recommend that nurses take on the responsibility for including the informal caregiver spouses in those aspects of decision-making that involve the common life of the patients and their spouses.

  • 13.
    Brobeck, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bergh, Håkan
    Odencrants, Sigrid
    Örebro University, School of Health and Medical Sciences.
    Hildingh, Cathrine
    Primary healthcare nurses' experiences with motivational interviewing in health promotion practice2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 23-24, p. 3322-3330Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of the study was to describe primary healthcare nurses' experiences with motivational interviewing as a method for health promotion practice. Background. A person's lifestyle has a major effect on his or her health. Motivational interviewing is one way of working with lifestyle changes in health promotion practice. The basic plan of motivational interviewing is to help people understand their lifestyle problems and make positive lifestyle changes. Motivational interviewing has been proven to be more effective than conventional methods in increasing patient motivation. Design. This study has a descriptive design and uses a qualitative method. Methods. Twenty nurses who worked in primary health care and actively used motivational interviewing in their work were interviewed. Qualitative content analysis was used to process the data. Results. The primary healthcare nurses' experiences with motivational interviewing as a method of health promotion practice demonstrate that motivational interviewing is a demanding, enriching and useful method that promotes awareness and guidance in the care relationship. The results also show that motivational interviewing is a valuable tool for primary healthcare nurses' health promotion practice. Conclusion. This study shows that motivational interviewing places several different demands on nurses who use this method. Those who work with motivational interviewing must make an effort to incorporate this new method to avoid falling back into the former practice of simply giving advice. Maintaining an open mind while implementing motivational interviewing in real healthcare settings is crucial for nurses to increase this method's effectiveness. Relevance to clinical practice. The nurses in the study had a positive experience with motivational interviewing, which can contribute to the increased use, adaption and development of motivational interviewing among primary healthcare professionals. Increased motivational interviewing knowledge and skills would also contribute to promotion of health lifestyle practices.

  • 14.
    Carlander, Ida
    et al.
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences.
    Hellström, Ingrid
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Ternestedt, Britt-Marie
    Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden; Research and Development Unit, Stockholm Sjukhem Foundation, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    The modified self: family caregivers’ experiences of caring for a dying family member at home2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 7-8, p. 1097-1105Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore situations in daily life that challenge caregivers' self-image when caring for a dying family member at home.

    Background: Caregiving affects the health and daily lives of family caregivers. Patterns of challenging situations may provide insight into the home caregiving experience, thus contributing to our understanding of the influence it has on the caregivers' self-image.

    Design: Qualitative descriptive study.

    Methods: Ten family caregivers who cared for a dying family member at home with support from an advanced home care team were interviewed 6-12 months after the death of the family member. The interviews were analysed with interpretive description.

    Result: Three patterns characterised the experiences of caregivers' daily lives in caring for a dying family member at home: challenged ideals, stretched limits and interdependency. These patterns formed the core theme, the modified self. Situations that challenged the caregivers' self-image were connected to experiences such as 'forbidden thoughts', intimacy and decreasing personal space.

    Conclusions: The caregivers met challenging situations in their daily lives that created a modified image of self. It is important to recognise the impact of caring for a dying family member at home.

    Relevance to clinical practice: This study argues for supporting family caregivers to maximise their potential to handle the demanding everyday life with a dying family member at home. This study contributes to understanding situations in the home that may challenge caregivers' self-image and points out the importance of talking about caregiving experiences. From a clinical perspective, this study emphasises the significance of creating a climate, which allows family caregivers to express thoughts and feelings. Sharing experiences such as 'forbidden thoughts' can be one way of handling the profoundly changed every day life.

  • 15.
    Carlsson, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eldh, Ann Catrine
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Accuracy and continuity in discharge information for patients with eating difficulties after stroke2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 1-2, p. 21-31Article in journal (Refereed)
    Abstract [en]

    Aims: To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke.

    Design: Prospective, descriptive.

    Methods: The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics.

    Results: Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities.

    Conclusions: Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking.

    Relevance to clinical practice: Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 16.
    Carlsson, Eva
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Stroke and eating difficulties: long-term experiences2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 7, p. 825-834Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have shown that eating difficulties after stroke are common and often associated with communication problems. These difficulties, however, have mainly been studied from a professional perspective. Although numerous aspects of dysfunction have been identified, little knowledge exists about the experiences of living with eating difficulties. AIM: To explore how people affected by stroke experience living with eating difficulties, during a prolonged period. DESIGN: Explorative, qualitative case study. METHODS: Repeated interviews and participant observations with three persons 1.5-2 years after their last stroke. Data were analysed using qualitative analysis. RESULTS: Eating difficulties after stroke were experienced as Striving to live a normal life, with the subthemes Abandoned to learn on one's own, Experiences of losses and Feeling dependent. The process of getting back to a life that resembled life before the stroke was experienced as long-lasting and hard work. The informants felt that they were abandoned to manage eating training on their own. The informants experienced a loss of functional eating ability and the ability to perform activities related to food and meals. Feelings of dependence were experienced in mealtime situations. CONCLUSION: Living with eating difficulties after stroke is a complex phenomenon. The informants felt abandoned because of lack of support from the nursing staff. They were left on their own to deal with the difficult process of adjusting to a new way of eating and losses regarding mealtime activities. The combination of repeated interviews and participant observations seemed to be an approach that should be tested in larger studies. RELEVANCE TO CLINICAL PRACTICE: This case study indicates a need for nurses to develop and use evidence-based guidelines for eating training during the continuum of care. Nurses need to assess patient's habits and desires related to eating, and to adjust environment according to patient preferences.

  • 17.
    Carlsson, Sofia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Carlsson, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    'The situation and the uncertainty about the coming result scared me but interaction with the radiographers helped me through': a qualitative study on patients' experiences of magnetic resonance imaging examinations2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 21-22, p. 3225-3234Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo describe patients' expectations before and experiences during a head-first magnetic resonance imaging scan. BackgroundPrevious studies have reported that patients experience fear and anxiety leading to discomfort before, during and after magnetic resonance imaging scans. Frequent problems persist in producing high-quality images due to motion artefacts. These results imply a need for improvement of patient conditions to allow for the added benefit of better diagnostic quality. Provision of extended written information has not appeared to reduce patients' stress, while interaction with staff has been described as the most important factor for reducing such feelings. Design and methodsA qualitative, phenomenological approach. Semi-structured interviews were conducted, and data were analysed with systematic text condensation. ResultsThe experiences of the ten participants were encapsulated by the main theme: The situation and the uncertainty about the coming result scared me but interaction with the radiographers helped me through'. Subthemes were Prescan preparation', Mastering threats to self-control' and Personal achievements by completing the scan'. ConclusionsOur study has provided a deeper understanding of the expectations before, and experiences during, a head-first magnetic resonance imaging scan. Valuable insight into patients' apprehension about written and verbal information was obtained. The patients reported how they coped with the unfamiliar and stressful magnetic resonance imaging scanning procedure. A trustful dialogue with the radiographer was described as being crucial for patients' ability to manage fear, discomfort and feelings of loss of self-control. We suggest a need for individualised information based on patient participation. Relevance to clinical practiceRadiographers, as well as nurses caring for patients who will undergo magnetic resonance imaging examinations, should recognise the difficulties inherent in written information. It is also of importance to adjust the patient-radiographer interaction to address patients' expressions of worries about the scanning procedure or the following result.

  • 18.
    Duprez, Veerle
    et al.
    University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Vansteenkiste, Maarten
    Department of developmental, personality and social psychology, Ghent University, Ghent, Belgium.
    Beeckman, Dimitri
    Örebro University, School of Health Sciences. University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
    Verhaeghe, Sofie
    University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; VIVES University College - Department Health Care, Roeselare, Belgium.
    Van Hecke, Ann
    University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium.
    Is nurses' self-esteem interwoven with patients' achievements? The concept of patient-invested contingent self-esteem2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To explore the notion of Patient-invested Contingent Self-Esteem (Pa-CSE) and investigate its association to nurses' self-reported engagement in controlling or autonomy-supportive interactions with chronic care patients.

    BACKGROUND: Considering the high number of patients sub-optimally managing their chronic condition, nurses might experience a drop and rise in self-worth when patients fail and succeed, respectively, in managing their chronic condition. This dynamic has not received prior research attention.

    DESIGN: Multivariate analysis employing cross-sectional data according to STROBE guidelines.

    METHODS: Self-reports among nurses employed in chronic care (N=394) from eight randomly selected hospitals in Belgium. Exploratory factor analysis and stepwise linear regression analyses were conducted.

    RESULTS: Success-based and failure-based orientations could be distinguished and refer to nurses' tendency to associate, respectively, patients' successes with feelings of professional success and self-worth and patients' failures with feelings of professional failure, shame, and inadequacy. Nurses' self-esteem is fairly interwoven with patients' achievements in the management of their chronic condition. A success-based orientation was positively related to autonomy-supportive care in case a failure-based orientation was low. Nurses with a simultaneous success-based and failure-based orientation interacted in a more controlling way.

    CONCLUSIONS: The findings of this study suggest that basing one's self-worth on patients' accomplishments may be a double-edged sword. Although tying one's personal glory to the successes of one's patient is related to greater patient participation and support of autonomy, these effects only emerge if nurses' self-worth is not interwoven with patients' failures. In fact, having both success- and failure-oriented contingent self-worth is related to a more pressuring approach.

    RELEVANCE TO CLINICAL PRACTICE: To prevent nurses from developing inferior professional feelings when their patients fail to manage their condition, a reflective stance towards the impact of patients' behaviour on the nurses' professional feeling of (in)adequacy is an important step to deal with such situations.

  • 19.
    Ehrenberg, Anna
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Department of Health and Society, Dalarna University, Falun .
    Ehnfors, Margareta
    Örebro University, Department of Nursing and Caring Sciences.
    Ekman, Inger
    Institute of Nursing, Sahlgrenska Academy at Göteborg University, Göteborg.
    Older patients with chronic heart failure within Swedish community health care: a record review of nursing assessments and interventions2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 1, p. 90-6Article in journal (Refereed)
    Abstract [en]

    Background: Older patients with chronic heart failure constitute a large group within community home care that is at high risk for re-hospitalization. However, hospital readmission can be prevented if early signs of deterioration are recognized and proper interventions applied.

    Aims and objectives: The aim of the study was to audit nursing care for older chronic heart failure patients within the Swedish community health care system.

    Design: The study adopted a retrospective descriptive design.

    Methods: In a Swedish urban municipality nursing documentation from 161 records on patients diagnosed with chronic heart failure was collected retrospectively from community nursing home care units. Patient records were reviewed for characteristics of nursing care and assessed for comprehensiveness in recording.

    Results: The main results showed that medical care of patients with chronic heart failure was poorly recorded, making it possible only to follow fragments of the care process. The nursing notes showed poor adherence to current clinical guidelines. Only 12% of the records contained notes on patients' body weight and only 4% noted patients' knowledge about chronic heart failure. When interventions did occur, they largely consisted of drug administration.

    Conclusions: The findings revealed flaws in the recording of specific assessment and interventions as well as poor adherence to current international clinical guidelines.

    Relevance to clinical practice: Supportive guidelines available at the point of care are needed to enhance proper community-based home health care for older patients with chronic heart failure.

  • 20.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences.
    Commentary on Arikan D et al. (2008) Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic. Journal of Clinical Nursing 17, 1754-1761.2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 21, p. 2945-2947Article in journal (Refereed)
  • 21.
    Feo, Rebecca
    et al.
    Adelaide Nursing School, University of Adelaide, Adelaide SA, Australia.
    Conroy, Tiffany
    Adelaide Nursing School, University of Adelaide, Adelaide SA, Australia.
    Jangland, Eva
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Uppsala University Hospital, Uppsala, Sweden.
    Muntlin Athlin, Asa
    Uppsala University Hospital, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Brovall, Maria
    School of Health and Education, University of Skövde, Skövde, Sweden; .
    Parr, Jenny
    Auckland University of Technology, Auckland, New Zealand; Middlemore Hospital, Auckland, New Zealand.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Kitson, Alison
    College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Adelaide Nursing School, University of Adelaide, Adelaide, Australia.
    Towards a standardised definition for fundamental care: a modified Delphi study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2285-2299Article in journal (Refereed)
    Abstract [en]

    AIMS: To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.

    BACKGROUND: There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.

    DESIGN: Modified Delphi study.

    METHODS: Three phases: (1) engaging stakeholders via an interactive workshop; (2) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (3) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n=38; Round 2 n=28).

    RESULTS: Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.

    CONCLUSIONS: This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users.

    Relevance to clinical practice: The definition and elements, through ongoing refinement, will contribute to a robust evidence base that will underpin policy development and the systematic and effective teaching, delivery, measurement and evaluation of fundamental care.

  • 22.
    Finnbakk, Elisabeth
    et al.
    Lovisenberg Deaconal Univ Coll, Oslo, Norway .
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fagerström, Lisbeth
    Høgskolen i Buskerud, Kongsberg, Norway.
    Olesen, Mette Anne
    VIA, Univ Coll, Aarhus, Denmark .
    Store, Ellen Blix
    Bodö Univ Coll, Bodö, Norway .
    Larsen, Reidun
    Lovisenberg Deaconal Univ Coll, Oslo, Norway.
    Kulla, Gunilla
    Appl Sci, Novia Univ, Vaasa, Finland.
    Ahonen, Pia
    Appl Sci, Turku Univ, Turku, Finland.
    An optimal future care for older people in the Nordic countries2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no Suppl. 1, p. 127-127Article in journal (Other academic)
  • 23.
    Florin, Jan
    et al.
    Department of Health and Social Sciences, Högskolan Dalarna, Falun.
    Ehrenberg, Anna
    Department of Health and Social Sciences, Högskolan Dalarna, Falun.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Clinical decision-making: predictors of patient participation in nursing care2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 21, p. 2935-2944Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care.

    Background: Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity.

    Design: A cross-sectional survey of 428 persons, newly discharged from inpatient care.

    Methods: The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation.

    Results: Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision-making in nursing care.

    Conclusions: Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient.

    Relevance to clinical practice: The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients' basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

  • 24.
    Fonad, Edit
    et al.
    Karolinska institutet.
    Robins Wahlin, Tarja-Brita
    Karolinska institutet.
    Winblad, Bengt
    Karolinska institutet.
    Emami, Azita
    Karolinska institutet.
    Sandmark, Helene
    Örebro University, School of Health and Medical Sciences.
    Falls and fall risk among nursing home residents2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 1, p. 126-134Article in journal (Refereed)
    Abstract [en]

    Aim and objectives. The aim of this study was to identify risk factors for falls in older people living in nursing homes.Background. Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved.Method. The study was carried out over four years (2000–2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom-restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient-bound. The study covered 2343 reported incidents.Results. There was a significant correlation between falls and fractures (r = 0·365, p = 0·004), fall risk and use of wheelchairs (r = 0·406, p = 0·001, safety belts (r = 0·403, p = 0·001 and bed rails (r = 0·446, p = 0·000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0·352, p = 0·005). Associations were also found between fall risk and the use of anti-depressants (r = 0·412, p = 0·001).Conclusion. In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti-depressants and sleeping pills, especially benzodiazepines

  • 25. Fossum, Mariann
    et al.
    Alexander, Gregory L.
    Göransson, Katarina E.
    Ehnfors, Margareta
    Örebro University, School of Health and Medical Sciences.
    Ehrenberg, Anna
    Örebro University, School of Health and Medical Sciences.
    Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2425-2435Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore the thinking strategies and clinical reasoning processes registered nurses use during simulated care planning for malnutrition and pressure ulcers in nursing home care.

    Background: Clinical reasoning is an essential component of nursing practice. Registered nurses’ thinking strategies and clinical reasoning have received limited attention in nursing science. Further research is needed to understand registered nurses’ clinical reasoning, especially for prevention of malnutrition and pressure ulcers as they are important quality indicators of resident care in nursing homes.

    Design: A qualitative explorative design was used with a think-aloud interview technique.

    Methods: The transcribed verbalisations were analysed with qualitative deductive content analysis. Data were collected during six months in 2007-2008 from 30 registered nurses at nine nursing homes in Norway.

    Results: The registered nurses used a variety of thinking strategies, but there were differences in the frequency of use of the different strategies. The three most commonly used thinking strategies were ‘making choices’, ‘forming relationships’ and ‘drawing conclusions’. None of the nurses performed a structured risk assessment of malnutrition or pressure ulcers. Registered nurses started with assessing data from the scenarios, but after a short and elementary assessment they moved directly to planning.

    Conclusion: Many different thinking strategies were used in registered nurses’ clinical reasoning for prevention of malnutrition and pressure ulcers. The thinking strategy ‘making choices’ was most commonly used and registered nurses’ main focus in their reasoning was on planning nursing interventions. Relevance to clinical practice. This study showed that most of the registered nurses go directly to planning when reasoning clinically about residents in nursing homes. A lack of systematic risk assessments was identified. The insight gained from this study can be used to recommend improvements in tools designed for nursing homes to support the registered nurses.

  • 26.
    Fransson, Eleonor
    et al.
    School of Health Sciences, Jönköpings University, Jönköping, Sweden.
    Arenhall, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Steinke, Elaine E
    Sch Nursing, Wichita State University, Wichita KS, USA.
    Fridlund, Bengt
    School of Health Sciences, Jönköpings University, Jönköping, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Perceptions of intimate relationships in partners before and after a patient's myocardial infarction2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 15-16, p. 2196-2204Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe and explore how partners rate their intimate relationship before and after the patients' first myocardial infarction. A further aim was to investigate the association between partners' rating of their intimate relationship and self-rated health.

    BACKGROUND:

    To date, information on how partners experience the intimate relationship before and after a patient's myocardial infarction is sparse.

    DESIGN:

    A descriptive and exploratory design with longitudinal data collection.

    METHODS:

    The study comprised 127 partners, aged 34-87 years. Data collection included self-reported information on socio-demographic data, intimate relationship and self-rated health one year before and one year after patients' first myocardial infarction. Intimate relationship was assessed by the Swedish version of the Relationship Assessment Scale. Self-rated health was evaluated by the EuroQoL visual analogue scale.

    RESULTS:

    In general, partners reported high satisfaction with their intimate relationship both before and after the patients' myocardial infarction. Women reported somewhat lower ratings in their intimate relationship than men before the myocardial infarction. Women increased their ratings after one year, while men on average decreased their ratings. Partners with higher education reported lower ratings for intimate relationship after one year. Those with children living at home rated intimate relationship lower than those without children living at home after one year. Partners' self-rated health status was stable over time. No significant association between intimate relationship and self-rated health was found.

    CONCLUSIONS:

    This study provides important insights regarding couples' relationships from the perspective of the partner. Socio-demographic factors such as sex, educational level, having children living at home and employment status may influence how the relationship, from the partners' perspective, is affected by a myocardial infarction event.

    RELEVANCE TO CLINICAL PRACTICE:

    This study provides insight into how partners rate their intimate relationship and self-rated health over time before and after patients' myocardial infarction.

  • 27.
    Franzén-Dahlin, Åsa
    et al.
    Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Larson [Windahl], Jenny
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Karolinska Institutet Danderyd Hospital; and Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Murray, Veronica
    Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Wredling, Regina
    Karolinska Institutet Danderyd Hospital, Stockholm, Sweden; Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Billing, Ewa
    Karolinska Institutet Danderyd Hospital, Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Predictors of psychological health in spouses of persons affected by stroke2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 5, p. 885-891Article in journal (Refereed)
    Abstract [en]

    AIM: To identify predictors of psychological health and examine if these predictors change over time in spouses of stroke patients during the first year after stroke. A second aim was to identify gender differences in psychological health among the spouses.

    BACKGROUND: The impact of burden in long-term caregivers may result in psychological consequences for the spouse. The rehabilitation process for the patient can be negatively affected by a stressed caregiver and result in long-term hospitalization. To identify spouses at risk for physical and psychological distress is, therefore, essential to support those in need.

    DESIGN: Longitudinal, comparative study.

    METHODS: One hundred spouses of stroke patients were assessed at baseline, as well as after six and 12 months, regarding psychological health, well-being, own illness, need of assistance from general practitioner and/or district nurse, social network and knowledge about stroke. Stepwise multiple regression analyses were conducted for baseline, six- and 12-month assessments, respectively, with psychological health as the dependent variable.

    RESULTS: General well-being and presence of illness in spouse were the most prominent predictors of psychological health, throughout the first year.

    CONCLUSIONS: Enhancing psychological health and preventing medical problems in the caregiver are essential considerations to enable patients with stroke-related disabilities to continue to live at home.

    RELEVANCE TO CLINICAL PRACTICE: Evaluating the situation for spouses of stroke patients is an important component when planning for the future care of the patient.

  • 28.
    Franzén-Dahlin, Åsa
    et al.
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Laska, Ann-Charlotte
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Larson [Windahl], Jenny
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Wredling, Regina
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Billing, Ewa
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Murray, Veronica
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Predictors of life situation among significant others of depressed or aphasic stroke patients2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 12, p. 1574-1580Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to examine predictors of the life situation of the significant other of depressed or aphasic stroke patients.

    BACKGROUND: Depression and aphasia are common consequences of stroke, and both may put pressure on the significant other who have to deal not only with a possible physical handicap but also with communication and/or serious psychiatric difficulties.

    DESIGN: Descriptive, cross-sectional study.

    METHODS: The participants were significant others of 71 depressed and 77 aphasic stroke patients. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder, and degree of aphasia was diagnosed with the Amsterdam Nijmegen Everyday Language Test. Assessments of the life situation, state of depression and aggression, personality change and need of assistance were made through questionnaires issued to the significant others.

    RESULTS: Perceived need of assistance was the only common predictor of life situation of the significant other in both groups (p < 0.001). With respect to the aphasic patients, perceived personality change (p < 0.001) and living with the patient (p = 0.004) were factors that had a negative effect on the life situation of the significant other.

    CONCLUSIONS: This study highlights that the perception of the patient's need of assistance is an important factor in predicting the life situation among spouses of depressed as well as aphasic stroke patients. A comparison of the two groups to explain the life situation of the significant others revealed greater explanatory power for the aphasic group.

    RELEVANCE TO CLINICAL PRACTICE: Assessments of the spouses' perception as well as of the patients' factual situation may identify those significant others at risk. With this new approach, necessary steps may be taken to alleviate pressure on the significant other.

  • 29.
    Granrud, Marie Dahlen
    et al.
    Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway; Faculty of Health, Science and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Health, Science and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden.
    Bisholt, Birgitta
    Faculty of Health, Science and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden.
    Steffenak, Anne Kjersti Myhrene
    Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
    Public Health Nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: a phenomenographic study2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 15-16, p. 2899-2910Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway.

    BACKGROUND: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10-20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools.

    DESIGN: Qualitative interviews were conducted with 18 public health nurses working in the school health services.

    METHOD: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist.

    RESULT: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are: 'The formal structure has an impact on interprofessional collaboration'; 'The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration'; and 'The primary players are the teachers in collaboration'.

    CONCLUSION: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible.

    RELEVANCE TO CLINICAL PRACTICE: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school. This article is protected by copyright. All rights reserved.

  • 30.
    Gustafsson, Margareta
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Ahlström, Gerd
    Örebro University, Department of Nursing and Caring Sciences. Centre for Nursing Research,Örebro University Hospital,Örebro, Sweden.
    Problems experienced during the first year of an acute traumatic hand injury: a prospective sudy2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 8, p. 986-995Article in journal (Refereed)
    Abstract [en]

    Background. Evidence-based nursing of patients with acute traumatic hand injuries treated at the hand-surgical clinic calls for knowledge about long-term implications. Aims and objectives. The aim of the study was to investigate consequences of an acute traumatic hand injury during the first year after the accident. Specifically, the objectives were to investigate changes in the experience of physical and psychological problems over time, frequencies of remaining problems and the impact of the injury on work situation and life situation 1 year after the accident.

    Design. The study was prospective and followed the patients from the first weeks to 1 year after the accident. Method. Ninety-one patients were assessed three times during the year. Each time the patients answered study-specific questions, the Impact of Event Scale and the Hospital Anxiety and Depression Scale.

    Results. Problems experienced decreased during the first 3 months but tended to remain unchanged during the rest of the year. In the 1-year follow-up, the majority of the patients experienced slight or moderate functional limitations in the hand, onethird had symptoms of trauma-related distress and one out of seven had troublesome pain. Half of the patients who had returned to work reported a worse work situation and 16% were still on the sick list. One-third of all patients considered their whole life situation to be worse as a result of the injury. Patients with amputations more often experienced a worse life situation. Blue-collar workers reported functional limitations and a worse life situation more often than white-collar workers.

    Conclusions. Patients with acute traumatic hand injuries requiring surgical treatment may experience problems, such as functional limitations, trauma-related distress and troublesome pain, with long-term implications for their work situation and life situation. Relevance to clinical practice. Caring for hand-injured patients should include, not only surgical treatment and other actions for restoring the function of the hand, but also preventive action and follow-up of trauma-related distress and pain.

  • 31.
    Gustafsson, Margareta
    et al.
    Örebro University, Department of Nursing and Caring Sciences. Department of Orthopaedic Surgery, Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden; Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden.
    Persson, Lars-Olof
    Associate Professor/Senior Lecturer, Department of Nursing, University of Gothenburg, Gothenburg, Sweden.
    Amilon, Anders
    Head of the Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
    A qualitative study of coping in the early stage of acute traumatic hand injury2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 5, p. 594-602Article in journal (Refereed)
    Abstract [en]

    Twenty patients with acute traumatic hand injury were interviewed 8-20 days after the day of the accident. The aim of the study was to identify coping strategies, defined as thoughts or actions used by the hand-injured patients to manage stress factors and resulting emotions in the early stage. Stress factors were reported in an earlier study. The analyses of the interviews followed the first steps in the analytical process described in a modified model of grounded theory. Eleven different coping strategies were identified in the interviews. By "comparing with something worse", "positive thinking", "relying on personal capacity", "distancing" and "distracting attention" the patients tried to play down the seriousness of the problem or situation. Other coping strategies used by the hand-injured were "accepting the situation", "seeking social support", "maintaining control", "solving practical problems by oneself", "pain-relieving actions" and "active processing of the trauma experience." The findings of the study show how important it is to identify the patient's own way of coping with a stressful illness situation in order to give adequate psychosocial support.

  • 32.
    Göransson, Carina
    et al.
    Örebro University, School of Health Sciences. School of Health and Welfare, Halmstad University, Halmstad, Sweden .
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
    Ziegert, Kristina
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Langius-Eklöf, Ann
    Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Irene
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Perspectives of health and self-care among older persons: to be implemented in an interactive interactive information and communication technology-platform2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4745-4755Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: To acquire knowledge regarding the contents to be implemented in an interactive ICT-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves.

    BACKGROUND: The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform (ICT-platform) could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals.

    DESIGN: Descriptive qualitative design.

    METHODS: This study was based on three samplings: a scoping review of the literature (n=20 articles), interviews with healthcare professionals (n=5), and a secondary analysis of interviews with older persons (n=8) and nursing assistants (n=7). The data were analysed using qualitative content analysis.

    RESULTS: Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons.

    CONCLUSIONS: The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive ICT-platform for use in regular daily care assessments. Descriptions of self-care was limited indicating a possible gap in knowledge that requires further research.

    RELEVANCE TO CLINICAL PRACTICE: Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.

  • 33.
    Göransson, Katarina E.
    et al.
    Örebro University, Department of Health Sciences.
    Ehrenberg, Anna
    Örebro University, Department of Health Sciences.
    Ehnfors, Margareta
    Örebro University, Department of Health Sciences.
    Triage in emergency departments: national survey2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 9, p. 1067-1074Article in journal (Refereed)
    Abstract [en]

    AIM:

    This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments.

    BACKGROUND:

    Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue.

    METHOD:

    A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden.

    RESULTS:

    The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings.

    CONCLUSION:

    In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended.

    RELEVANCE TO CLINICAL PRACTICE:

    The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

  • 34. Hrisanfow, Elisabet
    et al.
    Hägglund, Doris
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 97-105Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care.

    Background. Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant.

    Design. A questionnaire survey.

    Method. The study included 391 women and 337 men, aged 5075 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results. Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality-of-life scores, women with incontinence had lower physical state scores (37.6 +/- 10.4 vs. 41.4 +/- 9.9; p < 0.001) and mental state scores (44.3 +/- 10.2 vs. 47.1 +/- 10.5; p < 0.007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality-of-life scores, men with incontinence had lower mental state scores than did men without incontinence (46.0 +/- 9.7 vs. 49.8 +/- 9.7; p < 0.001).

    Conclusion. The present results indicate that cough and urinary incontinence lead to poor quality of life in women and men with chronic obstructive pulmonary disease.

    Relevance to clinical practice. In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.

  • 35.
    Hrisanfow, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hägglund, Doris
    Örebro University, School of Health and Medical Sciences.
    The prevalence of urinary incontinence among women and med with chronic obstructive pulmonary disease in Sweden2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 13-14, p. 1895-1905Article in journal (Refereed)
    Abstract [en]

    Aim.  The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with chronic obstructive pulmonary disease in primary health care.

    Background.  Information on the prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease is scant. Such knowledge may be important to the development of care for patients with chronic obstructive pulmonary disease.

    Design.  A questionnaire survey.

    Method.  The study included 391 women and 337 men, aged 50–75 years, with chronic obstructive pulmonary disease. A self-administered, evidence-based questionnaire for incontinence was used. A response rate of 66% was obtained, of which 89·3% had spirometry-confirmed chronic obstructive pulmonary disease, and most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results.  The prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease was 49·6 and 30·3%, respectively. Women and men with urinary incontinence had a significantly higher body mass index than did women and men without urinary incontinence. The most common type of incontinence in women was stress incontinence (52·4%) and in men postmicturition dribbling (66·3%). Women with urinary incontinence had a higher presence of a symptomatic cough than did women without urinary incontinence (p < 0·001). On the whole, incontinence affected women more than men concerning experienced bothersomeness of incontinence (p < 0·001). More women than men with urinary incontinence refrained from activities (p < 0·021) and had sought help for incontinence (p < 0·012).

    Conclusion.  The present results indicate that urinary incontinence content should be included in care plans for patients living with chronic obstructive pulmonary disease. In addition, the results imply that nurses and physicians working in primary health care should ask patients with chronic obstructive pulmonary disease about urinary incontinence and then offer appropriate assessment and management of it.

  • 36.
    Hägglund, Doris
    Örebro University, School of Health and Medical Sciences.
    A systematic literature review of incontinence care for persons with dementia: the research evidence2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 303-312Article, review/survey (Refereed)
    Abstract [en]

    Backgroud. Urinary/faecal incontinence in persons with dementia is a potentially treatable condition. However, which type of incontinence care is most appropriate for persons with dementia remains undecided. Aim. The aim of this study was to perform a systematic review of literature on incontinence care in persons with dementia focusing on assessment/management and prevention. Design. A systematic search of the literature. Method. The search was performed in the CINAHL, PubMed and Cochrane Library databases. Results. Of the 48 papers analysed, two were systematic literature reviews of management of urinary incontinence including persons with dementia. These reviews showed that the best-documented effect of toilet assistance for urinary incontinence in elderly persons with/without dementia had prompted voiding. However, prompted voiding in persons with dementia raises ethical concerns related to the person's integrity and autonomy. Timed voiding in combination with additional interventions like incontinence aids, staff training on the technique of transferring participants from bed to commode and pharmacological treatment decreased the number of urinary incontinence episodes in older persons with/without dementia. There is good scientific evidence that prevention of urinary incontinence in elders with/without dementia decreases incontinence or maintains continence. However, the evidence is insufficient to describe the state of knowledge of faecal incontinence. Conclusions. Toilet assistance, including timed voiding in combination with additional interventions and prompted voiding, are the available evidence-based interventions; however, nursing incontinence care is an experience-based endeavour for persons with dementia. Relevance to clinical practice. There is a lack of evidence-based nursing interventions related to incontinence care for persons with dementia. More research is needed to show whether experience-based incontinence care is effective and which activities are most appropriate for persons with dementia. However, the practice of effective nursing will only be realised by using several sources of evidence, namely research, clinical experience and patient experience.

  • 37.
    Hägglund, Doris
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ahlström, Gerd
    The meaning of women's experience of living with long-term urinary incontinence is powerlessness2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1946-1954Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI).

    BACKGROUND: Living with long-term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective.

    METHOD: Fourteen women with UI (range: 34-52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts.

    FINDINGS: The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub-themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub-themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness.

    RELEVANCE TO CLINICAL PRACTICE: Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self-care abilities

  • 38.
    Häggström, Elisabeth
    et al.
    Senior Lecturer, University of Gävle, V-institutionen, Gavle, Sweden; Neurotec-Department, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica
    Senior Lecturer, Neurotec-Department, Karolinska Institutet, Stockholm, Sweden; Centre of Nursing Science, University Hospital, Orebro, Sweden.
    Kihlgren, Mona
    Professor, Neurotec-Department, Karolinska Institutet, Stockholm, Sweden; Centre of Nursing Science, University Hospital, Orebro, Sweden.
    Sörlie, Venke
    Associate Professor, Centre of Nursing Science, University Hospital, Orebro, Sweden; Institute of Nursing and Health Sciences, University of Oslo, Oslo, Norway.
    Relatives' struggle for an improved and more just care for older people in community care2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 9, p. 1749-57Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of the present study was to describe the relatives' experience concerning older family members living in special housing facilities.

    BACKGROUND: During the 21st century, the relatives of older people and their efforts related to the care and nursing of older people have been observed. The interest in these relatives is because of factors such as demographic changes, where the number of older people has increased and the increasing gap between the resources that are available for geriatric care and the care needed for older people.

    DESIGN: The present study has a descriptive design and is part of a project including 24 specific residences, called special housing facilities.

    METHOD: The study focused on the narratives supplied by the relatives that were analysed using qualitative latent content analysis, an interpretative process where the researcher considers the content of the text.

    RESULTS: The relatives' experience of having an older person in a special housing facility that emerged from the study, was expressed in one main theme: The relatives' struggle for an improved and just care for older people and four sub-themes: (i)'To trust in caregivers'; (ii) 'To be confirmed'; (iii) 'To trust in care'; (iv) 'To receive the kind of care that one considers one has the right to receive'.

    CONCLUSIONS: The study shows that the relatives need more support and more opportunities, so that they can participate in the care. The study shows the relatives engagement in working for a just society's obligation towards the protection of older peoples rights and the staff's working conditions.

    RELEVANCE TO CLINICAL PRACTICE: It is important that caregivers and management working with older people realize that they, together with them and their relatives, are a part of society and that all individuals are influenced by the discourse of that society.

  • 39.
    Häggström, Elisabeth
    et al.
    University of Gävle, Gävle, Sweden; Neurotec-Department, Karolinska Institutet, Stockholm, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Neurotec-Department, Karolinska Institutet, Stockholm,Sweden; Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden.
    Fläckman, Birgitta
    University of Gävle, Gävle, Sweden; Neurotec-Department, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annica Larsson
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Neurotec-Department, Karolinska Institutet, Stockholm, Sweden; Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden.
    Kihlgren, Mona
    Örebro University, Department of Nursing and Caring Sciences. Neurotec-Department, Karolinska Institutet, Stockholm, Sweden: Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden.
    To feel betrayed and to feel that you are betraying the older residents: caregivers' experiences at a newly opened nursing home2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 6, p. 687-696Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses' Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care.

    AIMS AND OBJECTIVES: The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses' Aides. All were directly involved in patient care.

    DESIGN: The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi-experimental design.

    METHOD: The interviews were analysed with a phenomenological-hermeneutic method inspired by the philosophy of Ricoeur.

    RESULT: The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) 'Experience of betrayal' describes how the staff felt let down in several ways; (ii) 'Experience of failing others' describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) 'Experience of insufficiency' describes how the staff encountered overwhelming demands from several directions; (iv) 'Experience of work satisfaction' describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers' narratives.

    CONCLUSIONS: The study shows that the caregivers' experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed.

    RELEVANCE TO CLINICAL PRACTICE: The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.

  • 40.
    Häggström, Elisabeth
    et al.
    University of Gävle, Gävle, Sweden; Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm, Sweden.
    Skovdahl, Kirsti
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm.
    Fläckman, Birgitta
    University of Gävle, Gävle, Sweden; Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm, Sweden.
    Kihlgren, Annika L
    Örebro University, Department of Nursing and Caring Sciences. Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm.
    Kihlgren, Mona
    Örebro University, Department of Nursing and Caring Sciences. Centre of Excellence in Elderly Care Research, Neurotec Institute, Karolinska Institutet, Stockholm.
    Work satisfaction and dissatisfaction: caregivers' experiences after a two-year intervention in a newly opened nursing home2005In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 1, p. 9-19Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of the study was to investigate, from the narratives of nine enrolled nurses and one nurses' aide directly involved in patient care, the deeper meaning of work satisfaction and dissatisfaction when working with the older people.

    BACKGROUND: Both nationally and internationally, there is little research documented regarding the working situation of the enrolled nurses and nurses' aides who make up the majority of care for older people today. With this in mind, it is important to focus on how these occupational groups experience their work with the older residents in municipal care, following a two-year intervention.

    DESIGN: The study is part of a larger longitudinal study, with a quasi-experimental design within the municipal system of care for older people in Sweden. The investigation was carried out following a two-year intervention, which included: education, support and clinical supervision.

    METHOD: The interviews were performed 12 and 24 months after start of the intervention and were analysed with a phenomenological-hermeneutic method inspired by Ricoeur's philosophy.

    RESULTS: The findings from these narratives illustrated a change compared with the findings from the first interviews, when the nursing home had just opened. There was a shift from a dominance of dissatisfaction with work, to a dominance of work satisfaction and this was expressed in the following themes: experience of a changed perspective, experience of open doors, and experience of closed doors. Each theme emerged from several different subthemes and each subtheme that had been expressed in the caregivers' narratives was interpreted.

    CONCLUSIONS: The study shows that the caregivers' experience of work satisfaction in the workplace exceeded their experience of dissatisfaction and that the intervention, consisting of: education, support, and supervision might have facilitated this positive development where the older residents were prioritized. It also shows that communication and understanding between management and staff had increased as the nursing home had opened.

    RELEVANCE TO CLINICAL PRACTICE: The findings can be used to help to prevent work dissatisfaction, and thereby increase work satisfaction for caregivers working in nursing homes.

  • 41.
    Hälleberg Nyman, Maria
    et al.
    Örebro University, School of Health Sciences.
    Forsman, Henrietta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Ostaszkiewicz, Joan
    School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
    Hommel, Ami
    Faculty of health and Society, Department of Care, Science, Malmö University, Malmö, Sweden; Department of Orthopaedics, Skåne University Hospital, Lund, Sweden.
    Eldh, Ann Catrine
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Urinary incontinence and its management in patients aged 65 and older in orthopaedic care: what nursing and rehabilitation staff know and do2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 21-22, p. 3345-3353Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe what nursing and rehabilitation staff know and do with regards to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery.

    Background: Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent UI, there are indications that these guidelines are not applied in hospital care.

    Design: A qualitative study with descriptive design was conducted in two orthopaedic units.

    Methods: 46 interviews and 36 observations of care were conducted from January to October 2014 and analysed with qualitative content analysis.

    Results: Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.

    Conclusions: Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing UI.

    Relevance and clinical practive: An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.

  • 42.
    Hälleberg-Nyman, Maria
    et al.
    Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Department of Urology, Örebro University Hospital,Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences. Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 405-413Article in journal (Refereed)
    Abstract [en]

    Aim. To investigate the effect of clamping the urinary catheter before its removal in patients with hip fracture. Background. Difficulties to return to normal bladder function after removal of the urinary catheter are frequent in patients with hip fracture. Clamping the urinary catheter before removal is proposed to shorten the amount of time required to return to normal bladder function. Design. A randomised controlled trial was conducted at the orthopaedic clinic at a Swedish university hospital. Methods. Patients with hip fracture aged >= 50 without a urinary catheter, without cognitive impairment or additional severe physical problems at the time of admission (n = 113) were included. They were randomly assigned either to have their urinary catheter clamped before removal or to have their catheter removed with free drainage. Blinding was not possible because of the nature of the study. The primary outcome was the amount of time required to return to normal bladder function. Secondary outcomes were need for re-catheterisation and length of hospital stay. All patients were analysed in accordance with the intention-to-treat principle. Results. The median time required to return to normal bladder function was six (Q(1) 4-Q(3) 8) hours in the clamped catheter group and four (Q(1) 3-Q(3) 7.25) hours in the free drainage group. There were no significant differences between the groups regarding the time required to regain normal bladder function (p = 0.156), the number of patients requiring re-catheterisation (p = 0.904) and the mean time in hospital (p = 0.777). Conclusion. This randomised trial did not show any advantage or disadvantage with clamping the urinary catheter before removal. Relevance to clinica practice. Clamping is an additional task for the nursing staff in the removal of the indwelling urinary catheter. Therefore, when considering the present results, it seems that clamping the indwelling urinary catheters in patients with hip fracture is not indicated.

  • 43.
    Hälleberg-Nyman, Maria
    et al.
    Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Persson, Katarina
    Örebro University, School of Health and Medical Sciences.
    Gustafsson, Margareta
    Örebro University, School of Health and Medical Sciences.
    A prospective study of nosocomial urinary tract infection in hip fracture patients2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2531-2539Article in journal (Refereed)
    Abstract [en]

    Aim.  To investigate risk factors and consequences of nosocomial urinary tract infection in hip fracture patients. Background.  Nosocomial urinary tract infection is a well-known problem in hip fracture patients. There are several risk factors for nosocomial urinary tract infection described in the literature.

    Design.  Prospective observational study with a descriptive and comparative design.

    Methods.  Hip fracture patients were included consecutively between April 2006-March 2007. Excluded were those under 50, having an indwelling urinary catheter, signs of cognitive impairment or additional severe physical problems at the time of admission. To verify nosocomial urinary tract infection, a urine specimen was taken at admission and discharge. Patients with and without nosocomial urinary tract infection were compared.

    Results.  The study included 86 hip fracture patients, of whom 45 (52·3%) contracted nosocomial urinary tract infection in hospital. Earlier reported risk factors for nosocomial urinary tract infection were not confirmed in this study, with one exception: diabetes. All diabetic patients in the study contracted urinary tract infections. Patients receiving cloxacillin as antibiotic prophylaxis for wound infection contracted UTI less often than other patients. There were no statistical differences between groups with regard to urinary tract infection frequency four months after fracture or with regard to mortality after one year.

    Conclusion.  Diabetes was the only previously known risk factor for nosocomial urinary tract infection confirmed among hip fracture patients in this study. Cloxacillin as antibiotic prophylaxis for surgery seemed to offer a certain protection against nosocomial urinary tract infection. Relevance to clinical practice.  Nurses in clinical practice should be aware of the risk of urinary tract infections in hip fracture patients and especially in hip fracture patients with diabetes. Patients given cloxacillin as antibiotic prophylaxis seem less likely to contract nosocomial urinary tract infection.

  • 44.
    Höglund, Erik
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Schröder, Agneta
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Andersson-Hagiwara, Magnus
    Borås University, Borås, Sweden.
    Ohlsson Nevo, Emma
    Örebro University, School of Health Sciences. University Health Care Research Center.
    The ambulance nurse experiences of non-conveying patients2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 1-2, p. 235-244Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore ambulance nurses' (ANs) experiences of non-conveying patients to alternate levels of care.

    BACKGROUND: Increases in ambulance utilisation and in the number of patients seeking ambulance care who do not require medical supervision or treatment during transport have led to increased nonconveyance (NC) and referral to other levels of care.

    DESIGN: A qualitative interview study was conducted using an inductive research approach.

    METHODS: The study was conducted in a region in the middle of Sweden during 2016-2017. Twenty nurses were recruited from the ambulance departments in the region. A conventional content analysis was used to analyse the interviews. The study followed the COREQ checklist.

    RESULTS: The ANs experienced NC as a complex and difficult task that carried a large amount of responsibility. They wanted to be professional, spend time with the patient and find the best solution for him or her. These needs conflicted with the ANs' desire to be available for assignments with a higher priority. The ANs could feel frustrated when they perceived that ambulance resources were being misused and when it was difficult to follow the NC guidelines.

    CONCLUSION: If ANs are expected to nonconvey patients seeking ambulance care, they need a formal mandate, knowledge and access to primary health care.

    RELEVANCE TO CLINICAL PRACTICE: This study provides new knowledge regarding the work situation of ANs in relation to NC. These findings can guide future research and can be used by policymakers and ambulance organisations to highlight areas that need to evolve to improve patient care.

  • 45.
    Isaksson, Ann-Kristin
    et al.
    Örebro University, Department of Health Sciences.
    Gunnarsson, Lars-Gunnar
    Ahlström, Gerd
    Örebro University, Department of Health Sciences.
    The presence and meaning of chronic sorrow in patients with multiple sclerosis2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 11C, p. 315-324Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: The aim of this study was to explore the presence and meaning of chronic sorrow and the presence of depression in a fairly large group of persons with multiple sclerosis (MS). BACKGROUND: MS is a chronic and progressive neurological disease with a variety of symptoms. The patients have to live with losses of different kinds. A few earlier studies have used the concept of chronic sorrow to illustrate the emotional situation of such patients. METHOD: Sixty-one patients were interviewed about the occurrence of chronic sorrow and, thereafter, screened for depression. Thirty-eight (62%) of them fulfilled the criteria for chronic sorrow. The interviews were analysed with latent content analysis. RESULTS: Seven themes describe the losses that caused sorrow: loss of hope, loss of control over the body, loss of integrity and dignity, loss of a healthy identity, loss of faith that life is just, loss of social relations and loss of freedom. The sorrow was constantly present or periodically overwhelming. Only four of the 38 patients with chronic sorrow had symptoms of being mildly depressed. CONCLUSION: Chronic sorrow meant loss of hope, of control over the body, of integrity and of identity. The concept of chronic sorrow complements that of depression in providing important new knowledge relevant to understanding the consequences MS can have for the individual. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the meaning of chronic sorrow can contribute to the nurse's ability to give psychological support and promote a sense of hope and control in the MS patient.

  • 46.
    Josefsson, Karin
    et al.
    Örebro University, Department of Health Sciences.
    Sonde, Lars
    Robins Wahlin, Tarja-Brita
    Violence in municipal care of older people in Sweden as perceived by registered nurses2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 5, p. 900-910Article in journal (Refereed)
    Abstract [en]

    Aims. The main aim was to describe registered nurses' perceptions of violence and threats, as well as their access to prevention measures and routines for handling violent behaviour in municipal care of older people. Another aim was to compare nurses' perceptions working solely in dementia care with those working in general elder care where older people have diverse diagnoses. Background. Violence is often reported in care of older people. The development of dementia units and the implementation of reform have changed care of older people. Dementia disorders have been shown to be a predisposing factor to violence. Design. A non-experimental, descriptive design with a survey research approach was used. The setting was 60 special types of housing with subunits in a large town. The response rate was 62% (n = 213). Forty-five per cent (n = 95) of the nurses worked in dementia care and 55% (118) in general elder care. Method. A questionnaire. Results. Nurses had experienced a high degree indirect threats (dementia care, 45%; general elder care, 51%), direct threats of violent acts (dementia care, 35%; general elder care, 44%) and violent acts (dementia care, 41%; general elder care, 43%). Nurses had witnessed violence and threats towards staff (dementia care, 49%; general elder care, 38%). Even care receivers (dementia care, 20%; general elder care, 19%) were subjected to violence and threats. No statistical differences were found between groups. The nurses in dementia care had more access to education in managing violence and threats, as well as routines for handling violence and a door with a lock to their working unit. Conclusion. Violence occurred frequently in municipal care of older people without any difference between dementia care and general elder care. Nurses in dementia care were more often offered education on how to manage violence and had routines for when violence occurs. Relevance to clinical practice. Municipal authorities should increase staff education for handling violence and creating safety routines. Violence needs to be taken seriously with a 'zero tolerance' attitude.

  • 47.
    Kallstrand-Ericson, Jeanette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hildingh, Cathrine
    School of Social and Health Sciences, Halmstad University, Hamlstad, Sweden.
    Visual impairment and falls: a register study2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 3, p. 366-372Article in journal (Refereed)
    Abstract [en]

    The aim of this register study was to investigate falls and fall injuries of inpatients 65 years and over to determine whether a causal factor of visual impairment was documented. All Organisation for Economic Cooperation and Development (OECD) countries have an increasing older population with falls and fall injuries becoming a major problem. A visual impairment can be an independent risk factor for falls but can also occur in combination with other intrinsic and extrinsic risk factors. A retrospective non-randomised register study. In 2004, all documented falls of inpatients aged 65 years and over were examined. Medical records and eye clinic records were scrutinised to identify whether any visual impairment have been documented. The majority of falls occurred between the hours of 24:00-06:00 and the inpatients most often affected were those with a visual impairment. The falls occurred in connection with movement when the inpatient was unaccompanied. Documentation in records at the medical clinic was defective and subjectively perceived visual impairment was not documented at all. Both subjective and objective visual impairment occurred in all eye clinic records. Visual impairment along with the ageing process are features affecting falls and the hospital environment needs to be adapted by improving the use of strong, contrasting colours and providing good lighting for older inpatients with visual impairment during the night time period. Hospital safety for older people with visual impairment is a concern if falls are to be reduced. Healthcare professionals need to undertake individual risk assessments to establish the degree of visual impairment of the older person so that appropriate interventions can be implemented to reduce the incidence of falls and fall injuries.

  • 48.
    Karlsson, Christina
    et al.
    Jönköping University, Jönköping, Sweden.
    Sidenvall, Birgitta
    Jönköping University, Jönköping, Sweden.
    Bergh, Ingrid
    University of Skövde, Skövde, Sweden.
    Ernsth-Bravell, Marie
    Jönköping University, Jönköping, Sweden.
    Certified nursing assistants' perception of pain in people with dementia: a hermeneutic enquiry in dementia care practice2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 13-14, p. 1880-1889Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To interpret certified nursing assistants' perception of pain in people with dementia in nursing care practice.

    Background: Detection and understanding of pain in people with dementia remains a challenge due to their difficulty in verbalising their pain. Nursing assistants provide daily nursing care and therefore play a vital role in pain detection. Nevertheless, pain research from the nursing assistants' perspective is sparse.

    Design: A qualitative approach within the interpretive tradition was adopted.

    Methods: Individual interviews with twelve certified nursing assistants, all working in dementia care, were conducted and interpreted using philosophical hermeneutics.

    Results: Nursing assistants' perception of pain is on three levels. Each level consists of a theme. The first theme Being in the facing phase' refers to the initial perception of the person's expressions. The second theme Being in the reflecting phase' means ability to reflect more deeply on one's perception, together with other colleagues and next of kins. The third theme Being in the acting phase' means perception arising from preventive and protective care focusing on contributing to well-being. The themes served as a basis for comprehensive understanding, where perception of pain arises from closeness, compassion and dialogue based on personhood, accompanied by professional knowledge of pain and dementia.

    Conclusion: Nursing assistants' perception of pain is based on ethical concerns and on their own subjective pain experiences rather than on medical skills. Their perception derives from fundamental values that are important aspects of nursing care. Interdisciplinary solidarity may strengthen cooperation amongst CNAs and RNs to achieve best pain management practice.

    Relevance to clinical practice: Attention to nursing assistants' perception of pain needs to be highlighted when they are front-line staff and have developed important pain detection skills. Their skills are essential complements and must be used in the development of pain management in dementia care practice.

  • 49.
    Khanjari, Sedigheh
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Center for Nursing Care Research, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran .
    Oskouie, Fatemeh
    Center for Nursing Care Research, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran .
    Langius-Eklöf, Ann
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Psychometric testing of the Caregiver Quality of Life Index-Cancer scale in an Iranian sample of family caregivers to newly diagnosed breast cancer women2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 573-584Article in journal (Refereed)
    Abstract [en]

    Aim: To translate and test the reliability and validity of the Persian version of the Caregiver Quality of Life Index-Cancer scale.

    Background: Research across many countries has determined quality of life of cancer patients, but few attempts have been made to measure the quality of life of family caregivers of patients with breast cancer. The Caregiver Quality of Life Index-Cancer scale was developed for this purpose, but until now, it has not been translated into or tested in the Persian language.

    Design: Methodological research design. Methods. After standard translation, the 35-item Caregiver Quality of Life Index-Cancer scale was administered to 166 Iranian family caregivers of patients with breast cancer. A confirmatory factor analysis was carried out using LISREL to test the scale's construct validity. Further, the internal consistency and convergent validity of the instrument were tested. For convergent validity, four instruments were used in the study: sense of coherence scale, spirituality perspective scale, health index and brief religious coping scale.

    Results: The confirmatory factor analysis resulted in the same four-factor structure as the original, though, with somewhat different item loadings. The Persian version of the Caregiver Quality of Life Index-Cancer scales had satisfactory internal consistency ( 0 72-0 90). Tests of convergent validity showed that all hypotheses were confirmed. A hierarchical multiple regression analysis additionally confirmed the convergent validity between the total Caregiver Quality of Life Index-Cancer score and sense of coherence ((beta) over cap = 0 34), negative religious coping ((beta) over cap = -0 21), education ((beta) over cap = 0 24) and the more severe stage of breast cancer ((beta) over cap = 0 23), in total explaining 41% of the variance.

    Conclusion: The Persian version of the Caregiver Quality of Life Index-Cancer scale could be a reliable and valid measure in Iranian family caregivers of patients with breast cancer.

    Relevance to clinical practice: The Persian version of the Caregiver Quality of Life Index-Cancer scale is simple to administer and will help nurses to identify the nursing needs of family caregivers.

  • 50.
    Kihlgren, Annica Larsson
    et al.
    Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden, and Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Fagerberg, Ingegerd
    Senior Lecturer, Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden, and Department of Caring and Public Health Sciences, Mälardalen University, Västerås, Sweden.
    Skovdahl, Kirsti
    Doctoral Student, Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden, and Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Kihlgren, Mona
    Head of Centre, Centre for Nursing Science, Örebro University Hospital, Örebro, Sweden; Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden.
    Referrals from home care to emergency hospital care: basis for decisions.2003In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    The Swedish government implemented a reform, the Adel reform, in the care of older citizens in 1992, so that the communities where older people live became responsible for their care and housing. Nurses were appointed to make sure that older people were given accurate care and to act as supervisors for nurses' aides. In this study, 10 Registered Nurses from community home care services and four consultant head physicians in primary care were interviewed in order to illuminate what they thought influenced nurses' decisions to refer patients for emergency treatment and what support they requested to facilitate the decision. Content analysis showed the necessity of feeling secure in one's role as a community nurse. The categories that developed were: own competence, knowledge about the patient and a supportive working environment. The main theme was To feel safe in one's role - a basis for decision-making. High demands were put on the nurses' competence and their burden of responsibility became too great. This influenced decision-making negatively, if nurses felt that they were lacking in their own personal competence. Training in documentation for the nurses was required, as well as the need for organizations to provide staff with sufficient time for accurate documentation. A greater input of nursing and medical care was required to make it possible for patients to be cared for at home if they so wished. Respondents described considerable deficiencies in their working environment and in co-workers' competence, and nurses' professional roles within the community were not made clear. If these problems were remedied, this would improve working conditions, increase understanding, and reduce feelings of uncertainty among decision-makers.

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