bluuebunny/crossref_metadata_2025 huggingface dataset:
Students' Mental Health Problems: a Critical Inquiry
Authors: Potka Aniela
Published: March 2013

ABSTRACT. The aim of this study was to examine the subjective and environmental factors underlying students categorized as “single reports” reporting to the Academic Mental Health Consulting (MHC) units in Poland. An attempt was made to verify a common assumption that so called low‐achieving students use the health care system to find legitimate excuses for their academic and personal failures. Obtaining a doctor's certificate explaining their health status provides people with many “privileges”. This study revealed a discrepancy between the “official” description of 1740 student files and their subjective reasons for contacting the MHC obtained through a questionnaire. The study further revealed a lack of student follow up as recommended by the MHC. The study findings seem to confirm the assumed misuse of the health care system by underachieving students. A recommendation was made as how we can reduce this misuse of students services.
A Phenomenological Hermeneutic Access to Research of the Old Age Area
Authors: Ramhøj Pia , de Oliveira Ellen
Published: March 2013

ABSTRACT. The purpose of this article is to describe the phenomenological, hermeneutic research as a scientific research method. We shall introduce the scientifically theoretical placing of the qualitative research interview and the implementation of the interview, through presentation of twelve aspects which have functioned as a scientific‐theoretical/methodical guide for the whole process of interviewing. Finally, we shall briefly discuss problems connected with using the qualitative research interview as the primary method of the research process. The experience concerning the use of the qualitative research interview was gained through a study on life‐style specific ways of coping with a temporary period of illness and rehabilitation of the old. A final presentation of the results of the whole study and a discussion of these are being finalized for publication.
The Development of a Measure of Job Satisfaction for Use in Evaluating Change in the System of Care Delivery
Authors: Wade Barbara , Degerhammar Mari
Published: March 2013

ABSTRACT. The aim of the study was to produce a reliable, valid measure of job satisfaction in order to monitor the effect of a change in the method of care delivery. Principal components analysis of questionnaire responses by 121 nurses yielded two scales labelled “Intrinsic Job Satisfaction” and “Patient Focus”. Cronbach's alpha was 0.88 and 0.82 respectively. Further analyses revealed significant differences in scores on both scales for different grades of staff and significant differences in scores on “Patient Focus” for nurses working in different specialties. Significant increases in scores on both scales were found for registered nurses following changes in organisation on a surgical ward. This increase was maintained over time. For enrolled nurses an increase in “Intrinsic Job Satisfaction” was less well maintained and no differences were found over time on “Patient Focus”. The two scales are reliable and sufficiently sensitive to monitor the relationship between job satisfaction and system of care delivery for different grades of staff working in different specialties.
Family Dynamics and Infant Temperament in Urban Iceland
Authors: Tómasdóttir Margrét , Wilson Margaret E. , White Marjorie A. , Ágùstsdóttir Thorhildur
Published: March 2013

ABSTRACT. Pregnancy is a time of transition and crisis when many families are challenged with the addition of an infant. Studies of this challenge are unknown for Icelandic families. The purpose of this study was to investigate the effects of pregnancy and the young infant on family dynamics and the relationship between family dynamics and the infant's developing temperament. Fifty families completed the Family Dynamics Measure during the third trimester of pregnancy and when the infant was eight months old. Mothers also completed the Revised Infant Temperament Questionnaire. Mothers perceived a decrease in role reciprocity across this transition. More stable organized families had more rhythmic infants. There was no association between family structure and either family dynamics or infant temperament. After the birth of the child, fathers perceived more role reciprocity while mothers perceived more individuation and mutuality. Mothers of second infants reported greater individuation than mothers with first infants.
Medical Laboratory Technologists' Perception of Professional Self
Authors: Andréasson Sixten , Gullberg Mats T. , Olsson Henny M. , Hamrin Elisabeth
Published: March 2013

ABSTRACT. The subjective perception of professional self was studied for a sample of Medical Laboratory Technologists (MLTs) employed in Clinical Chemistry in Sweden. The sample (N= 488) consisted of a randomized tenth of members of their trade union. A mailed questionnaire with 21 items concerning self‐description compared with peers in a seven‐point Likert type scale was completed by 332 (68%). There was no significant overall difference concerning the four principal types of workplace: Clinical Chemistry, Blood Serology, Primary Care and Clinical Chemistry/Blood Serology. The main difference was found between those in managerial posts (N= 72) and the other MLTs (N= 260). Factor analysis showed three principal components, labelled Professionalism, Work Ethic, and Empathy, but also a different composition of variables of the components for the manager group compared with the non‐manager group.
Patient Involvement in Decision‐making in Surgical and Orthopaedic Practice
Authors: Larsson Ullabeth Sätterlund , Svärdsudd Kurt , Wedel Hans , Säljö Roger
Published: March 2013

ABSTRACT. As part of the project Perioperative Risk,—an epidemiological study of complications associated with surgical and orthopaedic operations—the article reports a study of patients' perception of their involvement in decisionmaking in medical consultations, and how the outcomes of surgery and subsequent care determine patients' evaluation of the treatment. Patients' view of their involvement in the decision‐making process was obtained before as well as after surgery. The results reveal that the more satisfied the patients were with the outcome of the operation, and the post‐operative situation, the more they were inclined to assume responsibility for the decision to have surgery. The opposite response pattern, indicating a negative evaluation of either the operation or the post‐operative care, resulted in an outcome where patients described others—especially the physician—as being responsible for the decision to have surgery. The results suggest that patients' evaluations of surgery are based upon a more global reaction to what happened during the entire care process. Dissatisfaction with either the operation or the post‐operative care leads to a negative outcome in terms of patients' perceptions of their own involvement. This emphasizes the importance of all health care professionals seeing themselves as a team with complementary responsibilities for success in health care.
Risk Factors Responsible for Patients' Falls
Authors: Plati Chrysanthi , Lanara Vassiliki , Mantas John
Published: March 2013

ABSTRACT. The study determined intrinsic factors which contributed to the falls of adults hospitalized in a general hospital during 1987–88. Two hundred and fourteen patients were studied in two groups. Group A consisted of 108 patients who fell during their hospitalization and control Group B consisted of 106 patients with the same characteristics also hospitalized during the same period who did not fall. Of the 23 variables which have been analyzed by the multivariate logistic regression method, seven present statistically significant incidence and increased risk of patients' falls: (1) gender: the number of accidents occurring among male patients was higher than that among females (p= 0.0022); (2) age: the majority of accidents occurred in the 65 ≥ years old age group (p= 0.00426); (3) general pathological conditions: mostly patients with cardiac problems (p=0.0062); (4) neoplasms (p=0.0334); (5) anaemias (p=0.0128); (6) postoperative conditions (p=0.0063); and the taking of hypnotic/tranquilizer drugs (p= 0.0486). Other significant findings were: the highest incidence of falls occurred during the first 4 days of the patients' admission to hospital and most during the early morning hours (5–6 am). Injuries incurred were bruises (32.4%), minor injuries (24%), major injuries (16.7%) and fractures (10.2%). The high correlation between patients' falls and (1) specific diseases, namely neoplasms, anaemias, cardiac and post‐operative conditions and (2) the taking of hypnotic/ tranquilizer drugs are risk factors in relation to patients' falls in general hospitals.
The Condition of the Oral Mucosa in Institutionalized Elderly Patients Before and After Using a Mucin‐Containing Saliva Substitute
Authors: Blixt‐Johansen Gunilla , Sjöholm Kerstin , Wiesel Kerstin , Ek Anna‐Christina
Published: March 2013

ABSTRACT. The purpose of this investigation was to evaluate whether the condition of the oral mucous membrane and the mouth comfort of the elderly could improve using a mucin‐containing saliva substitute. In total, 52 patients were examined before and after a 60‐day treatment period, with mucin‐containing saliva substitute given three times a day before meals. The patients were examined with regard to weight, oral mucosa condition, the duration of meals, eating and swallowing. Before the treatment period the prevalence of stomatitis was 90.4% and oral candidosis was 80.8% compared to 15.4% and 5.8% respectively after the treatment period. The pH increased significantly. Artificial mucin‐containing saliva substitute seems to be an adequate treatment of stomatitis and oral candidosis in elderly patients.
Short Communication
Authors: Hildingh Cathrine , Fridlund Bengt
Published: March 2013

Determination of Perceived Health Among Elderly Coronary Patients
Ethical Reasoning Among Registered Nurses Experienced in Dementia Care
Authors: Jansson Lilian , Norberg Astrid
Published: March 2013

Abstract. Registered nurses regarded as “experienced and good” in dementia care were interviewed about the feeding of a severely demented patient who showed refusal‐like feeding behaviour. Not one of the twenty nurses could see herself using force against her patients. Most interviewees justified their decisions to feed a severely demented patient and answered questions about whether they would change their minds if there were certain circumstances in terms of words that could be interpreted as referring to the ethical principle of beneficence. The nurses stressed the difficulty to understand the meaning of severely demented patients' feeding behaviour and decide when force‐feeding occurs. When asked to rank ethical principles of importance for the decision, however, the most common answer was that they would give priority to the ethical principle of autonomy. The nurses did not see the ethical principles as separate entities, that could be applied one by one, but tried to integrate them into a whole. The findings of this study were interpreted as indicating that principled ethics is not an adequate model to describe experienced nurses' ethical reasoning.
Coping Ability and Functional Status in a Swedish Population Sample
Authors: Langius Ann , Björvell Hjördis
Published: March 2013

The paper presents reference values of the questionnaires Sense of Coherence scale (SOC), measuring self‐rated prerequisite for coping ability, and Sickness Impact Profile (SIP), measuring self‐rated functional status. The sample used is randomly selected from a Swedish urban population consisting of 145 individuals (75 women, 70 men), divided into three age groups, 26–40, 41–55 and 56–70 years.

The mean SOC score was 151 (SD 18) and was not related to gender or age. The total SIP score was low (median 0) as expected in a general population. However, again as expected, the results revealed the functional status being worse in the older group of individuals than in the younger ones. The results might give further validity to the test. The SOC scores were significantly correlated to the overall SIP scores and to the subscales of mental and social character and not to those of a physical nature. Thus, the weaker the SOC the worse the functional status. These findings are suggested to give the Sense of Coherence scale a discriminating validity.

A single item concerning general health was also rated by the individuals showing the better the general health the stronger the SOC and the less the dysfunction.
A New Injection Technique for Insulin Treatment, Simpler to Use and as Effective?
Authors: Engström Lars , Bergman Anita
Published: March 2013

The absorption of insulin from subcutaneous tissue differs from that of muscle (Owens et al. 1981, Thow et al. 1989), and normally takes place more slowly from the former than from the latter. The rate of absorption is higher from the abdomen than from other parts of the body (Frid et al. 1988).
The Effects of Professional Group Supervision of Nurses
Authors: Segesten Kerstin , Ed Dipl Nurse
Published: March 2013

All the registered nurses in two orthopaedic wards participated in a four‐month period of professional group supervision. The main focus of the supervision was professional identity. The effect was measured by the Nurse Self Description Form, a 21‐item paper‐and‐pencil form for nurses to judge themselves in comparison to other nurses. The nurses answered the form before and after the period of supervision. They increased their total scores significantly. Some single items were influenced more than others. The results argue in favour of group supervision as a useful mean of strengthening the professional identity of nurses.
Quality of Care from a Patient Perspective
Authors: Wilde Bodil , Starrin Bengt , Larsson Gerry , Larsson Mayethel
Published: March 2013

The aim of the present study was to develop a theoretical understanding of quality of care from a patient perspective, using a grounded theory approach. Thirty‐five interviews were conducted with a sample of 20 adult hospitalized patients (mean age: 60 years) in a clinic for infectious diseases. Data were analysed according to the constant comparative method. A model was formulated according to which quality of care can be understood in the light of two conditions, the resource structure of the care organization and the patient's preferences. The resource structure of the care organization consists of person‐related and physical‐ and administrative environmental qualities. The patient's preferences have a rational and a human aspect. Within this framework, patients' perceptions of quality of care may be considered from four dimensions: the medical‐technical competence of the caregivers; the physical‐technical conditions of the care organization; the degree of identity‐orientation in the attitudes and actions of the caregivers and the socio‐cultural atmosphere of the care organization. The model is discussed in relation to existing theories in the field.
Use of the Edinburgh Postnatal Depression Scale in Some Swedish Child Health Care Centres
Authors: Lundh Wendela , Gyllang Cecilia
Published: March 2013

A Swedish version of the Edinburgh Postnatal Depression Scale was validated in 53 women, in comparison with an interview based on the Comprehensive Psychopathological Rating Scale (CPRS‐Depression). The EPDS was then applied to 258 women on four occasions, first at 2 and 6 weeks and then at 3 and 8 months post partum. At 2 weeks the proportion of women with signs of depression was 26%, 8% at 6 weeks, 13% at 3 months and 8% at 8 months. An analysis of the 10 items in the EPDS was performed. The subjects felt the questionnaire to express their situation accurately and relevantly. It was also regarded as easy to complete.
Characteristics of low back pain patients who do not complete physiotherapeutic treatment
Authors: Lansinger Birgitta , Nordholm Lena , MD Tatjana Sivik
Published: March 2013

Patients' problems in following recommendations of health professionals is an issue of great concern. The purpose of the present study was to investigate whether patients with low back pain (n = 46) who dropped out of a treatment programme differed in characteristics measured prior to treatment from a matched comparison group (n = 46) who completed the programme. Data collected on work disability and sick leave, frequency, duration and intensity of pain, physical function, and personality characteristics were compared. The results indicated that the groups differed significantly on 3 of 16 variables. The non‐completers had been on sick leave for a longer time period prior to treatment, experienced more intense pain and performed at a lower level on the test of physical function than those who completed the treatment programme.
Caring for Demented Elderly in Rural Primary Health Care
Authors: Sjöbeck Barbro , Isacsson Åke
Published: March 2013

In 1988, the demented in an elderly rural population (n = 851) were traced and assessed with the GBS geriatric rating scale. The aim of the study was to investigate the level of impairments of demented persons primary cared for and to relate their impairments to form of housing; to compare the distribution of care between not‐demented and demented in an elderly population, and to establish the primary caregiver/patient ratio. The majority of the demented (44/50) were cared for in the studied primary health care area, despite the scarcity of staff. All received formal care. They consumed more formal care than the not‐demented in the population. In relation to amount of elderly persons helped, the home‐help personnel ratio was 0.30, in district care the ratio was 0.02, whereas the ratio of general practitioners was 0.002, estimated from the number of contacts and staff.
The ‘Good Mother’
Authors: Welles‐Nyström Barbara , New Rebecca , Richman Amy
Published: March 2013

This paper is based on a comparative, psychologically informed ethnographic study of maternal goals and infant care during the first year of life for 20 mothers and infants in each of three Western settings: Stockholm, Sweden, outside Rome, Italy, and suburban Boston, in the United States. Two research questions were posed to consider cultural ideas and ideals about mothering; How was the ‘good mother’ defined? How did sample women themselves, mother? Research hypotheses were that definitions of a good mother would be culture‐specific with minimal within‐culture variance. Furthermore, the frequency of maternal behaviors would also exhibit culture specific patterns. Research methods included event based behavioral observations of infant‐caregiver interactions in the home, daily routine questionnaires, maternal attitude interviews, and ethnographic observations of community and family life. Research hypothesis were confirmed. Results revealed culture‐specific variation in conceptions of the ‘good mother’. Cultural differences were reflected in the short‐ and long‐term goals which the sample women described for their children. Patterns of infant care, in turn, were consistent with the cultural values expressed, as well as the cultural norms of social interaction.
Quality by Selection and Purchasing of Urinary Incontinence Aids
Authors: Måansson‐Lindström Ann , Dehlin Ove , Isacsson Åke
Published: March 2013

In a qualitative‐quantitative study, differences in the perceptions of nurses and administrators (admin's) dealing with the purchasing of urinary incontinence (UI) aids were studied by means of interviews with a cognitive and emotional approach. Various aspects of purchasing were concentrated on: cooperation, strategy, competence, costs, measures, and decisions, as well as quality in the selection of aids in order to improve quality of care and achieve better economy. The findings show a continued need for centrally coordinated purchasing (CCP), not least related to the European Community, and also problems of integration. Due to the decentralization process, the nurses perceived a need for more education in overall business strategies in order to underline more constructively their caring and patient‐oriented opinions. The admin's experienced uncertainty in their purchasing activities caused by the absence of purchasing policies and lack of knowledge of new demands and routines.
Visual Impairment Related to Cognition and Loneliness in Old Age
Authors: Holmen Karin , Andersson Lars , Ericsson Kjerstin , Rydberg Lennart , Winblad Bengt
Published: March 2013

Reported problems in visual acuity were examined as determinants of loneliness experienced by community dwelling people with either impaired or unimpaired cognition. The Mini‐Mental State Examination (MMSE) was used as a screening instrument to form a cognitively‐impaired (MMSE 20–23/30) and a cognitively‐intact group (MMSE 28–30/30). A total of 147 subjects took part in the study and were examined by an optometrist.

Subjects with intact cognition tended to report visual problems more often than subjects with cognitive deficits. One out of two subjects had slight visual impairment, in both cognitive groups. After acuity had been optimally corrected, six to seven out of ten subjects' visual acuity did improve. In a multiple regression analysis, higher MMSE score and visual improvement were significantly related to lower levels of self‐reported loneliness among the elderly with their cognition intact, but not among the subjects with impaired cognition.
Physiotherapeutic Treatment in Out‐Patient Psychiatric Care
Authors: Mattsson Monica , Mattsson Bengt
Published: March 2013

The present paper aims at describing historical features, developmental trends and key concepts in psychiatric physiotherapy (PPT). PPT was offered as an additional treatment to conventional psychiatric care and the aim was to examine the possibility of carrying out PPT with ten unselected patients (n = 10) in an out‐patient psychiatric clinic. Symptoms presented: anxiety and phobic states, depression and crisis reactions. The purpose of four individual sessions was to stimulate curiosity and offer exercises concerning body‐mind interactions. In examination of data qualitative research methods were used. All patients accepted the offer of PPT and participated in all sessions. Nine reported great or moderate symptom reduction. Of greatest importance for relief of symptoms was the patient's level of ‘engagement’. PPT implies physical proximity and an encounter on an existential level. The impact of a complementary physical approach in psychiatric care needs to be further elucidated.
The Impact of Public Health in Norwegian Postgraduate Programmes of Psychiatric Nursing
Authors: Hummelvoll Jan Kåre , Bunch Eli Haugen
Published: March 2013

The purpose of this descriptive study was by means of a questionnaire to obtain data on how 13 nursing schools, offering a postgraduate specialization in psychiatric nursing in Norway, have incorporated a public health perspective into their curricula. Since the mid‐1980s, national health policies and Health for All by A.D. 2000 have placed emphasis on decentralization of all health care services, including services for the mentally ill. The Community Health Law of 1984 guarantees all Norwegian citizens such services in their local communities. The schools have traditionally emphasized curative services in hospitals, rather than health promotion and preventive measures at community level. Are the new graduates prepared for psychiatric work at community level? A content analysis of a semistructured questionnaire revealed that a social psychiatric perspective has indeed been incorporated in today's curricula. This was supported by reviewing the required reading lists for each of the 13 schools. Roughly one can say that the schools represent two perspectives: 1) those focusing primarily on relational aspects, and 2) those focusing on relational aspects within a social psychiatric framework.
The Trustworthiness of the Stories of Elder Abuse Narrated by District Nurses
Authors: Britt‐Inger Saveman , Astrid Norberg , Anders Gustavsson , Birgitta Odén
Published: March 2013

The aim of the present study was to assess the trustworthiness of previously reported stories about elder abuse narrated by 21 district nurses (DNs) regarded as witnesses. Firstly, the stories were coded as to whether they were based on direct observation, hearsay or a mixture, and whether there were whole stories or story fragments. Secondly, they were coded and classified regarding a modification of the characteristics of reality developed from statement reality analysis. The DNs' single stories matched most of the characteristics. The results indicate that the DNs' stories are a reliable account of a personally experienced real event. Witnesses' stories are important sources in revealing phenomena, such as elder abuse. It also seems important to develop usable methods further.
Someone Who Cares
Authors: Rose Gisela , Segesten Kerstin
Published: March 2013

The aim of this inquiry was to gain an understanding of laymen's experiences and opinions about general health check‐ups. Medical experts often draw attention to unwanted effects, especially the risk of creating worry and of recommending and even giving unnecessary medical treatment. By using a qualitative research method with unstructured interviews we wanted to explore the participants' conceptions of health, their expectations before and their perceived benefits after health checks and whether the check‐up gave rise to negative feelings. The participants held broad views on health and, possibly as a consequence, also great expectations of health check‐ups. Consequences of the check‐ups were that examinees felt encouraged to change their life style, had learnt to handle risk factors for disease, and after some time, reported feeling better. The individual attention and care, which in general did not differ from other caring situations described in the literature, was highlighted as an important factor for a positive result. Worries afterwards either did not exist or could be rationalized by knowing the causes of abnormalities and receiving guidance from the medical staff.
The Oldest Old and Personal Activities of Daily Living
Authors: Bondevik Margareth , Skogstad Anders
Published: March 2013

The aim of this study was to evaluate the actual function of the personal activities of daily living in old people living in nursing homes and in the community. Another purpose was to evaluate and document the nursing load. The assessments were made over a four‐week period. Two groups of individuals, aged 80 years or older, were compared with respect to ability to perform activities of daily living. The first group comprised old people who had been resident in nursing homes for at least six months, while those in the other group lived alone in the community and received some kind of assistance from the home service providers. The subjects in the latter group were less disabled than those residing in nursing homes. Age group comparisons among nursing‐home residents showed no significant differences in the capacity of residents to function in activities of daily living, nor in the case of those living in the community. The nursing staff in the nursing‐home setting had a heavier work‐load than those working in the community concerning performance of personal activities of daily living. Caring for old people in institutions as well as in the community creates substantial challenges for the care personnel.
Influence of Dinner Music on Food Intake and Symptoms Common in Dementia
Authors: Ragneskog Hans , Bråne Görel , Karlsson Ingvar , Kihlgren Mona
Published: March 2013

The influence of dinner music on food intake and symptoms common in dementia such as depressed mood, irritability and restlessness was studied. The study was carried out in a nursing‐home ward in Sweden. Soothing music was played as dinner music for two weeks, Swedish tunes from the 1920s and 1930s for two weeks and pop music for two weeks. Prior to these periods, there was one week without music, and at the end of the intervention there was a two‐week control period. The effects of the intervention were assessed by psychological ratings and by weighing the food helpings. It was found that during all three music periods the patients ate more in total. The difference was particularly significant for the dessert. The staff were thought to be influenced by the music, as they served the patients more food, both main course and dessert, whenever music was played. The patients were less irritable, anxious and depressed during the music periods. The results of the study suggest that dinner music, particularly soothing music, can reduce irritability, fear‐panic and depressed mood and can stimulate demented patients in a nursing‐home ward into eating more.
Nursing Documentation in Patient Records
Authors: Nordström Gun , Gardulf Ann
Published: March 2013

The correct documentation of nursing care is a very important prerequisite for safe care. An extensive survey (n = 380 records), was conducted, using the NoGa© protocol for a review of the nurses' documentation. The documentation revealed considerable deficiencies in most of the wards, and the nursing history, status and planned interventions were inadequate in two‐thirds of the records. Furthermore, the nursing diagnosis, goals and discharge notes were especially poorly documented. The NoGa© protocol was easy to use as an audit tool, useful for screening the nurses' documentation and useful for evaluaton of the outcomes of educational programmes in nursing documentation.
Well‐being and Its Relation to Coping Ability in Patients with Colo‐rectal and Gastric Cancer Before and After Surgery
Authors: Forsberg Christina , Björvell Hjördis , Cedermark Björn
Published: March 2013

The aims of this study were, first, to describe and compare the perceived well‐being and general health, symptoms and coping ability of a group of patients with colo‐rectal and gastric cancer before and after surgery; secondly, to describe the patients' perceptions of the hospital stay and their difficulties after discharge from the hospital; and thirdly, to investigate a possible relationship between sense of coherence and well‐being. Seventy‐nine (36 men, 43 women) consecutively selected patients diagnosed with colo‐rectal or gastric cancer participated in the study. The Health Index (HI), the symptom checklist, the Sense of Coherence Scale (SOC scale), a study‐specific questionnaire and a single item were used. Six weeks after surgery many of the cancer patients perceived that their well‐being was poorer on the HI subscales energy, sleep and mobility than before. Bowel function had improved, and pain, which was a common symptom before surgery, was perceived as having lessened after surgery. Furthermore, the sense of coherence was shown to be related to the cancer patients' well‐being as measured by the HI. Patients living with relatives rated their well‐being as better than that of patients living alone. The problem areas identified after discharge concerned mobility, bowel function, fatigue, pain, nutrition, worry, difficulties in sleeping and problems with the wound. The instruments used in the study are seen as screening instruments to further structure the nursing‐care plan, so that the patients' perceptions of the disease situation can also be taken into consideration.
A Nurse in Preventive Work
Authors: Adelswärd Viveka , Sachs Lisbeth
Published: March 2013

The possibility of making scientifically objective statements about health risks is part of a new complex of ideas pervading our Western social institutions. The concept of prevention includes an assessment of risk and dangers which lay persons have difficulties in comprehending. Advances in medical technology have made it possible to detect a growing number of anomalies in the human body and thereby to define more and more people as being at risk of various diseases. Even if it seems desirable for society to be able to detect the risks menacing its members, it calls for delicate management of the test procedures and of the preventive intervention. This article presents some perspectives on preventive work in connection with a directed health survey. The primary aim of the survey in question was to diagnose particular risk factors, for instance a high level of blood cholesterol, and inform the patient about how to prevent or reduce the risk of cardiovascular disease. The preventive measures are commonly undertaken by a nurse; her encounters with the patients—to obtain test samples, communicate the results and provide information about health risks—raise complex issues. These and other dilemmas in preventive work are discussed and analyzed
Violation of the Patient's Integrity, Seen by Staff in Long‐Term Care
Authors: Kihlgren Mona , Thorsén Håkan
Published: March 2013

The aim of the study was to describe the views held by staff (n = 233) in long‐term care on what they regard as a violation of patient's integrity and to define the concept “integrity” in simple terms. The design of the investigation was inductive. The answers were coded into 775 items. Agreement was reached between the authors on 770 of the items when sorted into 13 categories: the unique personality, autonomous self, personal opinions, secret self, personal competence, professional self, family self, cultural self, information self, personal properties, private territory, corporal self, and ridiculing. The number of categories shows a great variation in the ordinary language definitions given by staff. It was also shown in two other ways: the difference in the level of abstraction in the items, and the fact that integrity referred to the patient, directly or indirectly. Our conclusion is that integrity by the staff reflects an ethical value and not a personal trait. If the staff have to violate the patient's integrity, because other vital values are involved, it is absolutely essential that they consider the ethical aspects of the situation carefully. Such violation demands that they preserve their respect for the patient to the greatest extent possible. It seems important in the training of different staff groups to show the complexity in the concept “integrity” and the ethical dilemmas that arise, especially in the interaction with vulnerable patients who are not able to protect and maintain their own integrity.
Allocation of Nursing Time
Authors: Lemonidou Chryssoula , Plati Chryssanthi , Brokalaki Hero , Mantas John , Lanara Vasiliki
Published: March 2013

The purpose of the study was to examine the allocation of nursing time to various activities of registered and assistant nurses during the day shift. Twenty‐three registered (RN) and eighteen assistant nurses (AN) working in medical and surgical wards of five large hospitals were studied. The findings have shown that the most frequent activities performed were: indirect care representing 35.6% of the time, direct care representing 23.8% of the time, personal activities representing 16.8% of the time, and direct nursing interventions representing 8.2% of the time. Cross‐tabulation revealed that RNs provided direct care less frequently and indirect care more frequently than ANs (25.3 activities per RN and 27.5 per AN, 62.1 activities per RN and 32.6 per AN, respectively). Many indirect care activities were found to be the responsibility of the head nurse (64), secretary (465), and others (104). Less expected results were the minimal amounts of time spent on both education and research activities (1.3% and 0.0% respectively). Nurse managers have to free nurses from subsidiary work and to find mechanisms to distribute nursing valuable time more efficiently.
Patients' Narratives Concerning Good and Bad Caring
Authors: Lövgren Gunvor , Engström Birgitta , Norberg Astrid
Published: March 2013

Narratives from patients (n = 80) and patients' relatives (n = 12) were collected in order to illuminate experiences of good and bad caring episodes and to obtain descriptions of good caring. Narratives describing good caring included such task aspects as swift and correct assessment and access to information. Aspects less frequently mentioned were, for example, being given time, receiving pain relief and good food. Relationship aspects mentioned; having an interest shown in the care, being taken seriously and being cared about. There are parallels regarding relationship aspects between the narratives concerning good and bad caring episodes; for example what was praised in the good caring narratives was criticized in those describing bad caring. Such parallels were being/not being trusted, being/not being believed and being/not being respected. The narrations concerning bad caring were more specific and more vivid than those about good caring. The authors' interpretation was that the bad episodes were unexpected and very painful and therefore remained imprinted in the patients' memories. The descriptions of good caring included relationship aspects in only 34 cases, task aspects in only five cases and a combination of both in 50 cases. The ultimate purpose of the study was to obtain a basis for the development of a policy for good caring founded on patients' experiences. It is desirable that further studies be undertaken within various clinical specialities which would also take into consideration medical, social and cultural perspectives.
Interrater Variability and Validity in Subjective Nutritional Assessment of Elderly Patients
Authors: Ek Anna‐Christina , Unosson Mitra , Larsson Jörgen , Ganowiak Wojciech , Bjurulf Per
Published: March 2013

The subjective Global Assessment technique was evaluated with regard to its reliability and validity in a Swedish elderly population. Ninety patients, 70 years of age or older, and newly admitted to the geriatric clinic, participated in the study. The nutritional state was assessed subjectively by two independent observers using the Subjective Global Assessment form, and objectively, using a combination of anthropometry and serum‐protein analysis. The subjectively assessed malnutrition rate was about 20% higher than that assessed objectively. The agreement level between the two observers was 77.8%, Kappa 0.56 (<0.001), and the levels between the subjective and objective assessments were 57.8% (Kappa = 0.17) and 73.3% (Kappa = 0.46), respectively. The experienced observer identified 85.2% of those who were defined as malnourished using the objective criteria and the less experienced observer, 66.6%. Furthermore, a regression analysis indicated weight index as the main significant objective factor influencing the subjective assessment. The subjective technique could be regarded as reliable from a clinical and preventive perspective since the agreement between the two rates was just under 80%. It seems also to be valid since the subnormalities in the selected criteria showed a similar pattern. The necessity of being well trained in order to manage nutritional status assessment, for both clinical and research purposes, is obvious.
Smoking Discussions at the Child Health Clinic
Authors: Arborelius Elisabeth , Peterson Barbara
Published: March 2013

Interviews with 15 nurses working in child health care revealed that most of them were very keen not to apportion blame when discussing smoking habits with parents. Thus, half of those interviewed chose a passive approach to counselling, which meant that they were cautious, evasive and tactful so as not to risk alienating or offending parents. Those who were more active tackled the issue of smoking by giving advice and suggesting ways in which the parents could cope with their smoking. A third approach was observed in which some of the nurses were judgemental, which they expressed by moralizing about the smoking habits of the parents. The present study shows that there is a need to develop a patient‐centred methodology, whereby smoking can be discussed from the standpoint of the parents, without making them feel guilty.
Falls Among Institutionalized Elderly—A Prospective Study in Four Institutions in Finland
Authors: Nurmi Nona , Sihvonen Marja , Kataja Matti , Lüthje Peter
Published: March 2013

We analyzed prospectively the incidence, the intrinsic and extrinsic factors and the consequences of falls during a 7‐month period in 4 institutions in Finland in 1993. A total of 370 falls among 160 patients were recorded. Of the fallers 56% fell once and 44% more than once (range 2–24). The mean fall rate in men was higher than that in women (p < 0.01). Fallen men were younger but less ambulatory than women. Of the falls 95% occurred without eyewitnesses and 27% during the night shift; 30% (114/370) resulted in an injury and 7% (11/160) of the fallers suffered a fracture.
Intuition—A Problematic Form of Knowledge in Nursing
Authors: Sarvimäki Anneli , Stenbock‐Hult Bettina
Published: March 2013

The purpose of this article is to discuss the concept and phenomenon of intuition in nursing. With an overview of theories of intuition in philosophy and empirical research as the starting point, the authors discuss the conceptualization of intuition in nursing. Concept analyses, intuition as phenomenological nursing knowledge, intuition as clinical knowledge and intuition as spiritual connection are discussed. The authors conclude that the conceptions of intuition in nursing differ with respect to their philosophical underpinnings and that it can be questioned whether ‘intuition’ is always a proper term for the kind of knowledge investigated. Intuition is seen as an important concept in nursing, but there are still philosophical as well as empirical and practical problems to investigate.
Bergmann′s rule in mammals: a cross‐species interspecific pattern
Authors: Clauss Marcus , Dittmann Marie T. , Müller Dennis W. H. , Meloro Carlo , Codron Daryl
Published: March 2013

Although Bergmann’s rule – stating that among closely related species, the bigger ones will inhabit the colder climates/higher latitudes – was formulated for inter‐specific comparisons, most analyses that tested this pattern in mammals were on an intra‐specific level. To date, no large‐scale taxonomy‐driven cross‐species evaluation of the pattern predicted by Bergmann exists. Here we show, in a dataset comprising 3561 mammal species from 26 orders, that while there is no significant correlation between latitude and body mass using conventional methods, this correlation is highly significant when the phylogenetic structure of the dataset is accounted for, thus supporting Bergmann’s claim that the rule only applies to closely related species. Analyses of different subsets indicate that the Bergmann’s rule is evident across a variety of latitude ranges. In many taxonomic subsets, when analysed alone, there is no significant correlation between body mass and latitude. In combination with both the significant relationship in the overall dataset and with results of intra‐specific analyses from the literature, this suggests that Bergmann’s rule describes a fundamental principle within mammals, but that its expression has been modified by a variety of factors during mammalian diversification yet to be resolved.
Contraceptive Use, Birth Spacing, and Child Survival in Matlab, Bangladesh
Authors: Saha Unnati Rani , van Soest Arthur
Published: March 2013

To reduce infant mortality through improved family planning, a better understanding of the factors driving contraceptive use and how this decision affects infant survival is needed. Using dynamic panel‐data models of infant deaths, birth intervals, and contraceptive use, this study analyzes the causal effects of birth spacing on subsequent infant mortality and of infant mortality on the use of contraceptives and the length of the next birth interval. Data are drawn from the Health and Demographic Surveillance System in Matlab, Bangladesh, where almost 32,000 births have been observed from 1982 to 2005. Our main finding is that complete contraceptive use could reduce infant mortality of birth order two and higher by 7.9 percent. The net effect of complete contraceptive use on the total infant mortality rate is small (2.9 percent), however, because the favorable effect on higher order births is partly offset by the rise in the proportion of high‐risk first births.
Lessons from the Recent Rise in Use of Female Sterilization in Malawi
Authors: Jacobstein Roy
Published: March 2013

Although female sterilization is the most widely used modern contraceptive method in the world, most family planning programs in Africa have had difficulty providing it. Malawi, however, despite daunting constraints, has made female sterilization widely and equitably accessible, thereby increasing method choice and helping its citizens better meet their reproductive intentions. Ten percent of currently married Malawian women of reproductive age rely on female sterilization for contraceptive protection, compared with less than 2 percent across Africa, and demand to limit births now exceeds demand to space births. Malawi's female sterilization prevalence surpasses that of some high‐resource countries. Key service‐delivery factors enabling this achievement include supportive policies, strong public–private partnerships, and mobile services delivered at no cost by dedicated providers. Challenges remain, but Malawi's achievement offers lessons for other countries with low availability of female sterilization and similar resource constraints.
High‐Resolution X‐ray Diffraction and Fluorescence Microscopy Characterization of Alkali‐Activated Slag‐Metakaolin Binders
Authors: Bernal Susan A. , Provis John L. , Rose Volker , de Gutiérrez Ruby Mejía
Published: March 2013

The effect of the activator concentration on the structure of alkali silicate‐activated slag/metakaolin pastes is assessed through synchrotron radiation‐based X‐ray techniques. As main reaction products, both calcium aluminosilicate hydrate (C–A–S–H) and sodium/calcium aluminosilicate hydrate [(C,N)–A–S–H] type gels are formed in activated binders solely based on slag, along with the zeolitic products gismondine and garronite. In activated blended pastes, the inclusion of metakaolin in the binder hinders the formation of zeolite products, instead favoring the formation of a (C,N)–A–S–H type gel consistent with the activation of metakaolin in the presence of high concentrations of Ca. The formation of the two distinct binding products is confirmed by high‐resolution X‐ray fluorescence microscopy, where the “inner” products and the “outer” products have compositions consistent with (C,N)–A–S–H and C–A–S–H type gels, respectively. These results provide important new insights into the gel chemistry and micro/nanostructure of blended alkali‐activated binder systems.
Volcanic Ash‐Induced Decomposition of EB‐PVD Gd2Zr2O7 Thermal Barrier Coatings to Gd‐Oxyapatite, Zircon, and Gd,Fe‐Zirconolite
Authors: Mechnich Peter , Braue Wolfgang
Published: March 2013

The resistance of EB‐PVD Gd2Zr2O7 thermal barrier coatings against high‐temperature infiltration and subsequent degradation by molten volcanic ash is investigated by microstructural analysis. At 1200°C, EB‐PVD Gd2Zr2O7 coatings with silica‐rich, artificial volcanic ash (AVA) overlay show a highly dynamic and complex recession scenario. Gd2O3 is leached out from Gd2Zr2O7 by AVA and rapidly crystallizes as an oxyapatite‐type solid‐solution (Ca,Gd)2(Gd,Zr)8(Si,Al)6O26. The second product of Gd2Zr2O7 decomposition is Gd2O3 fully stabilized ZrO2 (Gd‐FSZ). Both reaction products are forming an interpenetrating network filling open coating porosity. However, first‐generation Gd‐oxyapatite and Gd‐FSZ are exhibiting chemical evolution in the long term. The chemical composition of Gd‐oxyapatite does evolve from Ca,Zr enriched to Gd‐rich. AVA continuously leaches out Gd2O3 from Gd‐FSZ followed by destabilization to the monoclinic ZrO2 polymorph. Finally, zircon (ZrSiO4) is formed. In addition to the prevalent formation of Gd‐oxyapatite, a Gd‐, Zr‐, Fe‐, and Ti‐rich oxide is observed. From chemical analysis and electron diffraction it is concluded that this phase belongs to the zirconolite‐type family (zirconolite CaZrTi2O7), exhibiting an almost full substitution Ca2+ + Ti4+ <> Gd3+ + Fe3+. As all Gd2Zr2O7 decomposition products with the exception of ZrSiO4 exhibit considerable solid solubility ranges, it is difficult to conclusively assess the resistance of EB‐PVD Gd2Zr2O7 coatings versus volcanic ash attack.