| 1. |
- Bergh, Ingrid, 1956-, et al.
(författare)
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An application of pain rating scales in geriatric patients.
- 2000
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Ingår i: Aging (Milan, Italy). - 0394-9532. ; 12:5, s. 380-7
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Tidskriftsartikel (refereegranskat)abstract
- This study examined the applicability of three different pain rating scales, the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numeric Rating Scale (NRS), in geriatric patients. Data collection was performed in a geriatric clinic at a university hospital. A structured interview was conducted with 167 patients (mean age = 80.5 years). Patients rated their current experience of pain twice with a 5-minute pause in-between on the VAS, GRS and NRS, and were then asked if they experienced pain, ache or hurt (PAH) or other symptoms. The correlations were high and significant both between the ratings of the VAS, GRS and NRS (r = 0.78-0.92; p < 0.001) (alternative-forms reliability), and between the test and retesting (r = 0.75-r = 0.83; p < 0.001) (test-retest reliability). A logistic regression analysis showed that the probability to accomplish a rating on the pain scales decreased with advancing age of the patient, and this was especially marked for the VAS. The probability of agreement between the patients' ratings of pain and the verbal report of PAH tended to decrease with advancing age; this was especially so for the VAS. Patients who verbally denied PAH but reported pain on the scales rated it significant lower (p < 0.001) than those who verbally reported PAH and rated the pain as well. Eighteen percent of patients who denied pain but rated a pain experience verbally expressed suffering or distress. The study suggests that pain rating scales such as the VAS, GRS and NRS can be used to evaluate pain experience in geriatric patients. However, agreement between verbally expressed experience of PAH, and the rated experience of pain tended to decrease with advancing age. This indicates that the pain-evaluating process will be substantially improved by an additional penetration supported by a wide variety of expression of hurt, ache, pain, discomfort and distress.
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| 2. |
- Bergh, Ingrid, et al.
(författare)
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Assessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales.
- 2001
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Ingår i: Aging (Milan, Italy). - 0394-9532. ; 13:5, s. 355-61
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Tidskriftsartikel (refereegranskat)abstract
- Although pain is a frequent problem among elderly patients, they are often omitted in clinical trials and few studies have focused on assessing pain relief in this population. The aim of this study was to compare geriatric patients' verbally reported effect of analgesics with changes in pain experience rated with four different rating scales: the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS), the Numeric Rating Scale (NRS), and the Pain Relief Scale (PRS). Altogether 53 geriatric patients (mean=82 yrs) with non-pathological fractures in 4 geriatric units at a large university hospital were selected. In connection with the administration of analgesics, the patients were asked to "Mark the point that corresponds to your experience of pain just now at rest" on the VAS, GRS and NRS. This was repeated after 1.5-2 hours, and a direct question was asked about whether the analgesic medication given in connection with the initial assessment had had any pain-alleviation effect. Two comparisons were conducted with each patient. The results show that the probability of accomplishing a rating on the VAS, GRS, NRS, and PRS was lower with advancing age in these elderly fracture patients. The correlations between the ratings of the VAS, GRS and NRS were strong and significant (r=0.80-0.95; p<0.001) both at the initial assessments and at the re-assessments. However, the verbally reported effects of the analgesics were often directly opposite to the changes in rated pain. Therefore, application of the VAS, NRS, GRS and PRS for the purpose of assessing pain relief must be combined with supplementary questions that allow the patient to verbally describe possible experience of pain relief.
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| 3. |
- Bergh, Ingrid, 1956-, et al.
(författare)
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Pain and its relation to cognitive function and depressive symptoms: a Swedish population study of 70-year-old men and women.
- 2003
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Ingår i: Journal of pain and symptom management. - 0885-3924. ; 26:4, s. 903
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the prevalence of pain and its characteristics, and to examine the association of pain with cognitive function and depressive symptoms, in a representative sample of 70-year-old men and women. Data were collected within the gerontological and geriatric population studies in Göteborg, Sweden (H-70). A sample of 124 men and 117 women living in the community took part in the study. A questionnaire was applied which included four different aspects of pain experience: prevalence, frequency of episodes of pain, duration and number of locations. In close connection to this, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The prevalence of pain during the last 14 days was higher in women (79%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />91) than in men (53%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />65) (P<0.001). Women (68%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />78) also reported pain that had lasted for >6 months to a greater extent than men (38%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />46) (P<0.001). The frequency of episodes of pain was also higher among women, 64% (n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />74) reporting daily pain or pain several days during the last 14 days while 37% of the men (n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />45) did so (P<0.001). Women (33%, n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />38) also reported pain experience from ≥3 locations more often than men (11%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />13) (P<0.001). On the other hand, the association between depressive symptoms and pain experience was more evident in men than in women. Women were taking significantly more antidepressants compared to men (P<0.03). The results show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and the four aspects of pain experience were more pronounced among men
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| 4. |
- Bergh, Ingrid, 1956-
(författare)
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Pain in the elderly : rating scales, prevalence and verbal expression of pain and pain relief
- 2003
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Doktorsavhandling (övrigt vetenskapligt)abstract
- Aims: The overall purpose of the studies was to examine the prevalence of pain in elderly people and to evaluate the applicability of pain scales in assessing pain and pain relief in elderly patients.Methods: In Paper I, 167 geriatric patients (M=81 years) rated their current experience of pain twice with a 5-minute interval in between on the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numerical Rating Scale (NRS), and were then asked if they experienced pain, ache or hurt or other symptoms. In Paper II, 53 geriatric patients (M=82 years) rated their pain on the VAS, GRS and NRS in connection with the administration of analgesics. This was repeated after 1.5-2 hours and a direct question was asked about whether the analgesic medication given in connection with the initial assessment had had any pain-alleviation effect. The patients also rated pain relief on the Pain Relief Scale (PRS). The study in paper III, was conducted within the framework of the Gerontological and Geriatric Population Studies in Göteborg, Sweden (H70), 241 70-year-old men and women were assessed regarding pain experience, cognitive function and depressive symptoms. In Paper IV, 38 patients who have undergone hip replacement surgery due to Cox arthritis (M=75 years) and 22 patients with a surgically repaired hip fracture (M=81 years) were interviewed on the second day after the operation. This was divided into two parts, one tape-recorded and semi-structured in character and a structured interview.Results: In Paper I, 71% of the patients verbally reported pain when at rest and/or when moving. High and significant correlations were obtained both between the ratings on the VAS, GRS and NRS (p<0.001) and between the test and retesting (p<0.001). The probability of accomplishing a rating on the pain scales decreased with advancing age of the patient. The probability of agreement between the patients ratings of pain and the verbal report of pain tended to decrease with advancing age. Those patients who verbally denied having pain but reported pain on the scales, rated it significantly lower (p<0.001) than those who verbally reported pain and rated the pain as well. The results in Paper II show that the probability of accomplishing a rating on the VAS, GRS, NRS and PRS decreased with advancing age of the patient. The correlations between the ratings on the VAS, GRS and NRS were strong and significant (p<0.001) both at the initial assessments and at the re-assessments. The verbally reported effects of the analgesics were often directly contrary to the changes in rated pain. The results in Paper III show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and pain experience were more evident in men. In Paper IV, the majority of the elderly patients who participated in this study verbally reported pain and spontaneously used a large number of the words listed in the Short Form McGill Pain Questionnaire (SF-MPQ) and Pain-O-Meter (POM). The patients also used a number of additional words that are not found in the SF-MPQ or the POM. Conclusions: The results suggest pain is common in 70-year-old people and in elderly patients as well. Pain scales such as the VAS, GRS, NRS and PRS can be used to assess elderly patients' experience of pain and pain relief in combination with alternative expressions of pain, pain relief, discomfort and distress. The words of the SF-MPQ and POM are to be found in elderly patients descriptions of pain in everyday language.
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| 5. |
- Bergh, Ingrid, et al.
(författare)
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SMÄRTA HOS ÄLDRE: Skattningsskalor – förekomst och verbala uttryck för smärta och smärtlindring
- 2003
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Ingår i: Incitament. ; :7, s. 516-518
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Smärta är inte en del av det normala åldrandet, men många äldre drabbas av sjukdomar som leder till smärta. Smärta är en subjektiv sensorisk och emotionell obehagsupplevelse med faktisk eller potentiell vävnadsskada. Varje person upplever smärta på sitt sätt och denna uppfattning får avgörande betydelse för hur hälso- och sjukvårdspersonal kan förhålla sig till människor med smärta.Utgångspunkten för denna avhandling var att studera smärtförekomst bland äldre och att evaluera användandet av smärtskalor. Våra resultat visar att skattningsskalor kan vara till hjälp.Artikeln baseras Ingrid Berghs avhandling: Pain in the elderly - Rating scales, prevalence and verbal expression of pain relief
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| 6. |
- Furåker, Carina, et al.
(författare)
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Quality of care in relation to a critical pathway from the staff's perspective
- 2004
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Ingår i: Journal of Nursing Management. ; 12:5, s. 309-319
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Tidskriftsartikel (refereegranskat)abstract
- Specific groups with complex nursing requirements, such as patients suffering from stroke, are in greatest need of a critical pathway. Aim To study how the critical pathway is reflected in caring work from the staff's perspective. Method Personnel (n = 16): physicians, care developers, speech therapists, physiotherapists, occupational therapists, nurses, assistant nurses. Content analysis has been used. Two main categories were formed: function of the critical pathway and effects of the critical pathway. Findings The nurse in the stroke ward is seen as the 'spider in the web'. There is a need for more collaboration, both in and between hospitals and primary health care. Many of the staff members feel that they are working in a learning organization. Others say that they have low job satisfaction caused by low manning and, consequently, less time to spend with the patients. Conclusion The critical care chain has not been fully developed in accordance with the care model. It emerges that patients spend a lot of time waiting while the staff have too little time to spend with patients.
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| 7. |
- Kåberger, Tomas, et al.
(författare)
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Economic Efficiency of Compulsory Green Electricity Quotas in Sweden
- 2004
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Ingår i: Energy and Environment. - Multi-Science Publishing. - 0958-305X. ; 15:4, s. 675-697
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Tidskriftsartikel (refereegranskat)abstract
- Green certificates are not an efficient as a measure to correct for the effect of environmental external costs of fossil fuels and nuclear power. Nor are they efficient as a measure to create markets for new electricity supply technologies.Removing subsidies and introducing environmental taxes on energy sources with undesired external effects more efficiently corrects for incurred environmental costs. It appears that guaranteed feed-in tariffs are a more efficient policy instrument to promote the industrialisation of technologies for new sustainable sources of electricity.Alternatively, the certificate scheme could be reformed in a number of ways to improve performance. However decisions to change or abolish the instrument cannot be taken lightly since instrument stability is very important for the credibility of future policy.
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| 8. |
- Lindwall, Lillemor, et al.
(författare)
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Patients´ and nurses´ experiences of perioperative dialogues
- 2003
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Ingår i: Journal of Advanced Nursing. ; 43:3, s. 246-253
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has shown that perioperative visiting can aid the planning and implementation of nursing care by giving patients an opportunity to express their expectation and to receive information. This is in turn can reduce anxiety and stress. However, patients and nurses’ experiences of this process have not been studied before. Aim.The aim of the research was to describe and interpret the meaning of nursing care experienced by patients and nurse anaesthetists or operating-room nurses (referred to as perioperative nurses) through the pre-, intra- and postoperative dialogues. Methods.A hermeneutic approach was used when interpreting text from interviews with 10 patients after the operation and 10 nurses who were asked to write down their experiences after having conducted pre-, intra- and postoperative dialogues with their patients. The interpretation of the whole was: the common quality of the pre-, intra- and postoperative dialogues was continuity and the distinguishing quality was how the patient and nurse experienced continuity. Findings.Continuity in ‘the perioperative dialogue’ from the patients’ point of view is expressed as sharing a story and the body is in safe hands. From the nurses’ point of view continuity means that professional nursing care becomes visible and that continuity gives meaning to the work. Conclusion.If perioperative nurses used the perioperative dialogue they could create continuity for patients and for themselves in the pre-, intra- and postoperative phases. The nurse is, in this context, the continuity and continuity gives the possibility of establishing a caring relationship and caring for the patient in a dignified way
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| 9. |
- Warrén-Stomberg, Margareta
(författare)
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Postoperative pain management : Nurse perspectives on acute pain services
- 2004
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Doktorsavhandling (övrigt vetenskapligt)abstract
- Postoperative pain management (POPM) has remained an area of concern despite major efforts to improve pain assessment and management by the introduction of specified guidelines, advanced techniques for pain alleviation, and education of staff members. Different nurse specialists are involved in the perioperative care of surgical patients. It is still not known to what extent the specific information noted by the nurses about the individual surgical patient at the different steps of the perioperative management is taken into consideration so that a potentially more optimal, individualised POPM as part of acute pain services (APS) can be provided.The aims of the present study were to assess if information of potential value for the POPM is noted by nurse anaesthetists involved in the perioperative management of surgical patients and to what extent such information could be of value for an individualised POPM of surgical patients and if nurse involvement is of importance for the adequacy and efficacy of POPM routines in a nurse-based, anaesthesiologist-supervised acute pain service (APS) model on surgical wards.Semistructured interviews of nurse anaesthetists (n=40), questionnaire responses of staff members (n=375)/surgical patients (n=110) and assessment of medical records (n=135)/database data (n=222) were included for evaluation of factors of importance in the perioperative care and POPM of surgical patients. Descriptive statistics, non-parametric and parametric tests were used for the analysis of the data.It was found that nurse anaesthetists continuously monitor different stress evoked physiological signs induced by surgical interventions during general anaesthesia. Nurses considered the signs indicative of pain evoked stimuli and/or insufficient depth of anaesthesia. The intraoperative information of the response pattern and anaesthetic drug requirements of the individual patient noted by the nurse anaesthetist was considered at present not to be routinely taken into consideration but could be a successful strategy in an optimal multi-professional approach to postoperative pain management. The introduction of APS, using a nurse-based anaesthesiologist-supervised model, resulted in more adequate pain management routines, better patient satisfaction with information about POPM, and increased confidence in pain management among nurses on the surgical wards than was noted for the outcome data for the hospital not having introduced such an APS model. Database documentation of outcome measures of POPM for patients receiving postoperative epidural analgesia was found to provide valuable information about the adequacy of the POPM. The feedback of information from the anaesthesia services to the surgical ward nurses was found not to be efficient enough to make ward nurses properly aware of the importance of their own direct involvement in the documentation process of POPM and that such involvement could further optimise POPM outcome
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| 10. |
- Warrén-Stomberg, Margareta, et al.
(författare)
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Postoperative pain management on surgical wards-impact of database documentation of anesthesia organized services.
- 2003
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Ingår i: Pain management nursing : official journal of the American Society of Pain Management Nurses. - 1524-9042. ; 4:4, s. 155-64
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient’s level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.
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