| 1. |
- Smide, Bibbi, et al.
(author)
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Self-reported health and glycaemic control in Tanzanian and Swedish diabetic patients
- 2002
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 37:2, s. 182-191
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Journal article (peer-reviewed)abstract
- Aims of the study. To investigate self-reported health in adult Tanzanian and Swedish diabetic patients in relation to the general population in the two countries and to investigate whether diabetic patients with poor glycaemic control also rated their self-reported health to be impaired. Design/methods. The study design was cross-sectional and comparative. One hundred and fifty Tanzanian patients were age-and gender-matched with Swedish diabetic patients. Self-reported health was measured using the generic SF-36 health questionnaire, measuring eight different health domains. Glycaemic control was measured by testing glycosylated haemoglobin (HbA1c). Results. The main results were that Tanzanian diabetic patients had poorer health in comparison with general Tanzanian population living in the same geographical area. In contrast, diabetic patients in Sweden did not markedly differ from the Swedish general population. Furthermore, Tanzanian patients had poorer glycaemic control. In both countries poor glycaemic control did not associate with impaired self-reported health, with one exception. Tanzanian patients with unsatisfactory or poor glycaemic control had significantly poorer reported health in the mental health domain. Conclusions. The results indicated that patients' health should be assessed using a specific health measure in addition to general medical measures.
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| 2. |
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| 3. |
- Adolfsson, Eva Thors, et al.
(author)
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Type 2 diabetic patients' experiences of two different educational approaches : A qualitative study
- 2008
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In: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 7:45, s. 986-994
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Journal article (peer-reviewed)abstract
- Objective: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. Method: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. Findings: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance-care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. Conclusions: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.
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| 4. |
- Graue, M, et al.
(author)
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Diabetes nursing research in the Nordic countries
- 2013
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In: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 10:2, s. 46-51
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Journal article (peer-reviewed)abstract
- New knowledge from research studies is important as a foundation for high-quality care in practice as well as crucial to further stimulate research in the future.The aims of this study were to determine the total number of peer-reviewed articles on diabetes research reported by nurses in four Nordic countries (Denmark, Iceland, Norway and Sweden) from 1979–2009, and to identify the time periods in which they had been published, different study designs and the number of publications related to nurse authors.We performed an electronic search for potentially relevant scientific articles between 1 January 1979 and 31 December 2009 using the MEDLINE, Medline in process, EMBASE, CINAHL, PsycINFO and Cochrane databases. The studies focused either on the diabetes population or on diabetes health care professionals.We included 164 scientific articles; 132 resulting from electronic search and 32 from manual search. They were published in 63 different scientific journals, with 52 (32%) published in nursing journals and typically by authors with university degrees. Only one in four authors had published five or more articles. The majority of the studies originated from a single country, with 23 (14%) including co-authors from another country.It was concluded that research in diabetes reported by nurses has increased considerably after the year 2000. Further action is needed to build stronger national groups of researchers. International collaborative research networks facilitate funding opportunities and contribute to further development of professional research competence.
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| 5. |
- Iversen, Marjolein M., et al.
(author)
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Characteristics of nursing studies in diabetes research published over three decades in Sweden, Norway, Denmark and Iceland : a narrative review of the literature
- 2016
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 30:2, s. 241-249
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Journal article (peer-reviewed)abstract
- Similarities and differences across borders of Nordic countries constitute a suitable context for investigating and discussing factors related to the development of diabetes nursing research over the last three decades. The present study reviewed the entire body of contemporary diabetes nursing research literature originating in four Nordic countries: Norway, Sweden, Denmark and Iceland. Our aims were (i) to catalogue and characterise trends in research designs and research areas of these studies published over time and (ii) to describe how research involving nurses in Nordic countries has contributed to diabetes research overall. The larger goal of our analyses was to produce a comprehensive picture of this research in order to guide future studies in the field. We conducted a narrative literature review by systematically searching Medline, Medline in process, EMBASE, CINAHL, PsycINFO and Cochrane databases. These searches were limited to studies published between 1979 and 2009 that had an abstract available in English or a Nordic language. Two researchers independently selected studies for analysis, leading to the inclusion of 164 relevant publications for analysis. In summary, Nordic nurse researchers have contributed to the development of new knowledge in self-management of diabetes in childhood, adolescence and adulthood, and to some extent also in the treatment and care of diabetes foot ulcers. Future research may benefit from (i) larger nurse-led research programmes organised in networks in order to share knowledge and expertise across national groups and borders, (ii) more multidisciplinary collaborations in order to promote patient-centred care and (iii) further research directed towards improving the dissemination and implementation of research findings. Using complex intervention designs and a mix of research methods will enrich the research.
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| 6. |
- Kärvestedt, Lars, et al.
(author)
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Diabetes hos den äldre-äldre personen
- 2006
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In: Omvårdnad vid diabetes. - : Studentlitteratur, Lund. - 914403539X ; , s. 360-
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Book chapter (pop. science, debate, etc.)
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| 7. |
- Leksell, Janeth, et al.
(author)
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Psychometric properties of the Swedish Diabetes Empowerment Scale
- 2007
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 21:2, s. 247-252
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Journal article (peer-reviewed)abstract
- This study was conducted to determine the psychometric properties of the Swedish version of the Diabetes Empowerment Scale (Swe-DES-23). Research design and methods: A convenience sample of 195 patients with type 1 and type 2 diabetes completed the Swe-DES-23 questionnaire. To establish discriminant validity, Swe-DES subscales were compared with the Semantic Differential in Diabetes scale (SDD) and a general health scale (EVGFP). Construct validity was tested using factor analyses. To determine unidimensionality of the subscales, inter-item correlations were calculated. Internal consistency was tested by the use of the Crohnbach-α coefficient. Results: The factor analysis resulted in four factors (empowerment subscales) with eigenvalues >1.0, explaining 60% of the variance. The four empowerment subscales: goal achievement, self-awareness, stress management and readiness to change showed Crohnbach-α values ranging from 0.68 to 0.91. Patients with good self-reported health and low burden of diabetes scored significantly higher on almost all empowerment subscales. Only weak correlations were found between metabolic control and the empowerment subscales. Conclusions: The SWE-DES-23 scale had acceptable validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Further testing is needed to shorten the questionnaire.
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| 8. |
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| 9. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
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Clarifying responsibility for self-management in adolescents with diabetes using insulin pumps : a qualitative study
- 2011
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 67:7, s. 1547-1557
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Journal article (peer-reviewed)abstract
- Aim: To gain insight into and generate theoretical knowledge about the processes involved when insulin pump-treated adolescents take or miss taking their bolus doses. Background: Insulin pump treatment is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. Despite insulin pump-treatment, it is hard to maintain near-normal glucose control in adolescents; one reason for this is missed bolus doses to meals. Method: In this qualitative interview study, the grounded theory method was chosen as a model for the collection and analysis of data. Twelve adolescents (5 males and 7 females, mean age 14.4 years, range 12-19 years) from different Swedish paediatric diabetes clinics, four parents and one paediatric diabetes nurse were interviewed during 2008 and 2009. Findings: Responsibility in the context of taking or missing bolus doses emerged as the core category. It is elaborated and explained through three subcategories: distribution of responsibility, transfer of responsibility and clarifying of responsibility. The distribution of responsibility was clear among those who took most of their doses; they had high personal responsibility or shared it with their parents. The optimal transfer of responsibility is when it gradually moves from the parents to the adolescent. The findings revealed a need to clarify the responsibility for diabetes self-management in continuous negotiations between adolescents and parents to avoid missed bolus doses. Conclusion: Negotiations to clarify the responsibility for diabetes self-management must be a continuous process between adolescents and parents. Diabetes care teams may facilitate and encourage these negotiations.
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| 10. |
- Lindholm Olinder, Anna, et al.
(author)
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Clarifying responsibility for self-management of diabetes in adolescents using insulin pumps - a qualitative study
- 2011
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In: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 67:7, s. 1547-1557
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Journal article (peer-reviewed)abstract
- Aim. To gain insight into and generate theoretical knowledge about the processes involved when insulin pump-treated adolescents take or miss taking their bolus doses.Background. Insulin pump treatment is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. Despite insulin pump treatment, it is hard to maintain near-normal glucose control in adolescents; one reason for this is missed bolus doses with meals.Method. In this qualitative interview study, the grounded theory method was chosen as a model for the collection and analysis of data. Twelve adolescents (five boys and seven girls, mean age: 14.4 years, range: 12–19 years) from different Swedish paediatric diabetes clinics, four parents and one paediatric diabetes nurse were interviewed during 2008 and 2009. Two adolescents and two parents were re-interviewed after approximately 10 months. Data from clinical visits and diabetes camps were used to verify emerging categories.Findings. Responsibility in the context of taking or missing bolus doses emerged as the core category. It is elaborated and explained through three subcategories: distribution of responsibility, transfer of responsibility and clarification of responsibility. The findings describe the need to clarify the responsibility for diabetes self-management in continuous negotiations between adolescents and parents to avoid missed doses.Conclusion. Negotiations to clarify the responsibility for diabetes self-management must be a continuous process between adolescents and parents. Diabetes care teams can facilitate and encourage these negotiations.
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| 11. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
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Continuous subcutaneous insulin infusion in young girls : a two-year follow-up study
- 2007
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In: European Diabetes Nursing. - : John Wiley & Sons. - 1551-7853 .- 1551-7861. ; 4:1, s. 34-39
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Journal article (peer-reviewed)abstract
- Aims:To investigate why young girls decided to start continuous subcutaneousinsulin infusion (CSII) therapy, and to examine their opinions and concerns withregard to using an insulin pump. In addition, the girls were evaluated for HbA1cvalues, insulin requirements and body mass index standard deviation score (BMISDS) over a period of two years after starting CSII compared with a group of girlsusing multiple daily injections (MDI).Methods:Twelve girls (mean age 10.8 years) starting CSII were followed over a period of two years. Why the girls started CSII and whether they preferred CSII orMDI were investigated. Their statements about CSII were analysed and categorisedby two paediatric diabetes nurses. On four occasions HbA1c values, insulin require-ment and BMI SDS were collected and compared with those of a control group of 12 girls using MDI for the same period of time.Results:The girls started CSII due to a desire to test pump therapy, and their experiences of unstable blood glucose. They preferred CSII to MDI. The main positive statements were categorised as ‘quality-of-life benefits’. The main negativecategory was ‘the pump gets in the way’. In the CSII group, HbA1c decreased from8.5 (7.4–9.5) to 7.5 (6.9–8.1) (p<0.05) over two years, and the insulin requirementdecreased by 30%. In the control group these values were unchanged. There wereno changes in the BMI SDS mean values for either group.Conclusion:CSII was well accepted by the young girls, facilitated a decrease inHbA1c values, and did not result in weight gain.
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| 12. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
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Post-prandial glucose levels following three methods of insulin bolusing : A study in adolescent girls and in comparison with girls without diabetes
- 2009
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In: Practical diabetes international. - : Wiley. - 1357-8170. ; 26:3, s. 110-115
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Journal article (peer-reviewed)abstract
- The aims of this study were to assess whether one method of insulin bolusing wassuperior to two others in managing two pasta meals, and to compare the glucose levelswith those of females without diabetes.Fifteen continuous subcutaneous insulin infusion (CSII)-treated adolescent femalesand 10 adolescent females without diabetes consumed two pasta meals with different fatcontents. The plasma glucose (p-glucose) values were followed using capillarymeasurement and continuous glucose monitoring (CGMS) until three hours after themeal. The CSII-treated females received the same insulin dose at every occasion as:(1) normal bolus; (2) dual-wave bolus – 60% of the dose as normal bolus and 40% overone hour; and (3) square-wave bolus – a prolonged dose over one hour.No differences were found in p-glucose peak or AUC between the bolus methodsafter either of the meals. There was a difference in p-glucose increase at one time pointafter the less fat meal; after 60 minutes the increase was greater with a square-wavebolus (Friedman’s test p<0.02). Forty-eight percent of the measurements among thediabetes adolescents showed post-prandial p-glucose levels ≤10mmol/L. Femaleswithout diabetes had earlier and lower p-glucose peak and smaller AUC.It was concluded that there were no overall differences in p-glucose excursionsbetween different methods of bolusing for these adolescent females after these meals. Asquare-wave bolus may be less favourable with a less fatty pasta meal, giving a higherp-glucose increase. It was possible to achieve normoglycaemic post-prandial p-glucoselevels among adolescents with diabetes.
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| 13. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
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Reasons for missed meal-time insulin boluses, from the perspective of adolescents using insulin pumps – “lost focus”
- 2011
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 12:4, s. 402-409
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Journal article (peer-reviewed)abstract
- Objective: To investigate the reasons for missed bolus doses and strategies for avoiding this among adolescents using insulin pumps. Methods: The grounded theory method was chosen as a model for the collection and analysis of data. Data were collected through interviews with 12 adolescents treated with an insulin pump (5 males and 7 females, mean age 14.4 yr) from different Swedish pediatric diabetes clinics. All interviews were tape-recorded and immediately transcribed. Results: The core category 'lost focus' emerged as representing the main reason for missed bolus doses. Identified subcategories were delayed lost focus, directly lost focus, and totally lost focus. There was a risk of delayed lost focus when the adolescent used postprandial bolusing. Focus could also be lost directly in connection with the start of the meal. Totally lost focus could occur when the adolescent perceived the impact of diabetes as too high or tried to neglect that he or she had it. The category 'agreements about reminders' appeared to be the main strategy for avoiding missed bolus doses; subcategories were personal reminders and technical reminders. The adolescent needed to be involved in these agreements; otherwise, the reminding could be seen as nagging and did not work. Conclusion: The results may help diabetes care teams understand the circumstances in which adolescents miss their bolus doses. This understanding may make it easier to discuss missed doses and strategies for avoiding this with adolescents and support negotiations over agreements about reminders between them and their parents.
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| 14. |
- Lindholm Olinder, Anna, 1960-
(author)
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Self-management of diabetes in adolescents using insulin pumps
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Insulin pump treatment (CSII) is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. However, despite the use of CSII, achieving the recommended disease control is difficult for adolescents. The aim of this thesis was to explore aspects of self-management of diabetes in adolescents using insulin pumps in order to describe conditions contributing to the recommended disease control. Three methods of bolusing (normal, dual-wave and square-wave) in connection with pasta meals were tested in a crossover study among 15 adolescents with diabetes to assess whether one method was superior in managing glucose levels. A cross-sectional study among 90 adolescents being treated with CSII was conducted to investigate the management of CSII, including the administration of bolus doses. Two qualitative interview studies, based on the grounded theory method, were performed to gain insight into the processes involved in taking bolus doses and to investigate reasons for missed bolus doses and strategies for avoiding missing them. Twelve adolescents, four parents and one diabetes specialist nurse were interviewed. No method of bolusing was found to be superior in managing the glucose levels after these meals. The post-prandial glucose peaks were <10 mmol/L, in 48% of the cases, regardless of bolus methods. This indicates that adolescents can be encouraged to individually test which bolus method gives them the most normal post-prandial glucose levels. The cross-sectional study showed that adolescents were satisfied with CSII, but that 38% had missed more than 15% of the bolus doses the day under study. The frequency of bolus doses correlated with the disease control. Findings from the interview study revealed the need to clarify the responsibility for diabetes self-management in continuous negotiation between adolescents and parents to avoid insulin omission. The main reason for missed boluses was lost focus, and the strategies for remembering them were agreements involving reminders. The thesis describes that individual dose testing, clarification of responsibility and agreements involving reminders are conditions contributing to the recommended disease control. The thesis also describes that lost focus and a lack of responsibility can lead to insulin omission and be a hindrance to achieving disease control.
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| 15. |
- Lindholm Olinder, Anna, 1960-, et al.
(author)
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Treatment with CSII in two infants with neonatal diabetes mellitus
- 2006
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 7:5, s. 284-288
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Journal article (peer-reviewed)abstract
- This article reports the case studies of two children with neonatal onset of diabetes who were treated with continuous subcutaneous insulin infusion (CSII) from within 4 d to 3 wk of the diagnosis. The aim was to describe diabetes-related and insulin-pump-specific data in relation to growth and various feeding patterns when using CSII in infants with diabetes during their first year of life. The two children's medical records were scrutinized. The results showed that both children had good metabolic control [median hemoglobin A1c (HbA1c) 5.3 and 5.7%, high performance liquid chromatography (HPLC) method, reference: 3.4-5.0%. Compared with the Diabetes Control and Complications Trial (DCCT) HbA1c units, Swedish units give approximately 1% point lower results]. No episodes of severe hypoglycemia or diabetic ketoacidosis have been demonstrated. The children had normal growth patterns, as they followed a normal feeding regime for their age. The meal doses of insulin were given over 12 min to 3 h. The children had diluted Humalog((R)) insulin 10 U/mL (Eli Lilly & Co, Indianapolis, IN, USA) in their pumps. Different types of insulin pumps were used, namely, the Minimed 507C and 508 (Medtronic, Minneapolis, MN, USA), and a Disetronic H-tron V100 (Roche Diagnostics, Basel, Switzerland). The children used different types of infusion sets. Neither family reported any technical problems with their pump system. CSII was an effective and safe treatment for the two children suffering from neonatal diabetes. This offers an alternative for other infants with a similar diagnosis.
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| 16. |
- Lindmark, Anna, et al.
(author)
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Perception of healthy lifestyle information in women with gestational diabetes
- 2010
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In: European Diabetes Nursing. - : Informa UK Limited. - 1551-7853 .- 1551-7861. ; 7:1
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Journal article (peer-reviewed)abstract
- Background: Pregnant women with gestational diabetes mellitus (GDM) need information about the increased risk of developing type 2 diabetes mellitus (T2DM) in later life. Aims: To investigate how women with GDM perceived information about this condition during pregnancy; to explore their opinions on healthcare provision up to one year after delivery; to investigate their perceptions about lifestyle a year after delivery. Methods: Ten women were interviewed using a semi-structured guide. Data were analysed using content analysis. Questions included reactions to receiving the diagnosis and perceptions about information given during pregnancy and current health. Results: Six of the women perceived that information given had been too sparse; the remaining four considered it useful to learn about the risk of developing T2DM in later life. Written information about GDM was considered very brief or non-existent. Care received after delivery was perceived to be positive. Group meetings arranged up to one year after childbirth were appreciated by all attendees. At these meetings, recommendations were given regarding food and physical exercise, but no follow-up was arranged to encourage more permanent lifestyle changes. Conclusion: Opportunities for women with GDM to meet others with the condition and receive specialist support need to be maximised, so that these women can become more knowledgeable and be encouraged to change their lifestyle. This may help prevent or delay the onset of T2DM.
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| 17. |
- Löfmark, Anna, et al.
(author)
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Competence of newly-graduated nurses : a comparison of the perceptions of qualified nurses and students
- 2006
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 53:6, s. 721-728
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Journal article (peer-reviewed)abstract
- AIM: This paper reports a study that compares opinions of final year nursing students, rating their own competence, with the opinions of experienced nurses on the competence of newly-graduated nurses. BACKGROUND: The transition of nursing preparation into higher education is regarded as positive, although it has led to differences in opinion about the competence of newly-graduated nurses and their readiness to enter the nursing profession. There are studies showing that newly-graduated nurses perceive themselves as holistically focused, professional practitioners, while other nurses are concerned that newly-graduated nurses do not have necessary skills. METHODS: A convenience sample of 106 nursing students in the final week of their course and 136 nurses who had experience of supervising nursing students completed a questionnaire. The data were collected in 2002. RESULTS: Own competence, in the form of ability to perform nursing care, was rated by nursing students to be good or strongly developed in most of the investigated areas of nursing care. Experienced nurses also estimated newly-graduated nurses' competence to be good or strongly developed, although to a lesser extent. Nurses qualified within the previous 5 years rated newly-graduated nurses' competence to be higher in comparison with those with less recent education. CONCLUSIONS: Further studies are needed to broaden our understanding of why some areas of nursing care, such as ethical awareness, were rated very highly, while others, like informing and teaching of co-workers and planning and prioritizing interventions had the lowest rating.
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| 18. |
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| 19. |
- Mbwilo, G. S. K., et al.
(author)
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Family perceptions in caring for children and adolescents with mental disabilities : a qualitative study from Tanzania
- 2010
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In: Tanzania Journal of Health Research. - 1821-6404. ; 12:2, s. 1-12
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Journal article (peer-reviewed)abstract
- Observations have shown that the provision of services to children and adolescents withmental disability (CAMDs) is not responding to the needs of this population. This community based study was carried out in Temeke Municipality in Tanzania and aimed to explore factors that influence family perspectives in the provision of care to CAMDs. This is a qualitative study of 52 respondents from 29 families involved in the daily care of CAMDs, chosen through convenient sampling. A semistructured questionnaire was used in the interviews. The text was analysed using thematic content analysis. The results of the study revealed family characteristics; deficient knowledge about mentaldisability (MD); and lack of health care facilities and resources for caring for CAMDs. The communityand families of CAMDs had poor knowledge on MD and appropriate care, and about availability of resources and quality care. Families were not supported in the care of their children. Some children inconsequence did not receive adequate health care. Some suffered from physical problems due to inadequate care; others were being locked in their room during periods when no‐one was able to look after them. These factors were related to socio‐economic characteristics of the families as well as t olacking service facilities. “Patient”‐oriented, community/family‐based health services to support management of chronic or life‐long conditions such as MD are needed. The support of caregivers to children with MDs has to be improved. A well worked‐out strategy would improve health care of CAMDs through provision of guidance and supervision to the families. Community and family/home‐based care in the study area would benefit families of CAMDs.
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| 20. |
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| 21. |
- Ndoma, Asteria L. M., et al.
(author)
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Preventing IUC infections in Tanzanian patients; nurses´knowledge, clinical practice and patients´views
- 2008
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In: International Journal of Urological Nursing. - 1749-7701. ; 2:1, s. 33-41
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Journal article (peer-reviewed)abstract
- Nosocomial infections related to indwelling urinary catheters (IUC) are a worldwide problem. While this is true in areas of the globe where care facilities are optimal, it is even more the case that in countries where care conditions are compromised or when practice is lacking a substantial knowledge base. The primary aim of this study was to investigate nurses' knowledge and clinical practise regarding care of patients with IUC in preventing nosocomial infections in four hospitals in Tanzania. Additionally, the study investigated patients' views about received care relating to the presence of an IUC. Registered and enrolled nurses (n = 135) working in four hospitals in Dar-es-Salaam municipality completed a questionnaire about IUC procedures. Four nurse students performed bedside observations of nurses (n = 127) on the care for patients with IUC. Sixty patients were interviewed about their views of the care given in relation to IUC. The nurses' overall knowledge was good, but there was a discrepancy between knowledge and clinical practice. Hand washing prior to care for patients with IUC was poor due to lack of water and soap. Half of the patients experienced problems; haematuria, offensive smell, pus around the catheter and swelling of the scrotum in male patients. Patients expressed frustration regarding the care of IUC. There was a shortage of trained hospital staff, shortage of beds to the extent that patients had to share beds and appropriate equipment was not available. Although the nurses' knowledge in IUC care was relatively good, the nursing care for patients with IUC in the studied hospitals ought to be improved. This can be done by developing evidence-based, culturally congruent guidelines for assurance of quality care. Many of the problems that were considered to increase the risk of nosocomial infections were identified as being related to the logistics of the wards and lack of staff. Therefore, on the strength of these findings, it is recommended that unnecessary use of IUC should be avoided particularly where weak infrastructure has been identified.
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| 22. |
- Olinder, Anna Lindholm, 1960-, et al.
(author)
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Missed bolus doses : devastating for metabolic control in CSII-treated adolescents with type 1 diabetes
- 2009
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 10:2, s. 142-148
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the management of continuous subcutaneous insulin infusion (CSII) in adolescents with type 1 diabetes including their administration of bolus doses and to study relationships between insulin omission and metabolic control, body mass index, daily frequency of self-monitoring of blood glucose (SMBG) and bolus doses, health-related quality of life (HRQOL), the burden of diabetes and treatment satisfaction. METHODS: Ninety CSII-treated (> or =6 months) adolescents aged 12-18 yr, from four diabetes clinics in Sweden, participated in the study. The adolescents recorded their meal intake the previous day, which was compared with downloaded pump data, and the frequency of missed boluses was stated. Haemoglobin A1c (HbA1c) and diabetes-related data were recorded. HRQOL and treatment satisfaction were measured with questionnaires. RESULTS: Thirty-eight per cent of the adolescents had missed >15% of the doses the previous day, those had higher HbA1c (7.8 +/- 1.0 vs. 7.0 +/- 1.2%, p = 0.001), took fewer daily boluses (3.8 +/- 1.7 vs. 5.3 +/- 1.7, p < 0.001) and SMBG (2.4 +/- 1.8 vs. 3.6 +/- 1.8, p = 0.003), were less satisfied with their treatment (4.8 vs. 5.3, scale 0-6, p = 0.029) and perceived the medical treatment more negatively (72.1 vs. 79.7, scale 0-100, p = 0.029). Multiple linear regression analysis showed that the variations in HbA1c could be explained by the frequency of bolus doses (p = 0.013) and SMBG per day (p < 0.0001) adjusted for duration and age (r(2) = 0.339, p < 0.0001). CONCLUSION: Insulin omission was common. Those who missed doses were less satisfied and perceived more impact with the treatment. The frequencies of daily boluses and SMBG were associated with metabolic control. Diabetes teams need strategies to guide adolescents on how to avoid insulin omission.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Smide, Bibbi
(author)
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Fotkomplikationer
- 2006
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In: Omvårdnad vid diabetes. - : Studentlitteratur Lund. ; , s. 360-
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Book chapter (pop. science, debate, etc.)
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| 27. |
- Smide, Bibbi, 1943-
(author)
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Out-come of foot examinations in Tanzanian and Swedish diabetic patients, a comparative study
- 2009
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 18:3, s. 391-398
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Journal article (peer-reviewed)abstract
- Aims and objectives. The aim of the current study was to present the outcome of clinical nurse performed foot examinations in a group of Tanzanian diabetic patients and make comparisons with matched Swedish patients. Background. Nurses working with diabetic patients in any country need to be familiar with foot problems in diabetic patients to educate patients about foot care. Design. A comparative study examining diabetic patients in Tanzania and Sweden with a quantitative approach. Method. One hundred and forty-five diabetic patients in each country were examined. They were matched in gender and age. All patients responded verbally to questions about individual foot-care and underwent clinical foot examination concerning existing foot lesions, sensitivity testing using Semmes–Weinstein monofilament (5·07) and, vibratory perception using a tuning fork (128 Hz). Results. The Tanzanians had more reported foot problems than the Swedes. The latter reported problems due to poorly fitting footwear whilst the Tanzanians reported pain issues of the feet irrespective of footwear. In the Tanzanian group 37 patients presented with peripheral neuropathy (PN), 13 with peripheral vascular disease (PVD) and six had both PN and PVD. In the Swedish group of patients four had PN, three PVD, but none had both PN and PVD. Only 20 Tanzanians reported carrying out self-inspections of their feet, while 103 Swedes reported doing so. Conclusions. Nurse performed foot examinations showed that the Tanzanian diabetic patients in this study had poorer foot status than the Swedish study sample. Relevance to clinical practice. Knowledge about foot problems in diabetic patients worldwide will hopefully improve education about self foot-care and therefore decrease incidence of foot lesions and other foot problems in this cohort.
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| 28. |
- Smide, Bibbi, et al.
(author)
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People's reasoning about diagnosis in type 2 diabetes
- 2009
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In: Journal of nursing and healthcare of chronic illness. - : Wiley. - 1752-9816 .- 1752-9824. ; 1:3, s. 253-260
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Journal article (peer-reviewed)abstract
- Aim and objective. To identify how people with type 2 diabetes reason around their experiences of acquiring diabetes. Background. Effective self management after getting the diabetes diagnosis lowers the risk to developing late diabetes complications. However the diagnosis experience has received little attention in nursing research as well as psychological and sociological research and therefore the interest in the current study was to further explore the diagnosis experience among people with type 2 diabetes. Methods. Face-to-face narrative interviews were conducted in 2006 with nine persons with type 2 diabetes living in Mid Sweden and with 14 living in North Sweden. Results. Three main categories emerged. They were 'Diagnosis in a time perspective', and included the three subcategories 'Was prepared and diagnosis was easily integrated', 'Was not prepared and not having diabetes yet' and 'Was not prepared but diagnosis is successively integrated'. The second category emerged as 'Emotional reactions on diagnosis' and consisted of the following subcategories 'Reacted neutrally – the diagnosis was not threatening at all', 'Strived to take control over one's emotions' and 'Diminished the threats – is not really ill yet'. The third category was 'Cognitive reasoning about the diagnosis'. It consisted of the subcategories 'Did not consider diabetes to be an illness', 'Experienced diabetes as a disease hard to understand' and 'Decided not to bother about it'. Conclusion. The findings may help nurses working in any country to understand the importance of how to give information about diagnosis and focus on diagnosis experiences among persons with type 2 diabetes. Relevance to clinical practice. Persons newly diagnosed with type 2 diabetes should get adequate time to discuss the situation ongoing with the diabetes specialist nurse or a doctor but our findings are easily transferable to other diseases or other health professionals.
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| 29. |
- Smide, Bibbi
(author)
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Self-care, foot problems and health in Tanzanian diabetic patients and comparisons with matched Swedish diabetic patients
- 2000
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Doctoral thesis (other academic/artistic)abstract
- The overall aim was to study self-care, foot problems and self-perceived health in 150 consecutively invited Tanzanian diabetic patients and to compare them with gender- and age-matched Swedish diabetic patients (n=150) from a middle Sweden area. The main study was cross-sectional and took place at a diabetes clinic in Dar es Salaam. All patients answered questions about their self-care satisfaction, diabetes knowledge and skills, and educational needs. Foot examination also included questions about foot-care and perceived foot problems. The patients' health was assessed using the SF-36 general health questionnaire. The Swahili version of SF-36 was pre-tested in 518 Tanzanian diabetic patients showing an acceptable validity and reliability. Glycaemic control was measured by HbA1c. The results indicated that 45% of Tanzanians and 43% of the Swedes reported satisfaction with their self-care. The Tanzanian patients reported that following doctor's advice was the most important factor necessary for feeling well, whereas the Swedish patients emphasised diet and exercise. Lack of drugs and education were reasons of dissatisfaction in the Tanzanian group, whilst the Swedes were dissatisfied with their own behaviour. None of the Tanzanians monitored their blood glucose themselves, whilst 50% of the Swedes did it on a daily or weekly basis. Significantly more Swedes than Tanzanians knew the interaction between insulin, food and exercises, and how to manage hyperglycaemia and hypoglycemia. The Tanzanians wanted more education about diabetes, treatment and injection technique, whereas the Swedes wanted education about psychological aspects of diabetes, foot-care and oral anti-diabetic treatment. Foot problems reported in the Tanzanian group were pain, numbness and pricking sensations, whereas the Swedes reported ingrown toenails, pain and fissures. Seven Tanzanians and one Swede had foot ulcers. Twenty Tanzanians and 103 Swedes reported to inspect their own feet. The Tanzanians had significantly poorer self-perceived health and glycaemic control than the Swedish patients. A follow-up study was performed with the Tanzanian group of patients after two years. Many patients did not return for the second investigation and 70 patients were re-assessed. They showed an improved self-perceived health and a significant decrease in HbA1c-value. In conclusion the results indicated that Tanzanian patients needed better access to a continuous and regular supply of diabetes drugs. Furthermore the Tanzanians' burden of diabetes influenced their possibilities to work, whilst Swedish patients were hindered in social activities. In both countries the importance of regular foot inspections of the patients' feet should be emphasised. Glycaemic control and self-perceived health seemed to be poorly related and for that reason diabetes nurse specialists need to use both measures in order to guide the patients towards the goals experiencing a good health despite having diabetes.
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| 30. |
- Thors Adolfsson, Eva, et al.
(author)
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Does patient education facilitate diabetic patients’ possibilities to reach national treatment targets? : A national survey in Swedish primary health care
- 2009
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In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 27:2, s. 91-96
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Journal article (peer-reviewed)abstract
- ObjectiveTo describe how patient education is arranged in Swedish primary healthcare (PHC) and to assess whether the type of patient education and individual goal setting have an impact on diabetic patients’ possibilities of reaching national treatment targets.DesignA Swedish national survey.SettingSwedish PHC.SubjectsData from 485 primary healthcare centres (PHCCs) and 91 637 diabetic patients reported by the PHCCs to the National Diabetes Register in 2006.Main outcome measuresDescription of how patient education is arranged, HbA1c, body mass index, cholesterol, blood pressure, and physical activity.ResultsOf the PHCCs that reported how they performed the individual counselling, 50% reported checklist-driven counselling and 8% individualized counselling based on patients’ needs. A total of 105 PHCCs reported that they arranged group education. Of these, 67% used pre-planned programmes and 9% individualized the programme to the patients’ needs. The majority of PHCCs (96%) reported that they set individual goals (HbA1c, blood pressure, lipids, and lifestyle). A minority of the PHCCs (27%) reported that the patients were involved in the final decision concerning their goals. Individual goal-setting facilitated patients’ possibilities of reaching treatment targets. Goal-setting, list size of PHCCs, and personnel resources explained a variance of 2.1–5.7%. Neither individual counselling (checklist-driven or individualized to patients’ needs) nor group education had an impact on patients’ possibilities of reaching the targets.ConclusionThe current study indicates that improvement is needed in patient education in PHC to facilitate diabetic patients’ possibilities of reaching national treatment targets.
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| 31. |
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| 32. |
- Thors Adolfsson, Eva, 1957-
(author)
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Patient Education for People with Type 2 Diabetes in Primary Health Care
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The general aim of this thesis was to evaluate different aspects of patient education for people with type 2 diabetes in Swedish primary health care. The evaluation was conducted in a primary health care setting in central Sweden and in Swedish primary health care in its entirety. Seven centres in central Sweden had implemented the empowerment programme for patients with type 2 diabetes. Data on 16 care providers’ views on implementing the programme were collected in focus-group interviews. The effect and the patients’ experiences of the programme were evaluated in a randomized controlled trial (RCT) (n=101) and in individual interviews (n=28). In the RCT, 50 patients were assigned to the programme and 51 patients to routine diabetes care. The patients answered a 27-item questionnaire and BMI and HbA1c were measured, before the intervention and at one-year follow-up. Further, data from 485 primary health care centres with 91,637 diabetic patients were collected to evaluate patient education in Swedish primary health care in its entirety. The care providers experienced conflicting roles in changing from expert to facilitator in the empowerment programme. The programme improved patients’ confidence in diabetes knowledge and contributed to their experience of self-control, while patients in the routine diabetes care experienced external control. Of the 485 centres, 50% reported having checklist-driven individual counselling and 8% that they individualized the counselling based upon patients’ needs. Most centres (>90%) set individual goals, but only one-third involved patients in the final decisions regarding their goals. Setting individual goals was found to have an impact on patients’ possibilities to reach national treatment targets. In conclusion, the implementation of empowerment in patient education demands support to care providers in order to influence patients’ self-care. Furthermore, patients need to reflect upon necessary self-care changes and also set individual goals to facilitate the reaching of national treatment targets.
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| 33. |
- Thors Adolfsson, Eva, et al.
(author)
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Patient education in type 2 diabetes : A randomized controlled 1-year follow-up study
- 2007
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In: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 76:3, s. 341-350
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Journal article (peer-reviewed)abstract
- The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients’ confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients’ confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease.
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| 34. |
- Wikblad, Karin, et al.
(author)
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Check your health, validity and reliability of a measure of health and burden of diabetes
- 2014
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In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 28:1, s. 139-145
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Journal article (peer-reviewed)abstract
- Check Your Health was constructed as four-two-sided vertical thermometers (0–100) measuring physical and emotional health, social well-being and quality of life today and before onset of diabetes. Burden of diabetes was calculated as the difference between the two scores (today and before onset of diabetes). The aim was to examine concurrent and discriminant validity and reliability of Check Your Health in a convenience sample of 180 people with diabetes, who visited the diabetes clinic during a 3-month period. A randomly selected subsample of 43 of the 180 patients responded to the questionnaire twice (test–retest). Besides Check Your Health, three additional questionnaires were mailed to the patients, the EVGFP scale (EVGFP stands for Excellent–Very good–Good–Fair–Poor health) for measuring concurrent validity, the Diabetes Empowerment Scale (Swe-DES-23) and an attitude measure, Semantic Differential in Diabetes (SDD) for calculation of discriminant validity. There was significant agreement between Check Your Health and the five EVGFP health groups. The instrument discriminated well between patients with and without late diabetic complications. The measure on burden of diabetes showed that the higher the burden of diabetes, the lower the quality of life. The same pattern was found for both Swe-DES 23 and SDD; the higher the burden, the lower the sense of empowerment and the lower the burden, the more positive the attitudes towards diabetes. Check Your Health showed good stability (0.88–0.68). The results indicate that Check Your Health can be used as an acceptable and sufficiently accurate method for detecting health distress in people with diabetes.
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| 35. |
- Wikblad, Karin, et al.
(author)
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I'm the boss
- 2004
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In: European Diabetes Nursing. ; 1:1, s. 13-17
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Journal article (peer-reviewed)
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