bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensitivity, Specificity, and Predictive Value in Katz's and Barthel's ADL Indices Applied on Patients in Long Term Nursing Care
Authors: Törnquist Kristina , Lövgren Monika , Söderfeldt Björn
Published: March 2013

ABSTRACT. There are propositions that two indices of ADL ability, Katz's and Barthel's indices, are exchangeable for each other. Here this is investigated with regard to clinical applicability. The indices are applied on a material of 23 long term care patients. Sensitivity, specificity, predictive value and interassociations are calculated between the indices, and between indices, nurses' judgements of appropriate care level, an index of congnitive ability (PTS), and a physical examination. Results show clear differences between the indices as to specificity and predictive value, pluse differences in sensitivity on dichotomised measurement level. Associations between measures are very high, between measures and nurses' judgements and PTS medium high, and low between indices and physical status. It is concluded that the Katz's ADL index should be preferred in a clinical decision‐making for appropriate care level.
Uniform Guidance for Medical Care
Authors: Marklund Bertil , Bengtsson Calle , Björkander Eva
Published: March 2013

ABSTRACT. Advice by telephone is an important part of primary health care service. Telephone advice is given at different levels of care. In order to give people confidence in the health care system it is important that personnel at different levels give similar advice for the same symptom or complaint. In order to establish generally accepted guidelines, discussions were held between personnel at different levels of care. This procedure was laborious but successful. Generally accepted guidelines could be agreed upon for all the symptoms and complaints discussed, altogether more than 60. This paper describes the procedure used during the collaborative work to provide these guidelines. It must be emphasised, though, that the guidelines should be adapted to local circumstances before being used as a practical aid in the health care service at health centres and at other outpatient units.
Prevalence and Characteristics of Persons with Dependency on Feeding at Institutions for Elderly
Authors: Sandman Per‐Olof , Norberg Astrid , Adolfsson Rolf , Eriksson Sture , Nyström Lennart
Published: March 2013

ABSTRACT. The prevalence of dependency on feeding was estimated in 3 607 residents cared for in old people's homes, nursing homes, somatic long‐stay clinics, psychiatric long‐stay wards and psychogeriatric wards.

Ten per cent of the residents were found to be dependent on the staff to eat. The highest proportion was found in nursing homes and somatic long‐stay clinics. A considerably larger proportion of the residents with dependency on assisted feeding imposed the highest workload on the staff. Residents who were totally dependent on assisted feeding were more disabled with regard to other ADL functions and also they were demented more often. Loss of the ability to eat was related to an inability in other ADL functions. Support was gained for a hierarchical loss of ADL functions as suggested by Katz & Apkom. Feeding problems seem to be a terminal phenomenon in demented patients.
Health and Unhealth in Chronic Disease
Authors: Wikblad Karin F. , Wibell Lars B. , Montin Kent R.
Published: March 2013

ABSTRACT. When health is defined from a holistic view, traditional measures of control in diabetes, such as analysis of blood glucose or HbAlc, are of limited use as indicators of health and unhealth. On the other hand, evaluation of attitudes and certain personality variables might provide guidance both in discovering unhealth and in creating individual self‐care programmes for its treatment. In the present study the subjective experience of health and unhealth was studied in a defined population of patients with insulin dependent diabetes mellitus (IDDM). The patients could be divided into three categories: a) those not abandoning important goals because of their diabetes, b) “adapted abandoners” and, c) those abandoning vital aspects of life. On the basis of the findings, the question of how “problem patients” can be identified and treated is discussed.
Evaluating the Nursing and Educational Perspectives of Nurse Instructors
Authors: Janhonen Sirpa
Published: March 2013

ABSTRACT. The nursing and educational perspectives of nurse instructors (NIs) were compared. Three nursing perspectives (professional, vocational and technical) and two educational perspectives (inner teaching and outer teaching) were measured by quantitative methods. The evaluation of the perspectives was carried out by a questionnaire (sent to 268 NIs, of whom 72% responded) with both closed‐ended and open‐ended questions. Factor analysis produced the following factors: 1) a technical nursing perspective and an outer teaching perspective (unqualified NIs and older NIs had a more technical nursing perspective and a more marked outer teaching perspective); 2) a professional nursing perspective; and 3) an inner teaching perspective. It was shown by discriminant analysis that NIs displaying features (2) and (3) were qualified NIs.
The Sucking Behaviour of Two Patients in the Final Stage of Dementia of the Alzheimer Type
Authors: Asplund Kenneth , Norberg Astrid , Adolfsson Rolf
Published: March 2013

ABSTRACT. Two patients in the final stage of dementia of the Alzheimer type (DAT), who could no longer be given nutrition by assisted feeding, were given fluids by means of the sucking ability they still retained. They sucked more slowly under nutritive than under non‐nutritive sucking conditions. The sucking efficiency of one of them improved during training. The status of the patients in the final stage of their dementia differed from one another, which might explain the difference in outcome.

It is therefore suggested, that the use of the patients' sucking ability could serve as a complement and/or an alternative feeding technique when assisted spoonfeeding becomes extremely difficult or impossible. It is considered to be more gentle and natural than the present feeding techniques.
Care of Demented Patients with Severe Communication Problems
Authors: Ekman Sirkka‐Liisa , Norberg Astrid , Viitanen Matti , Winblad Bengt
Published: March 2013

ABSTRACT. Two time‐studies and an interview study were carried out at a geriatric clinic. The aim was to elucidate how much time caregivers use for direct patient care in their contact with severely demented patients compared with non‐demented patients as well as how they experience the care of demented patients in a task assignment care system. The analysis showed that more time was used to help non‐demented patients than demented patients with the same ADL‐performance. Five types of patient reactions to communicative attempts made by the caregivers were described: the patient seems to enjoy contact, he avoids contact, contact leads to aggression, he reacts only sporadically to contact and he does not show any reactions to it. The caregivers described negative reactions to demented patients with communication problems. Communication problems seem to be a threat to caregivers' commitment.
Hospital Staff Members are Satisfied with their Jobs
Authors: Björvell Hjördis , Brodin Birgitta
Published: March 2013

ABSTRACT. Job related satisfaction was evaluated by registered nurses, physicians, nurse assistants and aids at an internal medicine clinic at a university hospital in Sweden.

A questionnaire concerning cooperation, work load, support, independence and other work related factors was developed and filled out by 153 individuals.

The results mostly show high job satisfaction in all professional groups. Nevertheless, nearly half of the staff wanted to quit their jobs.

Those who planned to leave their jobs perceived themselves as less satisfied with such factors as cooperation, job complexity, help received from superiors and sufficient time for care delivery, than did those who did not plan to quit. The differences were most evident in the group of registered nurses.

The head nurse appeared to have an important supportive function.

In conclusion, the results suggest that a supportive organization might reduce personnel turnover in hospitals.
The Assessment of Psychological Distress
Authors: Kalfoss Mary Harris
Published: March 2013

ABSTRACT. This paper describes the assessment of psychological distress symptoms in the hospitalized physically ill elderly using a screening instrument known as the Comprehensive Psychopathological Rating Scale (CPRS) (Åsberg et al. 1978). The methodological properties of this scale and a subscale known as the Montgomery Åsberg Depression Scale (MADRS) (Montgomery‐Åsberg 1979) are discussed. It is suggested that the introduction of these scales into routine nursing practice would facilitate the identification and collection of psychological distress symptoms in this population and serve as a basis for nursing intervention and evaluation.
A Comparative Study of the Social Conditions of Spouses of Long Term Patients Cared For Either in Nursing Homes or Home Care
Authors: Löfgren Ann‐Christine , Bucht Gösta , Eriksson Sture , Winblad Bengt
Published: March 2013

ABSTRACT. In order to study the social conditions of spouses of patients suffering from long term illnesses structured interviews were performed. The interviewees were divided into two groups: spouses of persons with cronic conditions cared for at home and spouses of patients cared for in nursing homes. Each group consisted of 27 spouses and there were no differences in physical health score, Mini mental score or ability to manage primary Activities of Daily Living functions between the groups. Home care spouses paid fewer visits to children, had fewer friends and paid fewer visits to friends and they also had time for hobbies or interests significantly more seldom (reading, visits to church) than nursing home spouses. There were no significant differences between the groups concerning sex, socio‐economic class, housing conditions and amount of home health services. Their contact with children and their feelings of loneliness were reported to be the same.
Individual Evaluation of Accident Risks at Nursing Homes
Authors: Svensson Marie‐Louise , Landahl Sten , Rundgren Åke
Published: March 2013

ABSTRACT. The purpose of the study was to find a practical applicable method for estimating risk of accidents among nursing home patients by localizing specified risk factors and recording accidents during a period of one year. During 1987‐January‐15 to 1988‐January‐14, a total of 153 accidents happened to 23 men and 76 women among 335 admitted patients. The strongest accident predictors suggested by a logistic regression procedure were: impaired balance, walking with device or human assistance, drugs influencing the central nervous system, dizziness and poor night‐time sleep.

The conclusion is reached that it will probably be possible to reduce accidents in the institutionalized elderly by education of staff, identification of risk patients, individual nursing planning and measurements.
Basis of the Quality of Nursing Care
Authors: Leino‐Kilpi Helena
Published: March 2013

ABSTRACT. The purpose of the study is to create a descriptive evaluation basis for the quality of nursing care. In this article a short quantitative description of the most frequent elements of good nursing care is reported, using the views of Finnish nurses and nurse teachers. These elements are: interaction, comprehensiveness, need‐centerness, initiativeness, technical procedures and knowledge‐base. Based on these, further research areas can be seen both in nursing practice and in education.
Translation of an Instrument
Authors: White Marjorie , Elander Gunnel
Published: March 2013

ABSTRACT. Translation of a research instrument questionnaire from English to another language is analyzed in relation to principles involved, procedures followed, and problems confronted by nurse researchers from the US–Nordic Family Dynamics Nursing Research Project. Of paramount importance in translation are translation equivalency, congruent value orientation, and careful use of colloquialisms. It is important to recognize that copyright guidelines apply in the translation of an instrument. Approaches to solving instrument translation problems are discussed.
The Sense of Coherence Concept and its Relation to Personality Traits in Swedish Samples
Authors: Langius Ann , Björvell Hjördis , Antonovsky Aaron
Published: March 2013

ABSTRACT. The paper proposes that Antonovsky's salutogenic orientation and his sense of coherence (SOC) concept provide a sound theoretical basis for the study and strengthening of the caring component in clinical practice. In order to study the operational utility of the concept, the 29‐item SOC questionnaire (in two formats) was administered to five Swedish samples (3 groups of nurses, patients in a hospital emergency department, and a general population sample). Psychometric data are provided which test the internal and test‐retest reliability of the SOC scale. A Self‐Motivation Inventory (SMI) and the Karolinska Scales of Personality (KSP) were used to test the relation between the SOC concept and personality traits. The results revealed that those with strong SOC also scored as having more general motivation and less Somatic and Psychic Anxiety as well as less Hostility. In addition the data, though in some part modest in sample size, consistently supported the view that the SOC scale is a robust instrument. Particular note is taken of its crosscultural character and of its potential utility in clinical work.
The Ethical Impact of Advanced Biomedical Technology
Authors: Gjengedal Eva
Published: March 2013

Abstract. The development of medical technology has ethical impacts on both patients, health‐care providers and society. Even if the original purpose of technology was meant to be a means to the benefit of the patients, this purpose is no longer unquestionable. In some situations the very opposite seems to be the case, technology may even cause suffering. It may look as if technology tends to become an end in itself, while patients tend to become a means to technological development. If this tendency is real, it implies that a technological imperative is taking the place of moral imperatives.
Cases of Elder Abuse, Intervention and Hopes for the Future, as Reported by Home Service Personnel
Authors: Saveman Britt‐Inger , Norberg Astrid
Published: March 2013

This study aimed at describing cases of elder abuse reported by witnesses, intervention offered and opinions of further intervention strategies. Home service personnel from various parts of Sweden reported 97 cases. The abused person was a women in 75% of the cases. Many of the abused persons were physically and psychologically handicapped. In most of the cases the perpetrator was a spouse or a child and in one third of the cases they had a caregiving responsibility. Psychological abuse together with financial exploitation was most frequently reported. The perpetrators' possibilities to profit financially from the abused and the family conflicts were commonly reported to be contributory causes. In 75% of the cases intervention was offered. The Swedish welfare system has no specific intervention strategies in case of abuse of the elderly and therefore more possibilities to intervene and more research concerning intervention are needed.
Social Networks—The Metaphor that Became a Research Approach
Authors: Espnes Geir Arild
Published: March 2013

This article discusses whether the concept of social networks can be an effective approach for use in nursing research in Norway and Scandinavia. It also describes areas which may be especially well suited for this approach. The article does not answer the question as to whether nursing research should make use of social network studies, but it is concluded that this is one of the approaches which must be considered closely in connection with nursing research.
Personality Development during Nursing Education
Authors: Larsson Gerry , Hall‐Lord Marie‐Louise
Published: March 2013

The aim of the study was to explore personality development during nursing education. The sample consisted of 122 Swedish nursing students. Ninety‐three per cent of the students were female and the mean age at the beginning of the nursing education (which lasts for two years) was 27.6 years. Personality inventories were administered at the beginning and end of the education. The posteducation assessment rendered several statistically significant differences of means. Compared with the pre‐education assessment, the nursing students reported a more positive profession‐oriented self‐perception at the end of the education, a stronger ideal, real, and mirror identity, a reduced trait anxiety, stronger needs for achievement, exhibition, autonomy, dominance, and nurturance, and a weaker abasement need. The practical significance of the results was discussed.
Caregiver—Infant Interaction
Authors: Morse Janice M. , Solberg Shirley M. , Edwards Joy
Published: March 2013

Analysis of 40 h of videotaped caregiving to four male infants was conducted using ethology. All infants were full term and had major chest surgery 12 h previously. All incidents of caregiver‐infant interaction were examined, and the verbal and tactile comforting behavior of the caregiver was coded for duration, context, infant cue and infant state prior and following the interaction. A total of 191 comforting incidents occurred during the study. Stroking was the most common form of touch used. Most of the comforting (60%) was given in the context of caregiving; sleeping infants were touched often (38%); 25.3% of the touches were given to acutely distressed infants, and wide awake infants relatively little. Most of the infants showed no change in infant state after the relatively brief comforting incidents, but in 15.7% of the incidents the infants ‘settled’ after comforting. The authors conclude that this is a relatively strong effect considering the short duration of the comforting actions.
Breast Cancer Patients
Authors: Suominen Tarja , Laippala Pekka
Published: March 2013

The purpose of this part of a larger study on breast cancer patients' recovery was to analyse the support that nurses offer breast cancer patients before, during, and after their hospitalization, as seen from the nurses' viewpoint. The sample group consisted of 125 registered and radiological nurses at university and regional hospitals in southwestern Finland. A questionnaire was devised and mailed to the subjects. The statistical analysis of the data was based on percentage distributions, with correlations, cross‐tabulation, and loglinear models. The nurses reported that patient support is inadequate before and after hospitalization. However, most nurses maintained that the patients were well supported in hospital by the health care staff. The same nurses considered that their duty was to offer information and try to ensure continuity of care for the patient. They regarded their work as challenging, and they paid more attention to patients' relatives, too. However, there were differences of opinion as to whether the nurses actually gave support or not. We concluded that the concept support and its different implications for different groups (e.g. patients, nurses) must be studied in more detail, since the nurses' viewpoint is the one upon which care is currently based.
Geriatric Nursing Assessment—The Use of a Standardized Assessment Instrument in a Clinical Setting
Authors: Söderhamn Olle , Berthold Harriet
Published: March 2013

The purpose of the present study was to investigate the content and focus of nursing assessment when using a well‐known Swedish, commercially available, standarized structured multidimensional instrument in the assessment of nursing needs/problems in a geriatric rehabilitation department. Two hundred and fifty‐six assessment forms were quantitatively and qualitatively analysed. In 113 cases the corresponding nursing care plans were also analysed. Although a few important areas, such as communication and I‐ADL, were missing, the instrument enabled the nurses to make a fairly comprehensive nursing assessment. However, the data collected with the instrument were only partly used in the nursing care plans, and relevant nursing diagnosis could be formulated in only 36 cases. The conclusions are that the data collection must be more goal‐oriented and that education in diagnostic reasoning should be meaningful. To choose wide assessment areas could probably also facilitate holistic nursing care.
Experiences of Disease and Treatment among Chlamydia Patients
Authors: Faxelid Elisabeth , Krantz Ingela
Published: March 2013

Chlamydia trachomatis infection is a common sexually transmitted disease in Sweden, where counselling and partner notification are tools for prevention. Fifty infected patients (27 women, 23 men) were interviewed at an outpatient department. A majority of the patients felt that they were to blame for getting the disease and had the responsibility to inform partners. Women reacted more strongly against the disease and felt more negatively treated by the health care personnel. Chlamydia was considered a serious disease and 40% expressed fear for HIV/AIDS. Only eight per cent used condoms regularly. The concept ‘casual contact’ was very differently defined by the patients. Health personnel has to be more aware of the difficulties with ambiguous concepts and information need to be improved. More attention should be paid to women and their reactions.
Structuring Moral Meaning in Psychiatric Nursing Practice
Authors: Lützen Kim , Nordin Conny
Published: March 2013

Comparatively little is known about the experiential aspect of moral decision making in psychiatric nursing. Earlier research in this area has mainly focused on the cognitive aspects of moral reasoning, using hypothetical cases. The purpose of this study was to examine the experience of moral decision making in psychiatric nursing practice. In‐depth interviews with fourteen nurses, purposively selected for their reputed competency and long experience in psychiatric care, were conducted. By using the strategy of ‘constant comparative analysis’, the grounded theory, ‘structuring moral meaning’ was derived, which consists of three interrelated processes, perceiving, knowing and judging. This process identifies the nurse's manner of making sense of a perceived moral conflict and justifiying ‘good’ actions within the nurse‐patient framework.
Care of Persons with HIV Infection—An Ethnonursing Approach
Authors: Victor Birgit Westphal
Published: March 2013

The purpose of the present study is to gain an understanding of ‘the content’ and ‘the process’ of care of persons with HIV infection. A qualitative approach comparable to the ethnonursing method was adopted. Data were collected through interviews, participant observations and documentary material from 21 key informants (policy makers, planners, administrators), 35 staff members, and 51 persons with HIV infection in six selected home care programmes in Africa. A data collection guide provided direction for the study, but emphasis was on obtaining local viewpoints. Data were analyzed from within a caring paradigm. Characteristics of the care provided on home visits to 51 patients were identified, categories formulated and a model of care developed.
Articles Published in Scandinavian Journal of Caring Sciences Between 1987 and 1991
Authors: Segesten Kerstin
Published: March 2013

Nursing, occupational therapy and physiotherapy are new as areas of research in the Nordic countries. Scandinavian Journal of Caring Sciences, the first scientific journal based in the Nordic countries for these research areas was established in 1987. In this article the first five volumes of the journal are reviewed. The study revealed a growing number of manuscripts submitted and an increase of pages per volume. Most articles came from nurses in Sweden. However, other disciplines were represented and papers came from all the Nordic countries and also from countries outside Scandinavia. In most articles patients were studied and both quantitative and qualitative approaches were used.
Hoists for Locomotor Disability
Authors: Edlund Carola Klint , Harms‐Ringdahl Karin , Ekholm Jan
Published: March 2013

The purpose of this study was to make an inventory of the slings available for person hoists, to describe them and to carry out biomechanical analyses of the sitting positions in different slings. On the Swedish market 18 different slings were available. Nine were photographed with a subject sitting in them. The sagittal lengths of the supporting parts of the slings varied between 0.10 m and 1.0 m. The risk of falling through was considered largest in divided slings, but even in one‐piece slings with divided leg supports, the person lifted can most probably slip through inadvertently. Almost all the slings gave a backward‐inclined sitting position. However, in one of the slings the trunk inclination was small and the seat was slightly forward–downward inclined, giving a risk of falling/sliding forwards. Some of the slings entailed a trunk thigh angle smaller than 90d̀, perhaps a problem for patients with hip pain and reduced hip flexion. Given the great variety of slings available, it seems important to work for relevant instructions and information about their use.
Opinions and Expectations of Fathers of Young Families of Family Counselling
Authors: Hyssälä Liisa , Rautava Päivi , Sillanpää Matti
Published: March 2013

Opinions and experiences of fathers of young families were studied from questionnaires distributed through maternity welfare centres (MWC) and child welfare centres (CWC) in the provinces of Turku and Pori, southwestern Finland. The first phase of the Finnish Family Competence Study included a total of 1 414 fathers of families expecting their first baby. Of these, 1 279 responded to the first survey questionnaire. Afters the baby's birth, 1 134 responded to a second questionnaire. The present study used results obtained from these two inquiries. Special attention was paid to factors associated with fathers' participating in family counselling. The conventional methods of family training used in MWCs and CWCs do not always seem to be suitable for the Finnish man. Industrial employees and young fathers were irregular attendants of the family training sessions, although young fathers found them useful, especially for combating anxiety in novel family situations. They would have liked to receive more information on social support available to young families. Despite the apparently positive results, these subgroups clearly did not realize that they were expected to ask for more information during the training sessions, due to their low base of knowledge. The heaviest criticism of the training system was presented by fathers belonging to the professional subgroup. The fathers specifically complained that they had not been sufficiently informed about the possible psychological changes which they might experience during the wife's pregnancy and the birth of the child.
Distribution of Working Time and Contents of Physiotherapy Activities in a Clinical Setting.
Authors: Talvitie Ulla , Salenius Armi
Published: March 2013

The purpose of the present study was to collect personnel utilization data in the physiotherapy department of a general hospital as a basis for improving the practice of physiotherapy. Over a four‐week period in a process of continuous observation 12 physiotherapists recorded their activities under predefined task categories. The percentages of total time used in the observed activities were as follows: direct patient treatment 31%, other work (planning, recording, arranging walking aids and student guidance) 10%, and cooperation (consultation, meetings, arranging patients' affairs, counselling relatives and parents) 9%. The proportion of uncategorized work amounted to half of the total working time. Physical exercise and counselling in direct patient care, preparation and records in other work and teamwork and cooperation with parents were the commonest activities recorded. The physiotherapists' time schedule in the different wards differed in terms of mean treatment time per patient and amount of patients per day. The major problems were felt to be the lack of assessment methods of follow‐up and feed‐back systems for patients after hospital care and uncertainty as to what the content of practise should contain. The observation method appeared to be a useful tool for collecting personnel utilization data in a physiotherapy department.
The VIPs‐Model Used by Nursing Students
Authors: Björvell Hjördis , Thorell‐Ekstrand Ingrid
Published: March 2013

The VIPS‐model developed by Ehnfors et al. (1991) for nursing documentation and writing of care plans was used and evaluated by nursing students in connection with their final assignments. In addition to their evaluation by the use of a questionnaire, the students' written care plans were reviewed. Three instruments were used, two were tested in earlier studies when reviewing registered nurses' care plans, and one was developed especially for this review of the quality of the students' care plan assignments. The results showed that the key words for nursing assessment were evaluated as both useful and easy to use while the key words for nursing interventions were considered useful but more difficult and were used to a less extent. Many students did not document any outcome or any discharge notes. The instruments that were used for the review of the care plans were of great help in analyzing the use of the model as well as the content and comprehension of the key words.
Perceptions of caring behaviors and patient anxiety and depression in cancer patient‐staff dyads
Authors: von Essen Louise , Burström Lena , Sjödén Per‐Olow
Published: March 2013

Cancer patient and staff perceptions of the importance of caring behaviors (Caring Assessment Instrument, CARE‐Q) and patient levels of anxiety and depression (Hospital Anxiety and Depression Scale, HADS) were determined in 19 matched patient‐staff dyads. Both groups perceived comforting and anticipating behaviors to be among the most important ones. Patients considered behaviors focused on staff explaning and facilitating to be more important than did staff, whereas staff rated behaviors concerning accessibility as more important than did patients. Patient and staff perceptions of the importance of comforting behaviors were negatively associated. No significant mean value difference or correlation was found on the HADS anxiety or depression subscales. Members of matched patient‐staff dyads did not agree strongly on the importance of caring behaviors and patient levels of anxiety and depression.
District Nurses' Stories of Difficult Care Episodes Narrated during Systematic Clinical Supervision Sessions
Authors: Pålsson Maj‐Britt , Norberg Astrid
Published: March 2013

In systematic clinical supervision sessions 23 Swedish district nurses narrated 147 difficult care situations. The aim of the study was to illuminate their lived experiences of those situations. The following themes emerged in the analysis of the stories: coming too close to the patient; keeping and restoring patient's hope; conflicting opinions; feeling powerless; meeting unrealistic demands; patients' trust in alternative medicine; feeling disgust, shame and guilt; relations to patients' families; and communication gaps. The findings strongly emphasize that district nurses experienced problems in the home care of seriously ill patients. They must not only serve as containers for patients' emotional strain, but they also have to support relatives in their anxiety. However, findings also showed that there was often a balance between negative and positive dimensions in these meetings with dying patients and their families. It seems important to form support groups to help district nurses deal with demanding care situations and to relieve them of feelings and thoughts aroused in the provision of care. Support in the form of clinical supervision may impact the quality of care in a positive way.
Metaphorical Pain Language among Fibromyalgia Patients
Authors: Söderberg Siv , Norberg Astrid
Published: March 2013

Fourteen women with fibromyalgia described their pain experiences using words indicating a model of pain that presented pain as an aggressive physical deformation and a torture‐like experience. Metaphorical expressions were used which was seen as a means for enabling the patients to disclose tacit knowledge. The pain experience was narrated as being steady and without any distinct bodily location. Only causes explaining the present aggravation of the pain and treatment leading to a temporary relief were related.
Living with Continuous Muscular Pain—Patient Perspectives
Authors: Henriksson Chris M.
Published: March 2013

This second article of the study Living with Continuous Muscular Pain is Part II: Strategies for Daily Life. The primary purpose was to explore, analyse and describe how women with fibromyalgia, living in two different cultural, health care and social security settings, managed their everyday life in spite of the limitations imposed by the condition. Data were collected through qualitative semi‐structured interviews with 40 women, 20 living in the USA and 20 in Sweden. The different strategies used by the women were identified and a preliminary typology of strategies is proposed as a base for further and more specific studies. The results support earlier findings, though the qualitative approach adds knowledge regarding the women's own perception, interpretation and experiences of how to deal with the problems that arose. The findings in the two national groups were very similar, but differences in the medico‐legal compensation systems influenced the women's opportunities to reduce working hours. Changes of habits, roles and lifestyle, as well as ergonomic considerations were required. These changes take time and require continued support from the environment and the health care providers. Further insight into the consequences of the condition is necessary for the planning of successful treatment and support programs.
Nursing Students' Attitudes Towards Assisted Suicide and Euthanasia
Authors: Sørbye Liv Wergeland , Sørbye Sigrunn , Sørbye Sveinung Wergeland
Published: March 2013

In 1991/92, 289 students from four different schools of nursing in Norway participated in a case‐related attitudes test. The nursing students answered questions concerning their personal views on the moral and legal implications of either assisting suicide or performing euthanasia. They also indicated whether they thermselves were willing to perform these acts. The results were compared with responses from a study on students from other faculties in 1988. The findings suggested that nursing students were significantly (p < 0.0005) more restrictive than the other students in their attitudes towards voluntary active euthanasia (VAE). Factors that influenced the nursing students' attitudes towards VAE were measured by the index of VAE. Religious belief (p < 0.0001), conservative political view (p < 0.01), and the perception of life as meaningful (p < 0.02) were the best predictors of the dependent variable.
Predictors of Patient‐Perceived Quality
Authors: Larrabee June H. , Engle Veronica F. , Tolley Elizabeth A.
Published: March 2013

Larrabee's model of quality proposes a relationship between quality and value. This study tested the relationship by identifying predictors of patient‐perceived quality for nursing care. Data were obtained from interviews and records of 199 adult patients. Candidate predictors of patient‐perceived quality included patient goal achievement, nurse‐perceived quality, and nurse goal achievement. Candidate predictors also included seven demographic, seven financial, six illness, and six hospital variables. Predictors of both patient‐perceived quality global and patient‐perceived quality total were pain severity on exit interview, clinic referral, unit, and patient goal achievement. Medicare nonrecipient was a predictor of patient‐perceived quality global. Worry score on admission was a predictor of patient‐perceived quality total. The results support the relationship between quality and value and between quality and beneficence postulated by Larrabee's model of quality. Additional investigation of these relationships in other populations and using other operationalizations of the model concepts is needed to provide further support for the model. This model is potentially useful for investigating quality in diverse cultures because the operationalization of the model concepts can be designed to reflect local, regional, or national values.
Relation between Gait Speed, Knee Muscle Torque and Motor Scores in Post‐Stroke Patients
Authors: Lindmark Birgitta , Hamrin Elisabeth
Published: March 2013

A study was undertaken to investigate the relation between gait speed, motor function and isokinetic knee muscle torque in stroke victims. Two different gait speeds, freely chosen speed and fastest speed, were measured on a 10‐m long walkway in 34 stroke victims (median age 71 years) three months after the stroke. At the same time different motor functions were assessed, and isokinetic knee muscle torque was measured. One year after the stroke 24 of the subjects were again investigated. The two gait speeds measured were both slower than those in normal healthy subjects of the same age. The motor assessment revealed that the group of stroke patients had light to moderately severe stroke symptoms. The isokinetic muscle torque was significantly lower in the paretic than in the non‐paretic legs. The non‐paretic legs were also weaker than the legs of healthy subjects. No significant changes in any of the measured variables were found between the three months' assessment and the one year post‐stroke assessment. There were some significant correlations between gait speed and motor scores and between gait speed and muscle torque, but usually of moderate strength. Multiple regression analysis with gait speed as dependent variable and combined isokinetic muscle torque and three different motor scores as independent variables gave higher R values.
Implementing Coordination of Care
Authors: van Achterberg Theo , C. J. Stevens Fred , J. H. Hekkink Marion , F. J. M. Crebolder Harry , Philipsen Hans
Published: March 2013

In recent years the effects of interventions in the field of coordination of care have been well reported. However, the implementation of coordination of care is hardly addressed. This article focuses on the implementation of coordination of care for the elderly in three community settings in The Netherlands. A group of 38 professional and non‐professional care‐givers functioned as coordinators during a period of one year. Open interviews with coordinators, minutes from group meetings and forms and logbooks were used as sources of data. Major problems during implementation involved conflicting roles, preserving the client's privacy, lack of recognition and the perception that coordination was not always necessary. Coordinators had no difficulty in making a care inventory and in organizing care. On the other hand, introducing oneself as a coordinator, and planning and evaluating are tasks that need more attention in future interventions.
The Stories of Physicians, Registered Nurses and Enrolled Nurses about Ethically Difficult Care Episodes in Surgical Care
Authors: Udén Giggi , Norberg Astrid , Norberg Siv
Published: March 2013

Twenty physicians, 19 registered nurses (RN), and 20 enrolled nurses (EN) working in surgical care in Sweden narrated their experences of being in ethically difficult care situations. All three professional groups disclosed a strong wish to help patients. The narrations of the physicians and the ENs indicated that they were very much involved in their patients, while most of the RNs' stories were narrated from a distanced onlooker's perspective and disclosed a lot of moral outrage, mainly directed towards physicians. The physicians were the only group that emphasized the importance of acting in accordance with science and proven experience. Like RNs they emphasized the importance and difficulty of telling the truth to the patients and their families and being open to one's own and others' harsh experiences. RNs and ENs emphasized the patient's right to a death with dignity and the difficulties connected with being with dying patients, and they also described feelings of powerlessness and neglect of patients related to a heavy work load. ENs narrated difficulties related to providing patients with individualized but fair care.
A Swedish Version of the Appraisal of Self‐Care Agency (ASA) Scale
Authors: Söderhamn Olle , Evers Georges , Hamrin Elisabeth
Published: March 2013

The “Appraisal of Self‐care Agency” scale (the ASA scale) is designed to measure self‐care agency in accordance with Orem's self‐care deficit theory of nursing. The aim of this study was to obtain a reliable Swedish version of the ASA scale by measuring the internal consistency. ASA‐A for self‐appraisal and ASA‐B for appraisal of another were tested with a convenience sample of 52 elderly in‐patients and 53 caregivers in six geriatric care units. Cronbach's alpha reliability coefficient was 0.59 for the ASA‐A scores, 0.77 for ASA‐B scores obtained by caregivers comprising different professions, and 0.87 for scores obtained by registered nurses. Further testing of both validity and reliability is needed if this version of the scale is to be used in nursing research and practice.
Division of Labour in Clinical Microbiology
Authors: Timpka Toomas , Kinnunen Kristina , Forsum Urban
Published: March 2013

The aim of the study was to describe clinical microbiological practices in a hospital setting. A grounded theory was developed from qualitative data in two steps: initial participant observation to describe the clinical work‐flow, and a main case study based on in depth interviews and analyses of work practices using a video‐based stimulated recall technique. Six physicians, 2 senior medical laboratory technologists and one head nurse were interviewed in depth based on their organizational positions. Stimulated recall interviews were conducted with 11 nurses, 6 secretaries, 6 medical laboratory technologists, and 3 physicians. An informal clinical microbiological ‘workgroup’ was found to co‐operate around two physical objects: the microbiological sample and the laboratory request form. Work organization was divided into planning, based on science and legislations, and performance based on tradition and local supervision. None of the practitioners had a total overview of an analysis cycle, all being occupied with a discrete part of planning, practical work and information management. The conclusion of the study is that fragmentation in the division of labour may be a critical hindrance to development in clinical microbiology. If a common strategy is not shared between specialities and professions, even minor changes in routines by individual practitioners may influence patient outcome.
Postoperative Pain
Authors: Berndtsson Ina , Hultèn Leif , Öresland Tom
Published: March 2013

Postoperative pain is often a big problem after gastrointestinal surgery. The aim of the present investigation was two‐fold; To see whether supplying of lidocaine spray in the surgical wound influences postoperative pain and to evaluate the role of patients and caring factors on the perception of postoperative pain. Sixty consecutive patients undergoing major abdominal surgery were randomized into a control or a treatment group. Pain relief, apart from lidocaine, was given according to routine. The methods included interviews, pain registration on a visual analogue scale and registration of administered analgesics. No effect could be attributed to lidocaine. Nurses' ability to predict pain was unreliable, patients predicted pain better. Younger patients suffered greater pain than elderly. Preoperative anxiety correlated to postoperative pain, whereas malignant diagnoses did not. Most of the studied patients had considerable postoperative pain. Routines for postoperative pain relief should be improved.
Determinants of Work Satisfaction among Swedish Dental Hygienists
Authors: Ylipää Viola , Arnetz Bengt B. , Preber Hans , Benkö Singa Sandelin
Published: March 2013

This study examines factors that contribute to work satisfaction among Swedish dental hygienists. A questionnaire was used to collect data on health, demographics, work‐history, work characteristics, work satisfaction, and social support at work. The questionnaire was mailed to 471 hygienists; 77.3% responded. 70% of the hygienists are highly or very satisfied with their work tasks. Active leisure and working in large cities were significantly related to high work satisfaction. The best linear regression model explained 48% of the variance in work satisfaction. Thirty percent of the variance was explained by work tasks perceived to be skills developing. Skills development in the profession appears low (median = 44%). After controlling work factors, work satisfaction increased with growing skills development for all hygienists, even for those less satisfied with their work. The findings suggest that the opportunities for developing professional skills should increase to improve satisfaction among dental hygienists. Measures should also be taken to improve the work climate, work stimulation, and job variation as well as reduce the collegial pressure at work.
Social familiarity relaxes the constraints of limited attention and enhances reproduction of group‐living predatory mites
Authors: Strodl Markus A. , Schausberger Peter
Published: March 2013

In many group‐living animals, within‐group associations are determined by familiarity, i.e. familiar individuals, independent of genetic relatedness, preferentially associate with each other. The ultimate causes of this behaviour are poorly understood and rigorous documentation of its adaptive significance is scarce. Limited attention theory states that focusing on a given task has interrelated cognitive, behavioural and physiological costs with respect to the attention paid to other tasks. In multiple signal environments attention has thus to be shared among signals. Assuming that familiar neighbours require less attention than unfamiliar ones, associating with familiar individuals should increase the efficiency in other tasks and ultimately increase fitness. We tested this prediction in adult females of the group‐living, plant‐inhabiting predatory mitePhytoseiulus persimilis.We evaluated the influence of social familiarity on within‐group association behaviour, activity, predation and reproduction. In mixed groups (familiar and unfamiliar), familiar predator females preferentially associated with each other. In pure groups (either familiar or unfamiliar), familiar predator females produced more eggs than unfamiliar females at similar predation rates. Higher egg production was correlated with lower activity levels, indicating decreased restlessness. In light of limited attention theory, we argue that the ability to discriminate between familiar and unfamiliar individuals and preferential association with familiar individuals confers a selective advantage because familiar social environments are cognitively and physiologically less taxing than unfamiliar social environments.