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- Holst, M., et al.
(författare)
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Well-established nutritional structure in Scandinavian hospitals is accompanied by increased quality of nutritional care
- 2009
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Ingår i: e-SPEN. - : Elsevier BV. - 1751-4991. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate Scandinavian nurses self-reported attitudes, practice and barriers towards nutrition practice, and to explore whether nurses working in departments with a well defined structure (w-DS) for nutritional aspects, have better nutritional practise. Preventing and treating undernutrition is shown to be complicated. Investigations are needed to priority efforts. The design is a questionnaire-based investigation of Scandinavian hospital nurses attitudes and practise to clinical nutrition. A questionnaire regarding nutritional care process sent to 6000 nurses in Scandinavia. A definition of w-DS and p-DS (less defined structure) was made according to ESPEN Guidelines. Nurses were classified as working at w-DS or p-DS departments, if three or more of five organisational structure markers were met. Overall 2759 responded. Discrepancy was found between attitudes and practise (p less than 0.0001). W-DS was found in 49%. Nurses who worked at departments with w-DS had higher frequency for nutrition actions (p less than 0.0001). Knowledge and time past graduation, were amongst independent factors for good nutritional structure (p less than 0.0001). Differences were seen between countries and specialities (p less than 0.0005). Organisation structure recommended by ESPEN seems important. Knowledge and experience were independent factors for good nutrition structure. The content of nutrition education needs consideration.
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- Idvall, Ewa, et al.
(författare)
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Assessment of recovery after day surgery using a modified version of quality of recovery-40
- 2009
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 53:5, s. 673-677
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Tidskriftsartikel (refereegranskat)abstract
- A recent nationwide survey in Sweden found that day surgery accounts for 43% of all in-hospital procedures.1 Orthopaedic, general, and gynaecological procedures were the most common. About 40% of the day surgery units followed up with telephone calls within 1–2 days, and found pain to be the most common complaint. Quality of recovery had not been systematically evaluated with instruments tested for validity and reliability, and follow-ups beyond 2 days post-operative were not found.Quality of Recovery-40 (QoR-40)2,3 is a 40-item instrument to assess the quality of post-operative recovery. The instrument is divided into five dimensions; emotional state, physical comfort, psychological support, physical independence, and pain. These dimensions represent aspects of good-quality recovery after anaesthesia and surgery. QoR-40 has been used for patients undergoing different surgical procedures and tests for validity and reliability yielded initial support for the instrument. Myles et al.3 concluded that QoR-40 would be a useful outcome measure to assess the impact of changes in health care delivery on quality of care, but anaesthesia and surgery studies have rarely used this approach. Although QoR-40 has not been used exclusively for day surgery patients, some day surgery patients were included when the instrument was developed.2,3 Another study on day surgery patients4 used eight items from QoR-40 relevant to that study. In a systematic review of post-operative recovery outcomes measurements after ambulatory surgery, the QoR-40 was the only instrument that fulfilled the criteria that were set up but was not specifically designed for day surgery and anaesthesia.5 Another systematic review from 2008 also advises to use the QoR-40 in future validation and application studies.6 Day surgery is increasing, and it is important to measure the quality of care and the impact of change. When using an instrument such as QoR-40, each item must be carefully considered for the purpose and context it will be used in, especially when it differs from the original context, both concerning cultural differences between countries and the type of surgical procedure used. Therefore, our study created and used a modified version of the QoR-40 to measure the quality of recovery in day surgery patients. The study aimed to test this modified version in a Swedish context for day surgery patients, to assess the quality of recovery on days 1, 7, and 14 post-operative.
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- Idvall, Ewa, 1950-, et al.
(författare)
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Differences between nurse and patient assessments on postoperative pain management in two hospitals
- 2005
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 11:5, s. 444-451
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Differences between patient and professional assessments on pain and pain management have been reported, but no further analysis has described the statistical problems of pseudocorrelation concerning the nature of these differences. Aim: The aim of the present study was: (1) to investigate the differences between nurse and patient assessments of post-operative pain management in two hospitals, and (2) to discuss the nature and scope of these differences. Method: The subjects were 209 inpatients and 63 nurses from a central county hospital and 77 inpatients and 34 nurses from a university hospital. The 'Strategic and Clinical Quality Indicators in Postoperative Pain Management' questionnaire was used, comprising 14 items in four sub-scales (communication, action, trust and environment) and two questions concerning the worst pain experienced during the past 24 hours and general satisfaction. Result: Except for the trust sub-scale in one hospital, the correlations between patient and nurse ratings concerning all assessments were significant in both hospitals (r = 0.22 - 0.59). Both groups of patients had significantly higher (better) scores than judged by the nurses on the environment sub-scale and general satisfaction. In contrast, nurses from both hospitals tended to significantly underestimate patients' worst pain during the past 24 hours. Other differences between patient and nurse assessments were either non-significant or inconsistent between hospitals. Using so-called Oldham plots nurses tended to under-estimate severe pain more often than mild pain, as judged by the patients, but this association was weak and statistically significant in one hospital only. Conclusion: Although the effects of pseudocorrelation are minimized by using Oldham plots, they are not cancelled. This issue is discussed, and we conclude that this study does not support the notion that the nurses tend to underestimate severe pain more often than mild pain. © 2005 Blackwell Publishing Ltd.
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- Idvall, Ewa, 1950-, et al.
(författare)
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Perspectives of Swedish patients on postoperative pain management
- 2008
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Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 10:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to describe the perspectives of surgical patients towards postoperative pain management during their hospital stay. Thirty strategically chosen postoperative inpatients from different surgical wards in a university hospital in Sweden participated. A qualitative, descriptive approach using individual interviews was chosen. These were tape-recorded, transcribed verbatim, and analyzed according to a qualitative content analysis. The patients' descriptions of postoperative pain management indicated that pain was a symptom that was always in focus, either because it was constantly present or because pain could appear abruptly during different activities and movements. Although the focus was on pain and an awareness that it should be relieved or avoided, the solutions were often routine, short-term, and involved the regular intake of drugs, plus additional medication if needed for an acute pain episode. From the patients' descriptions of their experience with postoperative pain management, we distinguished three categories: "patients' pain knowledge", "patients' pain management approaches", and "patients' views of health-care professionals". The findings from this study highlight important aspects of nursing care that should receive greater attention in postoperative pain management. The patients' narratives could be a valuable asset in the quality improvement of postoperative pain management as these narratives highlight episodes difficult to elicit in other ways. © 2008 The Authors Journal compilation © 2008 Blackwell Publishing Asia Pty Ltd.
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- Johansson, Ulla M, et al.
(författare)
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Nutritional therapy in elderly care--a forgotten perspective. A questionnaire study shows clear shortages in the care of the elderly
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:40, s. 2538-2542
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Tidskriftsartikel (refereegranskat)abstract
- It has previously been demonstrated that the use of clinical nutrition in Swedish hospitals did not fulfill European standards. In the present study, a questionnaire-based investigation was performed among nurses working with elderly people living in sheltered housing. Overall, 765 (54.6%) responded. Nearly 90% of the nurses considered themselves responsible for nutritional assessment, although only 36% routinely registered energy intake on patients at risk of undernutrition. More than 60% stated that education regarding clinical nutrition was insufficient. Thus, despite a heavy responsibility in the nutrition care process for nurses, a lack of sufficient knowledge and education was evident. Special efforts should be aimed at a clarified organization as well as education.
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- Johansson, Ulla M, et al.
(författare)
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Nutritionsbehandling i äldrevård - ett bortglömt perspektiv : Enkätstudie visar tydliga brister i omhändertagandet av äldre
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:40, s. 2538-2542
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Tidskriftsartikel (refereegranskat)abstract
- Sjukdomsrelaterad undernäring har beskrivits i Europa under flera decennier. Europarådet antog år 2003 en resolution med rekommendationer till medlemsländerna kring nutritionsbehandling på sjukhus. En tidigare studie visar att rekommendationerna inte efterlevs inom svensk slutenvård, där flertalet patienter är äldre. Den aktuella enkätstudien, riktad till sjuksköterskor inom särskilda boenden, påvisar sjuksköterskornas ansvar för utritionsprocessen men även brister i både kunskap och utbildning. Brister har även beskrivits i ansvarsfördelning mellan yrkesgrupper, riktlinjer för nutritionsbehandling och övergripande organisation. En förändrad struktur efterlyses inom hälso -och sjukvårdsorganisationen. Såväl läkare, dietister, sjuksköterskor som undersköterskor bör vara aktiva i nutritionsprocessen vid särskilda boenden.
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| 10. |
- Johansson, Ulla M, et al.
(författare)
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Nutritionsbehandling i äldrevård - ett bortglömt perspektiv : Enkätstudie visar tydliga brister i omhändertagandet av äldre
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:40, s. 2538-2542
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Tidskriftsartikel (refereegranskat)abstract
- It has previously been demonstrated that the use of clinical nutrition in Swedish hospitals did not fulfill European standards. In the present study, a questionnaire-based investigation was performed among nurses working with elderly people living in sheltered housing. Overall, 765 (54.6%) responded. Nearly 90% of the nurses considered themselves responsible for nutritional assessment, although only 36% routinely registered energy intake on patients at risk of undernutrition. More than 60% stated that education regarding clinical nutrition was insufficient. Thus, despite a heavy responsibility in the nutrition care process for nurses, a lack of sufficient knowledge and education was evident. Special efforts should be aimed at a clarified organization as well as education.
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