| 1. |
- Prendergast, Virginia, et al.
(författare)
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Effects of a standard versus comprehensive oral care protocol among intubated neuroscience ICU patients : results of a randomized controlled trial
- 2012
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Ingår i: Journal of Neuroscience Nursing. - : Lippincott Williams & Wilkins. - 0888-0395 .- 1945-2810. ; 44:3, s. 134-146
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.
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| 2. |
- Blomqvist, Kerstin, 1953-, et al.
(författare)
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Recognising pain in older adults living in sheltered accommodation : the views of nurses and older adults
- 2001
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 38:3, s. 305-318
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-six randomly selected older adults and their contact nurses participated in interviews based on standardised assessments of pain and open-ended questions focusing how pain was expressed and recognised. The sample included older adults with normal as well as cognitively impaired function. Seventy-nine percent of older adults with normal cognition were often in pain. Contact nurses assessed pain in 57% of cognitively impaired older adults. The content in the statements showed that pain recognition was a communicative interactive process based on verbal and non-verbal expressions. The process comprised attempts to understand the cause and intention of the expression and to verify the presence of pain. Changes in mood, facial expressions and physiological responses were described less often by older adults than by their nurses. Contact nurses of cognitively impaired older adults judged immobility as the source of pain, that it was possible to see when the person was in pain and that pain was expressed by paralinguistic and body language more often than contact nurses of cognitively healthy older adults. Characteristics of nurses and older adults could facilitate or hinder pain recognition. The findings indicate a need for reflective discussions in the staff group focusing on how to perform systematic assessments of verbal and non-verbal expressions and of hindrances and facilitators for recognising pain in older adults.
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| 3. |
- Borglin, Gunilla, et al.
(författare)
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Older people in Sweden with various degrees of present quality of life : their health, social support, everyday activities and sense of coherence.
- 2006
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Ingår i: Health & Social Care in the Community. - : Blackwell Publishing. - 0966-0410 .- 1365-2524. ; 14:2, s. 136-146
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Tidskriftsartikel (refereegranskat)abstract
- Public health policies in most European countries are concerned with how to keep older people living independently with a qualitatively good life in the community as long as possible. However, knowledge about what may characterise those seemingly 'healthy' older people is sparse. The aim of the study was to investigate the characteristics of a sample of people (75+) reporting various degrees of Quality of Life (QoL) with respect to QoL in different areas, as well as self-rated health, health problems, social support, everyday activities and sense of coherence. A postal questionnaire was sent out in spring 2001 to a randomly selected population-based sample (n= 600) in the southern parts of Sweden. A two-step cluster analysis was performed (n= 385, mean age 84.6, SD = 5.7) with 'present QoL' as clustering attribute. Three groups were disclosed, classified as high, intermediate and low present QoL, of which 33.8% could be regarded being at risk of low QoL. Those with low present QoL (18.4%) were the oldest and most vulnerable, a majority were women with 'poor or bad' self-rated health, high frequencies of health problems, low total QoL, low social support and sense of coherence and less physically active. Those with high present QoL (47.8%) reported more 'excellent or good' self-rated health, physical activity, satisfactory social support and higher sense of coherence and total QoL than the other two groups. Those with intermediate present QoL (33.8%) had more of 'poor or bad' self-rated health, more health problems were less physically active, had lower total QoL and sense of coherence, and less social support than those with high present QoL. The sample seemed to reflect the ageing process in that the respondents were at different stages of ageing. However, the fact that the level of social support, sense of coherence and self-rated health followed the same curve as QoL may indicate that some are more vulnerable to low present QoL given the same health and these should be targeted in preventive programmes since they report low QoL.
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| 4. |
- Bondesson, Susanne M., et al.
(författare)
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Hospital utilization and costs for spinal cord stimulation compared with enhanced external counterpulsation for refractory angina pectoris
- 2013
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell. - 1356-1294 .- 1365-2753. ; 19:1, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives The aim of this study was to compare acute hospital utilization and costs for patients with refractory angina pectoris undergoing spinal cord stimulation (SCS) versus enhanced external counterpulsation (EECP). Method Seventy-three persons were included in this register study. The acute hospital utilization and costs for SCS and EECP were followed over a period from 12 months before treatment to 24 months after treatment using Patient Administrative Support in Skåne for publicly organized care. Results SCS was significantly more expensive than EECP (P < 0.001). Both SCS and EECP entailed fewer days of hospitalization for coronary artery disease in the 12-month follow-up compared with the 12 months preceding treatment. Patients treated with EECP showed an association between reduced hospital admissions and an improved Canadian Cardiovascular Society classification class compared with 1 year before treatment. A significant reduction in cost was seen in both the SCS group (P = 0.018 and P = 0.001, respectively) and the EECP group (P = 0.002 and P = 0.045, respectively) during 12 and 24 months of follow-up compared with before treatment. There were no significant differences between the groups for hospitalization days or admissions, including costs, at the different follow-ups. Conclusions Cost-effective treatment modalities such as SCS and EECP are valuable additions to medical and revascularization therapy in patients with refractory angina pectoris. Pre-existing conditions and the patient's preferences should be taken in consideration when clinicians choose between treatments for this group of patients.
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| 5. |
- Jakobsson, Ulf, et al.
(författare)
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Exploring determinants for quality of life among older people in pain and in need of help for daily living
- 2007
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 16:3a, s. 95-104
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. The aim of the study was to investigate the quality of life and related factors among older people who are in pain and in need of help to manage daily living. Background. To intervene against the low quality of life in nursing care knowledge about factors affecting it is needed and this is especially important for vulnerable people such as those who suffer from pain and who are in need of help to manage daily living. Methods. Five hundred and twenty-six people, aged 75–102 years participated in this study. Results. Those in pain reported a significantly higher degree of all complaints and lower quality of life in all measures compared with those not in pain. Overall quality of life was associated with mobility problems, sleeping problems and depressed mood, while health-related quality of life was associated with living in special accommodations, walking problems, mobility problems and fatigue. Conclusions. Those in need of help to manage daily living and in pain seem to be at higher risk of lowered quality of life than those not in pain and the lower quality of life among those in pain is probably caused by the complex of complaints rather than pain per se. Relevance to clinical practice. Daily nursing care should identify and treat the complex of complaints related to pain as well as pain itself, to improve everyday life and quality of life for older people in pain.
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| 6. |
- Karlsson, Staffan, et al.
(författare)
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Functional ability and health complaints among older people with a combination of public and informal care vs. public care only
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - Chichester : Wiley-Blackwell Publishing Inc.. - 0283-9318 .- 1471-6712. ; 22:1, s. 136-148
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate functional ability and health complaints of people, 65+, living in special accommodation (equivalent to nursing home) and their counterparts who live at home and receive municipal care or a combination of municipal and informal care. Persons (n = 1958) receiving municipal care were assessed in terms of functional ability, health complaints, and level of informal and municipal care and services. The results showed that more home care, services and help with Instrumental Activities of Daily Living (IADL) were provided to those receiving only municipal care at home, while more home care and services associated with Personal Activities of Daily Living (PADL) as well as nursing care were provided to those receiving informal care in addition to formal care. Cohabitation was a predictor of a combination of municipal and informal care in the home (OR: 5.935), while assistance with IADL provided by municipal home care and services predicted municipal care only (OR: 0.344). Care in special accommodation was predicted by advanced age (OR: 1.051), dependency in IADL (OR: 19.883) and PADL (OR: 2.695), and impaired cognitive ability (OR: 3.849) with receiving municipal care only as a reference. Living alone (OR: 0.106), dependency in IADL (OR: 11.348) and PADL (OR: 2.506), impaired cognitive ability (OR: 3.448), impaired vision or blindness (OR: 1.812) and the absence of slowly healing wounds (OR: 0.407) were predictors of special accommodation with a combination of informal and municipal care at home as a reference. The distribution of municipal care divided older people into three distinct groups. The most frail and elderly people who had no cohabitants received care in special accommodation, determined by their level of physical and cognitive dependency. The frailest individuals living at home were cohabiting and received a combination of municipal and informal care, while those who were less dependent mainly had help with IADL from municipal care only. The results indicate that there is a shift from the substitution to the complementary model and highlights that attention to the family carers is needed.
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| 7. |
- Karlsson, Staffan, et al.
(författare)
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Professional's and older person's assessments of functional ability, health complaints and received care and service : a descriptive study
- 2010
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 47:10, s. 1217-1227
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to investigate the level of agreement between the needs assessment made by professional on the one hand, and the older person's views on the other. A further aim was to explore if the estimations made by the professional were systematically lower or higher compared to the views of the older person.PARTICIPANTS: The study included 152 individuals, 65+, who received public care and services in southern Sweden. The concept public care and services include home help, home nursing care, rehabilitation and special accommodation.METHODS: Standardised needs assessments were performed by home help officers, registered nurses and one physiotherapist. Subsequently to the needs assessment, the older person's view was collected in a personal interview. Standardised assessment form was used covering items about demographic data, functional ability, health complaints, adaptation in housing, public and informal care. The concept informal care includes care from spouse and children. Cohen's Kappa was used for analysis of level of agreement and Chi-square tests for differences in estimation.RESULTS: Level of agreement for dependency in instrumental activities of daily living (IADL) and personal activities of daily living (PADL) varied between good (kappa=0.78) and moderate (kappa=0.43). Poor agreement was found for occurrence of dizziness (kappa(w)=0.17) and fair agreement for impaired hearing (kappa(w)=0.27), urinary incontinence (kappa(w)=0.38), pain (kappa(w)=0.21), anxiety (kappa(w)=0.37) and depressed mood (kappa(w)=0.37). Older persons reported more health complaints than in the professional's assessments, significantly lower estimation was found for incontinence and vision. Level of agreement for provided public care at home (home help and home nursing care) was poor, for informal care it varied between very good and moderate.CONCLUSIONS: Needs assessments appeared to focus on older persons ADL, cognition and informal care, while health complaints and social needs were less in focus. A more comprehensive view including preventive and palliative approach may improve quality of life for older persons receiving care and service.
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| 8. |
- Lethin, Connie, et al.
(författare)
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Family caregivers experiences of formal care when caring for persons with dementia through the process of the disease
- 2016
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 30:3, s. 526-534
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Family caregivers' experiences of formal care when caring for persons with dementia through the process of the disease is sparsely investigated.AIMS: To investigate family caregivers' experiences of formal care when caring for a person with dementia, through the stages of the disease.DESIGN: A qualitative approach with focus group interviews.METHODS: Four focus group interviews were conducted in October 2011 with 23 spouses and adult children of persons with dementia and analysed with content analysis.RESULTS: The participants' experiences of formal care when caring for a person with dementia were captured in the theme 'Family caregiving requires collaboration with formal care to get support adjusted to needs specific to the stages of dementia'. This can be broken down into the categories 'The dementia diagnosis - entry into formal care as a novice family caregiver', 'Needing expanded collaboration with formal care to continue care at home' and 'Being dependent on a nursing home and trying to maintain involvement'.CONCLUSION: Family caregiving requires collaboration with formal care to get support adjusted to the individual's needs, specific to the stages of dementia. Caregivers experience a transition process with three main turning points: the dementia diagnosis; when they realise increased need for formal care to continue caring at home; and when the person with dementia is moved into a nursing home. The interviewed caregivers experience formal care reactive to their needs and this often promoted unhealthy transitions. Formal care needs to be proactive and deliver available care and support early on in the dementia trajectory. Interventions should focus on facilitating a healthy transition for family caregivers through the trajectory of the dementia disease to ensure their well-being.
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| 9. |
- Stenzelius, Karin, et al.
(författare)
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Bowel function among people 75+ reporting faecal incontinence in relation to help seeking, dependency and quality of life
- 2007
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 16:3, s. 458-468
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The aim was to compare faecal incontinence and related bowel symptoms among men and women and being dependent or not (aged >or=75 years) and furthermore to identify which bowel symptoms predicted help seeking, dependency and low quality of life (QoL). BACKGROUND: Faecal incontinence (FI) in old age is a common condition and influences daily life to a great extent, although few actually seek medical help. METHODS: A total of 248 people with reported difficulties controlling faeces answered a postal questionnaire or were interviewed with questions about FI-related bowel symptoms. A factor analysis resulted in four areas of bowel symptoms and was used in logistic regression with help seeking, dependency and low QoL as dependent variables. RESULTS: Of all the subjects, 56.4% had leakage, 54.7% did not reach the toilet in time, 55.6% had incomplete emptying, 27.9% had hard stool, 36.8% bother from moisture from the anus, 32.2% could not withstand urgency for five minutes and 17% had red skin or wounds in the genital region. Women and those dependent were most affected. Totally 40.8% had sought help and 30.1% used protective aids. Leakage, discomfort, consistency and contractibility symptoms were the categories of bowel symptoms related to FI. Discomfort predicted help seeking (OR 3.0), dependency (OR 1.5) and physical QoL (OR 1.7). Leakage predicted help seeking (OR 1.9) but not dependency and QoL. CONCLUSIONS: Overall bowel function was disturbed among those with FI and unmet needs seem problematic especially for women and those needing help in Activities of Daily Living (ADL). Encouragement to seek and get medical help and to use protective aids may improve the very low quality of life in this group. RELEVANCE TO CLINICAL PRACTICE: Older people with FI should be asked about, assessed for and examined for overall bowel function to get adequate treatment and be encouraged to use protection.
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| 10. |
- Andersson, Magdalena, et al.
(författare)
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Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life : a qualitative study
- 2008
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 45:6, s. 818-828
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOld people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective.ObjectiveThe aim of this study was to investigate the experiences of aspects that bring about a good life in the last phase of life among people (75+ years) receiving municipal care.ParticipantsOlder people living in a municipality in Southern Sweden being 75 years or older, receiving help and/or care from the municipality, and having a life-threatening disease and/or receiving palliative care were asked to participate. In all 17 people, 10 women and 7 men, aged 78–100 years were included.MethodsQualitative interviews, with the emphasis on their present life situation especially what brought about a good life, were performed. The interviews were analysed using qualitative content analysis.ResultsThe experience was interpreted to be Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life: Maintaining dignity, Enjoying small things, Feelings of “being at home”, Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death.ConclusionThis study confirm theories suggesting that the last phase of life in old age meant focusing inwards, reflecting on the entire life as a way of completing it as well as enjoying small things and also viewing oneself in the perspective of contributing to the future. It also indicated that this phase of life meant being trapped by health complaints and functional limitations. The struggle to maintaining dignity as opposed to being in the hands of others implies that the concept of palliative care may be useful as a framework for providing nursing care to very old people, especially at the end of life.
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| 11. |
- Andersson, Magdalena, et al.
(författare)
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The experience of being next of kin to an older person in the last phase of life
- 2010
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Ingår i: Palliative & Supportive Care. - : Cambridge University Press. - 1478-9515 .- 1478-9523. ; 8:1, s. 17-26
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to investigate the experience of being next of kin to an older person in the last phase of life as narrated after the older person's death.METHOD: Qualitative interviews were performed with the next of kin (n = 17) to people aged 75 years and older who had recently died and had received help and/or care from the municipality in the last phase of life. Eleven women and six men participated, of whom seven were spouses, nine were children, and one was a grandchild. The interviews were analysed using qualitative content analysis.RESULTS: The experience of the next of kin could be understood as being a devoted companion during the transition toward the inevitable end, embracing the categories of living in the shadow of death; focusing on the needs of the dying person, making adjustments to everyday life; feeling the major responsibility; struggling with the health and social care system; and gaining strength from support.SIGNIFICANCE OF RESULTS: Being next of kin to an old person at the end of life means being a devoted companion during the transition toward the inevitable end, including the feeling of bearing the major responsibility and the need to be acknowledged by professionals. This study points to the importance of having access to professional care when it is needed, to complement and support the next of kin when his or her own resources and strength falter. This also includes support to enable the next of kin to remain involved in the care of his or her loved ones, thereby fulfilling their own wishes.
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| 12. |
- Berg, Agneta, 1950-, et al.
(författare)
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Nurses' reflections about dementia care, the patients, the care and themselves in their daily caregiving
- 1998
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 35:5, s. 271-282
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Tidskriftsartikel (refereegranskat)abstract
- In this study the aim was, through interviews, to disclose 13 nurses personal knowledge about the patients, themselves, and care provision, using a phenomenological-hermeneutic analysing method. Caring for people with severe dementia meant an intertwined life world emanating from making and doing together and the delicate interpretative work that the care provision required. The intertwined life world consisted of the interaction between the nurses and the patients separate lives, their common life and the environment, culminating in mutual dependency. Making together signifies the relationship being based on the nurses knowledge and skills as nurses i.e. the task they had to perform. Doing together signifies the relationship being based on the oneness of the nurses and the patients with severe dementia as ordinary human beings. The delicate interpretation process required, to adapt care to the individual patient, was based on knowledge about the patients personality, life history and disease progression in combination with the nurses interpretation of the current situation. The nurses searched for meaning and that, in turn, meant that the patients inner world was determined by the nurses and thus the patient was seen as being in their hands. It seems important to further understand the human aspects of both the nurse and the patient and to examine this dynamic, ongoing, vulnerable interpretation process, critically, in order to achieve high quality nursing care for the patients with severe dementia, and an experience of well-being in nurses everyday working lives.
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| 13. |
- Berg, Agneta, 1950-, et al.
(författare)
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The meaning and significance of clinical group supervision and supervised individually planned nursing care as narrated by nurses' on a general team psychiatric ward
- 2000
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Ingår i: Australian and New Zealand Journal of Mental Health Nursing. - : Wiley-Blackwell. - 1324-3780 .- 1440-0979. ; 9:3, s. 110-127
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Tidskriftsartikel (refereegranskat)abstract
- By interviewing 22 psychiatric nurses, the present study aimed to reveal the meaning and significance of systematic clinical group supervision and supervised individually planned nursing care, using latent content analysis. The interpreted meaning was 'confronting the complexity of ongoing life in daily nursing care' and the interpreted significance was 'strengthening the foundation for nursing care'. Reflection on action and confirmation seemed to be core components in the process of clinical supervision. Focusing on the relational and task aspects in nursing care within a group approach may have contributed to the positive experiences of development that occurred.
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| 14. |
- Hovde, Boel, et al.
(författare)
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Older immigrants' experiences of their life situation in the context of receiving public care in Sweden
- 2008
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Ingår i: International Journal of Older People Nursing. - : Wiley-Blackwell. - 1748-3735 .- 1748-3743. ; 3:2, s. 104-112
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The aim of this study was to illuminate older immigrants' experience of their life situation in the context of receiving public care in Sweden. Background. To meet the varying needs from the growing number of older immigrants, more knowledge about the experience of their life situation, health, illness and family ties is needed, especially in the context of receiving public health care and service. Methods. Data were collected through interviews with sixteen immigrants aged 65 years and older, originally from nine different countries, living in Southern Sweden and receiving continuous care and service. The texts were analysed using qualitative content analysis. Results. The overall impression from the texts was that the informants expressed a debt of gratitude to Swedish society. Their experience could be understood as - being burdened with health complaints; experiencing painful losses; wanting to manage by oneself and feeling exposed and deserted. Conclusions. The results show that older immigrants are vulnerable when receiving public care. This was related to previous life events, cultural differences as well as communication difficulties. When planning for and providing care for older immigrants, it is important to be aware of their exposed situation and to acknowledge their life history and family context.
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| 15. |
- Karlsson, Staffan, et al.
(författare)
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Older people receiving public long-term care in relation to consumption of medical health care and informal care
- 2008
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Ingår i: The Open Geriatric Medicine Journal. - Bussum : Bentham Open. - 1874-8279. ; 1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate medical health care and informal care consumption among older people receiving public long-term care, and factors associated with medical health care consumption. 1958 persons aged 65 years and over were included. Data were collected from two registers, including demography, functional ability and received long-term, informal and medical health care. 35% of those at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care and fewer contacts with specialist care other than psychiatric care. Informal care was associated with more contacts with primary health care, specialist care, admissions to and days in hospital. More elderly people being cared for at home may mean more hospital and outpatient care consumption.
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| 16. |
- Werntoft, Elisabet, et al.
(författare)
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Older people's reasoning about age-related prioritization in health care
- 2007
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 14:3, s. 399-412
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the reasoning of people aged 60 years and over about prioritization in health care with regard to age and willingness to pay. Healthy people (n = 300) and people receiving continuous care and services (n = 146) who were between 60 and 101 years old were interviewed about their views on prioritization in health care. The transcribed interviews were analysed using manifest and latent qualitative content analysis. The participants' reasoning on prioritization embraced eight categories: feeling secure and confident in the health care system; being old means low priority; prioritization causes worries; using underhand means in order to be prioritized; prioritization as a necessity; being averse to anyone having precedence over others; having doubts about the distribution of resources; and buying treatment requires wealth.
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| 17. |
- Andersson, Pia, et al.
(författare)
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Oral health problems in elderly rehabilitation patients
- 2004
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Ingår i: International Journal of Dental Hygiene. - : Wiley-Blackwell. - 1601-5029 .- 1601-5037. ; 2:2, s. 70-77
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Tidskriftsartikel (refereegranskat)abstract
- A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8–27.8; P < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.
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| 18. |
- Afram, Basema, et al.
(författare)
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Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries
- 2014
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610. ; 15:2, s. 108-116
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries. Design: An explorative cross-sectional study was conducted in 8 European countries. Setting: Per country, a minimum of 3 long term care facilities, offering care and accommodation as a package, participated in this study. Participating countries were selected to represent different geographic areas in Europe. Participants: Of the 791 informal caregivers involved in the RightTimePlaceCare project of people with dementia who were recently admitted to a long term care facility, 786 were included for this study. Measurements: As part of a semistructured interview, informal caregivers were asked the main reason for institutionalization in an open-ended question. Answers were categorized according to a conventional coding approach. All reasons were then quantified and tested. Results: Mainly patient-related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%), and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in most countries. Besides patient-related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analyzed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared with child-caregivers. Conclusion: Multiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Because of a wide variation in reasons between countries, no one-size-fits-all approach can be offered to guide informal caregivers when facing the possibility of institutionalization of the person with dementia. (C) 2014 - American Medical Directors Association, Inc. All rights reserved.
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| 19. |
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| 20. |
- Alvira, M. Carme, et al.
(författare)
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The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study
- 2015
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402. ; 71:6, s. 1417-1434
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Tidskriftsartikel (refereegranskat)abstract
- AimTo describe the associations between positive and negative reactions of informal caregivers of people with dementia and health outcomes across eight European Countries. BackgroundCaring for someone with dementia may have implications for the caregiver's own health and for the care recipient. These consequences could be associated with caregivers' reactions to the process of care. DesignAssociation study based on cross-sectional data. MethodsParticipants were people with dementia and their informal caregivers living at home or in long-term care institutions. Data were collected between November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems, disrupted schedule and health problems) and associations were sought with informal caregiver burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric symptoms, comorbidity and dependency in activities of daily living using correlation coefficients. ResultsData from 2014 participants were used. Variability across countries was noted, as well as differences between care at home and in long-term care institutions. In general, self-esteem and lack of family support correlated with caregiver burden and psychological well-being. Associations were also found between disrupted schedule and caregiver burden, psychological well-being and quality of life. Health problems were clearly associated with caregiver burden, psychological well-being and quality of life. ConclusionStudy results support links between the reactions of informal caregivers of people with dementia and health outcomes. These may have implications in terms of how services are addressed.
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| 21. |
- Andersson, Edith, et al.
(författare)
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Acute confusional episodes in elderly orthopaedic patients: the patients' actions and speech.
- 2002
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 39:3, s. 303-317
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate the pattern of confusional episodes with regard to the content of elderly patients' actions and speech. Fifty-one (11.2%) out of 457 people admitted to an orthopaedic clinic developed acute confusional state. Non-participant direct observations and daily clinical bedside follow-up observations were made during the confusional episodes, focusing on the patients' speech, actions and reactions with reference to situation, the surroundings, and the nurses' actions, including their verbal communication with the patient. The texts were analysed using manifest and latent content analysis and revealed disturbances in motor activity, speech and mood. 'Struggling to understand and to gain control when in a state of confusion and viewing oneself as being confused' was the main theme illuminated in the texts. In the struggle to achieve understanding and take control over themselves and what was currently taking place, the patients used a variety of strategies. They attempted to find clarity, to make a sensible story out of the present and to impute meaning to the present by using their life story. The findings indicated that the patients had a drive to achieve control when they were confused and that they were both aware and unaware of their state and tended to oscillate between being in a confused state and viewing their confusion from an outside perspective. The findings indicated that possibly the best approach is to support their inner drive to gain control. This means moving between confirmation of their emotional state and their perceptions and trying to introduce 'reality' when they realize their state of confusion. Thus the nurse--patient relationship perhaps needs to hold a balance between confirmation and introducing in reality.
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| 22. |
- Andersson, Edith, et al.
(författare)
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Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care
- 2001
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Ingår i: International Journal of Geriatric Psychiatry. - 1099-1166. ; 16:1, s. 7-17
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences between patients who developed ACS and those who did not. METHOD AND RESULTS: Assessment, observations and interviews with 505 patients admitted to an orthopaedic clinic revealed that 51 patients developed ACS during their in-hospital stay. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was several other physical diseases 15.94 (CI: 4.60-55.31 and p-value <0.00001) and the lowest was age 1.10 (CI: 1.04-1.15 and p-value <0.0002). The ACS lasted from 1 to 9 days, and patients had one (N=42), two (N=8) or three episodes (N=1) of confusion during their stay on the ward. More patients who developed ACS before surgery had two or more confusional episodes and emergency patients developed ACS more rapidly. The ACS lasted longer in patients with a higher score on the OBS scale at admittance and with rapid development of ACS. CONCLUSIONS: Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the development of ACS makes it possible to more systematically identify those at risk, for instance by systematic assessment in the first interview with the patient on admission to hospital.
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| 23. |
- Andersson, Edith, et al.
(författare)
-
Nurses' experiences of the encounter with elderly patients in acute confusional state in orthopaedic care.
- 2003
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 40:4, s. 437-448
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate nurses’ experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses’ actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses’ experiences showed that the nurses found it difficult to reach the patients’ reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients’ situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients’ irritation and anger. The results were more successful when the strategies were derived from the nurses’ interpretation of the patients’ situation and the nurses paid attention to the patients and confirmed them.
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| 24. |
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| 25. |
- Andersson, Edith, et al.
(författare)
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The meaning of acute confusional state from the perspective of elderly patients.
- 2002
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 17:7, s. 652-663
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to illuminate lived experience of having been in an acute confusional state (ACS) as narrated by elderly patients in orthopaedic care. METHOD: Qualitative study with phenomenological hermeneutic method for analysing the data based on narrative interviews. Fifty patients (67-96 years of age) who developed ACS during hospitalisation and in all cases the ACS ceased during their stay on the ward were interviewed once lucid again regarding the course of the event, their experiences, memories and interpretation of what had happened during the ACS. RESULTS: The meaning of the patients' lived experiences of being and having been confused was interpreted as 'Being trapped in incomprehensible experiences and a turmoil of past and present and here and there', comprising the themes trying to get a grip on the experience of the confusion, encountering past, present and the realm of the imagination as reality during the period of confusion and confronting the idea of having been confused. Contradictory to earlier research the patients remembered and could tell in great detail about their ACS. While confused, the confusional state means that impressions of all kinds invade the mind of the person and are experienced as reality, making him/her a victim of these impressions rather than the one who controls what comes into his/her mind. While in the middle of these experiences the person simultaneously senses that the impressions are unreal, thus indicating that he/she is in some sort of borderland between understanding and not understanding. The things that come into the mind of the person can either be frightening or neutral or enjoyable scenarios that seem to be mainly familiar but can also be unknown. These scenarios seem to be a mixture of past and present, of events and people while they seem to float from location to location. CONCLUSIONS: The findings indicates that what takes place during the ACS is not nonsense but probably a mix of the patient's life history, their present situation and above all a form of communication concerning their emotional state and inner experiences in this new situation. The findings also indicated that one possible approach to the patients is to confirm and support the patients in narrating their experiences both during the confusion and also after the ACS had ceased.
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| 26. |
- Andersson, Magdalena, et al.
(författare)
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Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life.
- 2008
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 1873-491X .- 0020-7489. ; 45:6, s. 818-828
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Tidskriftsartikel (refereegranskat)abstract
- Background: Old people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective. Objective: The aim of this study was to investigate the experiences of aspects that bring about a good life in the last phase of life among people (75 + years) receiving municipal care. Participants: Older people living in a municipality in Southern Sweden being 75 years or older, receiving help and/or care from the municipality, and having a life-threatening disease and/or receiving palliative care were asked to participate. In all 17 people, 10 women and 7 men, aged 78-100 years were included. Methods: Qualitative interviews, with the emphasis on their present life situation especially what brought about a good life, were performed. The interviews were analysed using qualitative content analysis. Results: The experience was interpreted to be Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life: Maintaining dignity, Enjoying small things, Feelings of "being at home", Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death. Conclusion: This study confirm theories suggesting that the last phase of life in old age meant focusing inwards, reflecting on the entire life as a way of completing it as well as enjoying small things and also viewing oneself in the perspective of contributing to the future. It also indicated that this phase of life meant being trapped by health complaints and functional limitations. The struggle to maintaining dignity as opposed to being in the hands of others implies that the concept of palliative care may be useful as a framework for providing nursing care to very old people, especially at the end of life.
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| 27. |
- Andersson, Magdalena, et al.
(författare)
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The experience of being next of kin to an older person in the last phase of life.
- 2010
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Ingår i: Palliative & Supportive Care. - 1478-9515. ; :Mar 3, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Objective:The aim of the study was to investigate the experience of being next of kin to an older person in the last phase of life as narrated after the older person's death.Method:Qualitative interviews were performed with the next of kin (n = 17) to people aged 75 years and older who had recently died and had received help and/or care from the municipality in the last phase of life. Eleven women and six men participated, of whom seven were spouses, nine were children, and one was a grandchild. The interviews were analysed using qualitative content analysis.Results:The experience of the next of kin could be understood as being a devoted companion during the transition toward the inevitable end, embracing the categories of living in the shadow of death; focusing on the needs of the dying person, making adjustments to everyday life; feeling the major responsibility; struggling with the health and social care system; and gaining strength from support.Significance of results:Being next of kin to an old person at the end of life means being a devoted companion during the transition toward the inevitable end, including the feeling of bearing the major responsibility and the need to be acknowledged by professionals. This study points to the importance of having access to professional care when it is needed, to complement and support the next of kin when his or her own resources and strength falter. This also includes support to enable the next of kin to remain involved in the care of his or her loved ones, thereby fulfilling their own wishes.
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| 28. |
- Andersson, Pia, et al.
(författare)
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Comparison of oral health status on admission and at discharge in a group of geriatric rehabilitation patients
- 2003
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Ingår i: Oral health & preventive dentistry. - 1757-9996 .- 1602-1622. ; 1:3, s. 221-228
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to compare oral health status on a geriatric rehabilitation ward among patients who were assessed using the Revised Oral Assessment Guide (ROAG) on admission and at discharge; and to investigate in what respect the oral health procedures (OHP) suggested in ROAG were applied when oral health problems were detected. MATERIALS AND METHODS: Registered nurses on the ward performed oral health assessments using ROAG with 107 patients on admission and at discharge. When oral health problems were detected measures to be taken were suggested using ROAG. RESULTS: Oral health problems were common among the patients on admission (86%), as well as at discharge (51%). The frequency of the problems was significantly lower at discharge compared to admission. The OHP that were recommended in ROAG were completely followed when saliva flow-related problems were detected. Regarding other oral health problems, measures other than the recommended ones were often performed. CONCLUSION: This study demonstrated that the oral health was better at the end of the hospital stay compared to admission.
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| 29. |
- Andersson, Pia, et al.
(författare)
-
Comparison of oral health status on admission and discharge in a group of geriatric rehabilitation patients
- 2003
-
Ingår i: Oral Health and Preventive Dentistry. ; 1:3, s. 221-228
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare oral health status on a geriatric rehabilitation ward among patients who were assessed using the Revised Oral Assessment Guide (ROAG) on admission and at discharge; and to investigate in what respect the oral health procedures (OHP) suggested in ROAG were applied when oral health problems were detected. MATERIALS AND METHODS: Registered nurses on the ward performed oral health assessments using ROAG with 107 patients on admission and at discharge. When oral health problems were detected measures to be taken were suggested using ROAG. RESULTS: Oral health problems were common among the patients on admission (86%), as well as at discharge (51%). The frequency of the problems was significantly lower at discharge compared to admission. The OHP that were recommended in ROAG were completely followed when saliva flow-related problems were detected. Regarding other oral health problems, measures other than the recommended ones were often performed. CONCLUSION: This study demonstrated that the oral health was better at the end of the hospital stay compared to admission.
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| 30. |
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| 31. |
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| 32. |
- Andersson, Pia, et al.
(författare)
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Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward
- 2002
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Ingår i: Special Care in Dentistry. - : Wiley. - 0275-1879 .- 1754-4505. ; 22:5, s. 181-186
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.
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| 33. |
- Andersson, Pia, et al.
(författare)
-
Inter-rater reliability of an oral assessment guide för elderly patients residing in a rehabilitation ward
- 2002
-
Ingår i: Special Care in Dentistry. - 0275-1879. ; 22:5, s. 181-186
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.
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| 34. |
- Andersson, Pia, et al.
(författare)
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Oral health and nutritional status in a group of geriatric rehabilitation patients
- 2002
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 16:3, s. 311-318
-
Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to evaluate the oral health status and nutritional status in a group of geriatric rehabilitation patients, and to analyse the relationship between these two parameters. Nurses at the ward performed structured assessments of oral and nutritional status using the Revised Oral Assessment Guide and the Subjective Global Assessment form in 223 newly admitted patients. Most oral health problems were found among patients who stayed longer at the hospital and were more dependent on help as compared with the healthier patients. Thirty-four per cent of the patients were either severely undernourished, at risk or suspected to be undernourished (UN). Oral health problems were more common among UN patients (p < 0.0005) compared with well-nourished patients. The most frequent oral health problem was found on teeth or dentures (48%). Problems related to the tongue and lips were also common among UN patients (56 and 44%, respectively). Oral health status was correlated (r = 0.32) to nutritional status. Problems with swallowing had the strongest association to the nutritional status (OR 6.05; 95% CI 2.41-15.18). This study demonstrated that poor oral health status was related to undernourishment.
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| 35. |
- Andersson, P, et al.
(författare)
-
Oral health and nutritional status in a group of geriatric rehabilitation patients
- 2002
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 16:3, s. 311-318
-
Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to evaluate the oral health status and nutritional status in a group of geriatric rehabilitation patients, and to analyse the relationship between these two parameters. Nurses at the ward performed structured assessments of oral and nutritional status using the Revised Oral Assessment Guide and the Subjective Global Assessment form in 223 newly admitted patients. Most oral health problems were found among patients who stayed longer at the hospital and were more dependent on help as compared with the healthier patients. Thirty-four per cent of the patients were either severely undernourished, at risk or suspected to be undernourished (UN). Oral health problems were more common among UN patients (p < 0.0005) compared with well-nourished patients. The most frequent oral health problem was found on teeth or dentures (48%). Problems related to the tongue and lips were also common among UN patients (56 and 44%, respectively). Oral health status was correlated (r = 0.32) to nutritional status. Problems with swallowing had the strongest association to the nutritional status (OR 6.05; 95% CI 2.41-15.18). This study demonstrated that poor oral health status was related to undernourishment.
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| 36. |
- Andersson, P, et al.
(författare)
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Oral health problems in elderly rehabilitation patients
- 2004
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Ingår i: International Journal of Dental Hygiene. - : Wiley. - 1601-5029 .- 1601-5037. ; 2:2, s. 70-77
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Tidskriftsartikel (refereegranskat)abstract
- A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8-27.8; P < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.
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| 37. |
- Andersson, P, et al.
(författare)
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Testing an oral assessment guide during chemotherapy treatment in a Swedish care setting: a pilot study
- 1999
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 8:2, s. 150-158
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Tidskriftsartikel (refereegranskat)abstract
- Oral complications are common in patients with haematological malignancies who undergo chemotherapy treatment. A pilot study including 16 haematological patients was carried out to evaluate the oral status using an Oral Assessment Guide (OAG) and to test the reliability of the OAG. The oral assessments were made daily by registered nurses at a Department of Internal Medicine in Sweden. Once a week a dental hygienist made the oral assessments independent of the registered nurses in order to provide data for calculations of inter-rater reliability. All patients had varying degrees of alterations in the oral cavity, especially in the mucous membranes, teeth/dentures and gums. The inter-rater agreement between the nurses and the dental hygienist was good for saliva and swallow, and moderate for voice and gums. Assessments to detect alterations in the oral cavity afford the opportunity for early and individualized interventions and may decrease the risk of oral infections. It is necessary to train the nurses to ensure high levels of reliability in the oral assessments. The OAG seems to be a reliable and clinical useful tool for assessing the oral cavity status and determining changes.
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| 38. |
- Axelsson, Ulrika, et al.
(författare)
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A multicenter study investigating the molecular fingerprint of psychological resilience in breast cancer patients : Study protocol of the SCAN-B resilience study
- 2018
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Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 18:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Individual patients differ in their psychological response when receiving a cancer diagnosis, in this case breast cancer. Given the same disease burden, some patients master the situation well, while others experience a great deal of stress, depression and lowered quality of life. Patients with high psychological resilience are likely to experience fewer stress reactions and better adapt to and manage the life threat and the demanding treatment that follows the diagnosis. If this phenomenon of mastering difficult situations is reflected also in biomolecular processes is not much studied, nor has its capacity for impacting the cancer prognosis been addressed. This project specifically aims, for the first time, to investigate how a breast cancer patient's psychological resilience is coupled to biomolecular parameters using advanced "omics" and, as a secondary aim, whether it relates to prognosis and quality of life one year after diagnosis. Method: The study population consists of newly diagnosed breast cancer patients enrolled in the Sweden Cancerome Analysis Network - Breast (SCAN-B) at four hospitals in Sweden. At the time of cancer diagnosis, the patient fills out the standardized method to measure psychological resilience, the "Connor-Davidson Resilience scale" (CD-RISC), the quality of life measure SF-36, as well as providing social and socioeconomic variables. In addition, one blood sample is collected. At the one-year follow-up, the patient will be subjected to the same assessments, and we also collect information regarding smoking, exercise habits, and BMI, as well as patients' trust in the treatment and their satisfaction with the care and treatment. Discussion: This explorative hypothesis-generating project will pave the way for larger validation studies, potentially leading to a standardized method of measuring psychological resilience as an important parameter in cancer care. Revealing the body-mind interaction, in terms of psychological resilience and quality of life, will herald the development of truly personalized psychosocial care and cancer intervention treatment strategies. Trial registration: This is a retrospectively registered trial at ClinicalTrials.gov, ID: NCT03430492on February 6, 2018.
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| 39. |
- Bachrach-Lindström, Margaretha, 1957-
(författare)
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Nutritional status and functional capacity in elderly people with hip fracture
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to study nutritional status and functional capacity in elderly men and women admitted to hospital with a hip fractnre, and to evaluate the effect of nutritional intervention and surgical method. A total of 176 patients participated in the study. Of them 84 received protein- and energy-enriched meals at hospital and nutritional advice on discharge and at home. A total of 100 patients with displaced femoral neck fracture were randomised to treatment with either total hip arthroplasty or osteosynthesis with Olmed® screws.The patients were examined and interviewed the first time within 4-6 days after surgery, as well as one and three months aud one year after surgery. The nutritional status was assessed with body mass index, measures of triceps skinfold thickness, estimation of muscle mass and body composition. Serum albumin, insulin-like growth factor-I and hormones were measured. Functional capacity was assessed with the Modified Norton scale, Katz index of ADL and a questionnaire measuring instrumental activities of daily living.Mentally impaired patients had worse nutritional status aud functional condition compared with the lucid group at inclusion, deteriorated more in activity and mobility fimctions and had a higher one-year mortality rate. The nutritional intervention was not powerful enough to have effect on anthropometric or biochemical measurements. The patients treated with total hip arthroplasty had reduced pain, better locomotion ability and a slight weight gain compared with the osteosynthesis group.In conclusion, a marked deterioration of nutritional and functional status was found after a hip fracture. Studies of the effect of a more powerful nutritional intervention on nutritional status and functional capacity in this group are warranted. Patients treated with total hip arthroplasty had a more favourable rehabilitation period with regard to nutritional status and locomotion ability.
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| 40. |
- Berg, Agneta, et al.
(författare)
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Effects of systematic clinical supervision on psychiatric nurses' sense of coherence, creativity, work-related strain, job satisfaction and view of the effects from clinical supervision: a pre-post test design
- 1999
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126 .- 1365-2850. ; 6:5, s. 371-381
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Tidskriftsartikel (refereegranskat)abstract
- There are few investigations of the type and the outcome of interventions aimed at supporting nurses caring for psychiatric patients. Therefore a prepost-test design study was used in which 22 psychiatric nurses, on a general psychiatric ward were examined before, during and after one year of systematic clinical supervision combined with supervised documented, planned, individualized care. The methods used were the Sense of Coherence scale (SOC), the Creative Climate Questionnaire (CCQ), the Work-Related Strain Inventory and 34 statements from the Satisfaction with Nursing Care and Work Questionnaire (SNCW). In addition 14 statements were developed to evaluate the nurses' view of the effects from clinical supervision. The baseline values for the CCQ indicated a stagnant organization and a high score in the conflict dimension indicated personal and emotional tensions within the organization. The intervention led to a significantly increased creative and innovative climate in the dimensions for trust, idea time and reduced conflicts. However, the organizational climate remained stagnant. The nurses' view of the effects from clinical supervision also increased significantly. There were no significant changes in the nurses' SNCW, WRSI or SOC score. The result of the correlation analysis indicated that a strong sense of coherence was related to low work-related strain but not to unsatisfactory working conditions/milieu. The results gave some support to the idea that systematic clinical supervision and supervised nursing care plans constitute one type of support strategy that improves creativity and the organizational climate. It may, not, however, buffer for interpersonal problems. Further research is required to explore the need for effects of various support systems depending on the circumstances in the organization.
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| 41. |
- Berg, Agneta, et al.
(författare)
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Nurses' reflections about dementia care, the patients, the care and themselves in their daily caregiving
- 1998
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Ingår i: International Journal of Nursing Studies. - 1873-491X. ; 35:5, s. 271-282
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Tidskriftsartikel (refereegranskat)abstract
- In this study the aim was, through interviews, to disclose 13 nurses' personal knowledge about the patients, themselves, and care provision, using a phenomenological-hermeneutic analysing method. Caring for people with severe dementia meant an intertwined life world emanating from making and doing together and the delicate interpretative work that the care provision required. The intertwined life world consisted of the interaction between the nurses' and the patients' separate lives, their common life and the environment, culminating in mutual dependency. Making together signifies the relationship being based on the nurses' knowledge and skills as nurses i.e., the task they had to perform. Doing together signifies the relationship being based on the oneness of the nurses and the patients with severe dementia as ordinary human beings. The delicate interpretation process required, to adapt care to the individual patient, was based on knowledge about the patient's personality, life history and disease progression in combination with the nurses' interpretation of the current situation. The nurses searched for meaning and that, in turn, meant that the patient's inner world was determined by the nurses and thus the patient was seen as being in their hands. It seems important to further understand the human aspects of both the nurse and the patient and to examine this dynamic, ongoing, vulnerable interpretation process, critically, in order to achieve high quality nursing care for the patients with severe dementia, and an experience of well-being in nurses everyday working lives.
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| 42. |
- Berg, A, et al.
(författare)
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Psychiatric nurses' lived experiences of working with inpatient care on a general team psychiatric ward
- 2000
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126. ; 7:4, s. 323-333
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Tidskriftsartikel (refereegranskat)abstract
- To reveal the meaning of being a nurse working with inpatient care on a team psychiatric ward in Sweden, 22 psychiatric nurses were interviewed and the transcribed texts were analysed by means of latent content analysis. Three themes emerged from the analysis: developing a working relationship with the patient in everyday caregiving; encountering and handling the unforseeable in daily living; and struggling with professional independence and dependency. Developing a working relationship with the patient in everyday caregiving meant that the nurse-patient relationship was the foundation of the caregiving and included being with, as well as doing for, and with, the patient. Four different approaches in daily caregiving were revealed: networking, teaching, containing and protecting. The nurses' approaches in the nurse-patient relationship alternated between being an 'expert' and a 'collaborator'. Encountering and handling unforeseeable situations meant that the nurses were exposed to and had to be prepared for unpredictable situations where they were on their own, handling sometimes strong emotional reactions and relying on their own ability to act. Struggling with professional independence and dependency meant that the nurses seemed to lack professional confidence, although they had many responsibilities, but also less authority to decide about overall care planning. Contextual aspects such as organizational hindrance, unsatisfactory work-environment and co-operation difficulties were illuminated. The result indicates the need for a stable and predictable organizational structure if nurses are to manage the demanding nurse-patient relationships that everyday caregiving requires. A question highlighted by this study is whether multidisciplinary team organization has been effectively developed in Sweden, as uncertainty about the roles and responsibilities of nurses was apparent.
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| 43. |
- Berg, Agneta, et al.
(författare)
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The meaning and significance of clinical group supervision and supervised individually planned nursing care as narrated by nurses on a general team psychiatric ward
- 2000
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Ingår i: Australian and New Zealand Journal of Mental Health Nursing. - : Wiley. - 1324-3780 .- 1440-0979. ; 9:3, s. 110-127
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Tidskriftsartikel (refereegranskat)abstract
- By interviewing 22 psychiatric nurses, the present study aimed to reveal the meaning and significance of systematic clinical group supervision and supervised individually planned nursing care, using latent content analysis. The interpreted meaning was 'confronting the complexity of ongoing life in daily nursing care' and the interpreted significance was 'strengthening the foundation for nursing care'. Reflection on action and confirmation seemed to be core components in the process of clinical supervision. Focusing on the relational and task aspects in nursing care within a group approach may have contributed to the positive experiences of development that occurred.
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| 44. |
- Blomqvist, Kerstin, et al.
(författare)
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Managing pain in older persons who receive home-help for their daily living. Perceptions by older persons and care providers
- 2002
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Ingår i: Scandinavian Journal of Caring Sciences. - OXFORD : BLACKWELL PUBLISHING LTD. - 0283-9318 .- 1471-6712. ; , s. 319-328
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Tidskriftsartikel (refereegranskat)abstract
- Pain is a common problem for older persons who need professional help for their daily living. In this study 94 older persons (75+) in persistent pain were compared with 52 care providers concerning the pain management methods they had used/administered during the previous week and how helpful they perceived these methods to be. interviews were based on 16 items from the original version of the pain management inventory (PMI). Both groups perceived prescribed medication, rest and distraction as the most frequently utilized methods. Specific methods such as transcutaneous electrical nerve stimulation (TENS) or bracing/splinting or bandaging the affected body part were seldom employed, although most users perceived these methods as helpful. Care providers perceived most methods for managing pain as more effective than older persons did. The results imply that care providers need skills in a variety of pharmacological and nonpharmacological methods to manage pain and a need to evaluate effectiveness of the methods in a systematic way.
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| 45. |
- Blomqvist, Kerstin, et al.
(författare)
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Pain in older adults living in sheltered accommodation--agreement between assessments by older adults and staff
- 1999
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 8:2, s. 159-169
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to investigate the presence of pain, pain duration, localization(s), intensity, type and pharmacological treatment among older adults living in sheltered accommodation or receiving rehabilitation, as well as the agreement between pain assessments performed by staff and the older adults. Twenty-nine randomly selected older adults (65+ years) and the staff who looked after them participated in a structured interview based on standardized measures for pain assessment and physical, intellectual and communicative functions. Pain was found to be common, with a majority of participants experiencing it every day or all of the time. Nine out of 22 of the older adults in pain had no pain relief drugs at all. Agreement between assessments by the older adults and the staff was no higher than moderate and in general pain levels were underestimated. The findings indicate that older adults were at risk of undetected and untreated pain and the risk was even higher for those with speech difficulties. The provision of good nursing care for older adults in sheltered accommodation requires systematic routines for frequent pain assessments.
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| 46. |
- Blomqvist, Kerstin, et al.
(författare)
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Recognising pain in older adults living in sheltered accommodation: the views of nurses and older adults
- 2001
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Ingår i: International Journal of Nursing Studies. - 1873-491X .- 0020-7489. ; 38:3, s. 305-318
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-six randomly selected older adults and their contact nurses participated in interviews based on standardised assessments of pain and open-ended questions focusing how pain was expressed and recognised. The sample included older adults with normal as well as cognitively impaired function. Seventy-nine percent of older adults with normal cognition were often in pain. Contact nurses assessed pain in 57% of cognitively impaired older adults. The content in the statements showed that pain recognition was a communicative interactive process based on verbal and non-verbal expressions. The process comprised attempts to understand the cause and intention of the expression and to verify the presence of pain. Changes in mood, facial expressions and physiological responses were described less often by older adults than by their nurses. Contact nurses of cognitively impaired older adults judged immobility as the source of pain, that it was possible to see when the person was in pain and that pain was expressed by paralinguistic and body language more often than contact nurses of cognitively healthy older adults. Characteristics of nurses and older adults could facilitate or hinder pain recognition. The findings indicate a need for reflective discussions in the staff group focusing on how to perform systematic assessments of verbal and non-verbal expressions and of hindrances and facilitators for recognising pain in older adults.
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| 47. |
- Bondesson, Susanne, et al.
(författare)
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Comparison of patients undergoing enhanced external counterpulsation and spinal cord stimulation for refractory angina pectoris.
- 2008
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Ingår i: Coronary Artery Disease. - 0954-6928. ; 19:8, s. 627-634
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: As more patients survive coronary events, the prevalence of patients with refractory angina pectoris is increasing. The aim was to evaluate the effects of enhanced external counterpulsation (EECP) and spinal cord stimulation (SCS) and compare with optimal medically treated patients with refractory angina. METHODS: 153 patients with refractory angina were treated with either EECP, SCS, or were retained on their pharmacological treatment (control). Glyceryl trinitrate usage and Canadian Cardiovascular Society classification were registered at baseline, 6 and 12 months after therapy. RESULTS: Both EECP and SCS reduced the angina as compared with controls (P<0.001). Patients treated with EECP showed a more effective reduction as compared with SCS patients (P<0.05). Both treatments resulted in significantly decreased glyceryl trinitrate usage at 6 and 12 months follow-up (P<0.001). The nitrate consumed was unaltered in the controls. DISCUSSION: The results from this study show that both EECP and SCS therapy reduce angina in patients with refractory angina pectoris; the response to EECP was slightly more effective than that to SCS. Thus, EECP can be used as an alternative treatment for patients not responding to electrical stimulation. The beneficial effects in the treated groups were maintained during the 12 months follow-up period.
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| 48. |
- Bondesson, Susanne, et al.
(författare)
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Effects on blood pressure in patients with refractory angina pectoris after enhanced external counterpulsation
- 2010
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 19:5, s. 287-294
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to reduce the frequency and severity of angina pectoris. Little is known how EECP affects the blood pressure. Methods. 153 patients with refractory angina were treated with either EECP or retained on their pharmacological treatment (reference group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate were measured pre- and post-treatment and at 12 months follow-up. Results. EECP treatment altered the blood pressure in patients with refractory angina pectoris. A decrease in the blood pressure was more common in the EECP group compared with the reference group. In the reference group, an increase in the blood pressure was more common. A correlation between a decrease in blood pressure after EECP treatment and a higher baseline MAP, SBP and DBP was seen. No such correlation was seen in the reference group. The blood pressure response did not persist at 12 months follow-up. Conclusion. EECP treatment affects the blood pressure in patients with refractory angina pectoris. The decreased blood pressure may be a result of an improved exercise capacity, an improved endothelial function and vasoreactivity in general.
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| 49. |
- Bondesson, Susanne, et al.
(författare)
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Hospital utilization and costs for spinal cord stimulation compared with enhanced external counterpulsation for refractory angina pectoris
- 2013
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Ingår i: Journal of Evaluation in Clinical Practice. - : Wiley-Blackwell Publishing Ltd. - 1356-1294 .- 1365-2753. ; 19:1, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives The aim of this study was to compare acute hospital utilization and costs for patients with refractory angina pectoris undergoing spinal cord stimulation (SCS) versus enhanced external counterpulsation (EECP). Method Seventy-three persons were included in this register study. The acute hospital utilization and costs for SCS and EECP were followed over a period from 12 months before treatment to 24 months after treatment using Patient Administrative Support in Skåne for publicly organized care. Results SCS was significantly more expensive than EECP (P < 0.001). Both SCS and EECP entailed fewer days of hospitalization for coronary artery disease in the 12-month follow-up compared with the 12 months preceding treatment. Patients treated with EECP showed an association between reduced hospital admissions and an improved Canadian Cardiovascular Society classification class compared with 1 year before treatment. A significant reduction in cost was seen in both the SCS group (P = 0.018 and P = 0.001, respectively) and the EECP group (P = 0.002 and P = 0.045, respectively) during 12 and 24 months of follow-up compared with before treatment. There were no significant differences between the groups for hospitalization days or admissions, including costs, at the different follow-ups. Conclusions Cost-effective treatment modalities such as SCS and EECP are valuable additions to medical and revascularization therapy in patients with refractory angina pectoris. Pre-existing conditions and the patient's preferences should be taken in consideration when clinicians choose between treatments for this group of patients.
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| 50. |
- Borg, Christel, et al.
(författare)
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Life satisfaction among informal caregivers in comparison with non-caregivers
- 2006
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 20, s. 427-38
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Tidskriftsartikel (refereegranskat)abstract
- Being a caregiver with responsibility for someone with reduced health compared with not being a caregiver maymean different views of life satisfaction. Knowledge of what leads to reduced life satisfaction in caregivers may be helpful in interventions. Informal caregivers gainfully employed or not, aged 50–89 years, were studied with regard to life satisfaction depending on the extent of caregiving to identify types of social support of value for caregivers. A cross-sectional study was conducted including a sample of 151 informal caregivers with a high caregiving extent, 392 caregivers with a lower caregiving extent and 1258 non-caregivers. The sample was randomly selected to correspond with older Swedes as a whole aged 50–89 years. A questionnaire containing a modified form of Older Americans’ Resources Schedule (OARS) and Life Satisfaction Index Z (LSIZ) was used; 19.6% helped someone with activities of daily living and of these 27% stated that they did so frequently. Frequent caregivingimplied significantly higher age, being more often married and retired, than less frequent caregivers and non-caregivers. Frequent caregivers also performed personal activities of daily living (PADL) to a higher extent than less frequent caregivers and had significantly lower LSIZ (mean 14.8) than less frequent caregivers (mean 17.6) and noncaregivers (mean 17.7). No significant differences were found between less frequent caregivers and non-caregivers in LSIZ. One-fourth had support from others, the commonesttype being able to converse with a next of kin, and help and advice from professionals. Lower life satisfaction was associated with not being employed, low social resources, not refreshed after a night’s sleep, overall poor health and frequent caregiving in the entire sample. High caregiving extent was associated with lower life satisfaction. The most important factors explaining lower life satisfaction among frequent caregivers were having low social resources and having poor health. Economic compensation or payment was the support most desired.
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