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Edfeldt K, Jangland E, Larsson Ingwall L, Wistedt SM, Gunnarsson AK, Fröjd C. Oral health and oral care in patients in a surgical context: A quantitative study comparing patients' and nurses' assessments. J Clin Nurs 2024; 33:2201-2208. [PMID: 38093514 DOI: 10.1111/jocn.16961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
AIMS To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments. DESIGN A descriptive and comparative study, with a consecutive selection. METHODS A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. RESULTS Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did. CONCLUSION There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. IMPACT There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. PATIENT CONTRIBUTION Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. REPORTING METHOD This study was carried out according to the STROBE checklist.
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Affiliation(s)
- Katarina Edfeldt
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Linn Larsson Ingwall
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Sandra-Marie Wistedt
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
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Edfeldt K, Nyholm L, Jangland E, Gunnarsson AK, Fröjd C, Hauffman A. Missed nursing care in surgical care- a hazard to patient safety: a quantitative study within the inCHARGE programme. BMC Nurs 2024; 23:233. [PMID: 38584285 PMCID: PMC10999080 DOI: 10.1186/s12912-024-01877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Missed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context. METHODS A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%. RESULTS Aspects of nursing care rated to be missed the most were 'attending interdisciplinary care conferences', 'turning patient every 2 h', 'ambulation 3 times per day or as ordered', and 'mouth care'. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were 'inadequate number of staff' and 'unexpected rise in patient volume and/or acuity on the unit'. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department. CONCLUSIONS The occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.
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Affiliation(s)
- Katarina Edfeldt
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lena Nyholm
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Eva Jangland
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Camilla Fröjd
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna Hauffman
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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Embring A, Blomstrand M, Asklid A, Nilsson MP, Agrup M, Svärd AM, Fröjd C, Martinsson U, Fagerström Kristensen I, Engellau J. Re-irradiation in Paediatric Tumours of the Central Nervous System: National Guidelines from the Swedish Workgroup of Paediatric Radiotherapy. Clin Oncol (R Coll Radiol) 2023; 35:571-575. [PMID: 37246041 DOI: 10.1016/j.clon.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
There is a lack of clinical protocols for re-irradiation in paediatric central nervous system (CNS) tumours. To fill this void, the Swedish Workgroup of Paediatric Radiotherapy (SBRTG) compiled national guidelines on re-irradiation in paediatric CNS tumours (diffuse intrinsic pontine glioma, ependymoma, germinoma and medulloblastoma). These have been in clinical practice since 2019 in all paediatric radiotherapy centres in Sweden. Since the implementation, the guidelines have been complemented with a yearly review on clinical outcome and toxicities in all paediatric patients treated according to the guidelines. This article presents the Swedish national guidelines on re-irradiation in paediatric CNS tumours.
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Affiliation(s)
- A Embring
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
| | - M Blomstrand
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Sweden
| | - A Asklid
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - M P Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - M Agrup
- Department of Oncology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A-M Svärd
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - C Fröjd
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - U Martinsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - I Fagerström Kristensen
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - J Engellau
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Hult A, Lundgren E, Fröjd C, Lindam A, Jangland E. Patient complaints about communication in cancer care settings: Hidden between the lines. Patient Educ Couns 2023; 114:107838. [PMID: 37295042 DOI: 10.1016/j.pec.2023.107838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate patient complaints in cancer care settings reported to patient advisory committees (PACs) and describe the frequency and content of communication failures across all reports. METHODS Content analysis, with a summative approach, was applied to cancer care complaints (2016-2020) by 692 patients to PACs in one Swedish healthcare region. RESULTS More than half the patients reported communication failures. Patients reported not receiving proper information, not being listened to, and being treated disrespectfully or impersonally. Communication failures occurred in different stages of the patients' cancer care, from diagnostic workup to end-of-life. Compared with the results of the PACs, communication failures were underreported, and were often combined with complaints in other categories. CONCLUSIONS Communication failures are hidden "between the lines" and do not appear clearly in existing reporting systems. Healthcare must utilize the knowledge conveyed by patient complaints and create conditions and environments that support healthcare providers in delivering person-centered care. PRACTICE IMPLICATION A summary picture of patients' complaints in Swedish cancer care is provided. These results could be used to further improve the patient complaint system. Above all, the results could serve as a "wake-up call" about the importance of communication and a valuable resource in improving cancer care.
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Affiliation(s)
- Anna Hult
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden.
| | - Ewa Lundgren
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Eva Jangland
- Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden
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Jangland E, Gunnarsson AK, Hauffman A, Edfeldt K, Nyholm L, Fröjd C. Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories - Using the fundamentals of care framework. J Adv Nurs 2023; 79:1082-1093. [PMID: 35352387 DOI: 10.1111/jan.15238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/28/2022] [Accepted: 03/15/2022] [Indexed: 12/29/2022]
Abstract
AIMS To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework. DESIGN A qualitative descriptive study design applying the Fundamentals of Care framework. METHODS Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis. RESULTS Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing. CONCLUSION Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice. IMPACT The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Anna Hauffman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Edfeldt
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Nyholm
- Department of Neuroscience, neurosurgery, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Holmström IK, Bohlin S, Wanhainen A, Björck M, Fröjd C. Swedish men and smoking: Views on screening-detected abdominal aortic aneurysm. Nurs Health Sci 2018; 21:119-125. [PMID: 30238675 DOI: 10.1111/nhs.12570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/11/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Abstract
Abdominal aortic aneurysms (AAA), most common among elderly male smokers, often show no symptoms before rupture. To facilitate better care and counselling targeted to smoking cessation for these patients, more knowledge is required about their views. Therefore, the aim of the present study was to describe the views on AAA and smoking among male smokers with screening-detected AAA. A qualitative approach with individual interviews with 16 men with screening-detected AAA was applied. Three had quit smoking by the time of the interviews. Thematic analysis was performed, and four themes emerged: (i) accepting the course of life; (ii) the elusive AAA: a disturbing experiencing or merely a minor inconvenience?; (iii) being in safe hands; and (iv) smoking as an unexpected topic of discussion. Most of the participants felt they were in "safe hands", although thoughts about death were also evoked. However, the information about smoking cessation was unexpected, and the relationship between AAA and smoking unclear. Presenting the connection between AAA and smoking in a clear manner and motivating smoking cessation in an individually-targeted way are important.
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Affiliation(s)
- Inger K Holmström
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sofia Bohlin
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Engström J, Bruno E, Reinius H, Fröjd C, Jonsson H, Sannervik J, Larsson A. Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study. Acta Anaesthesiol Scand 2017; 61:62-72. [PMID: 27813055 DOI: 10.1111/aas.12827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/11/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common. METHODS A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation. RESULTS In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate. CONCLUSION In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.
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Affiliation(s)
- J. Engström
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - E. Bruno
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - H. Reinius
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - C. Fröjd
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - H. Jonsson
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - J. Sannervik
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - A. Larsson
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
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Engström J, Reinius H, Fröjd C, Hans J, Hedenstierna G, Larsson A. Maintenance of airway pressure during filter exchange due to auto-triggering. Respir Care 2015; 59:1210-7. [PMID: 24282318 DOI: 10.4187/respcare.02892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Daily routine ventilator-filter exchange interrupts the integrity of the ventilator circuit. We hypothesized that this might reduce positive airway pressure in mechanically ventilated ICU patients, inducing alveolar collapse and causing impaired oxygenation and compliance of the respiratory system. METHODS We studied 40 consecutive ICU subjects (P(aO2)/F(IO2) ratio ≤ 300 mm Hg), mechanically ventilated with pressure-regulated volume control or pressure support and PEEP ≥ 5 cm H2O. Before the filter exchange, (baseline) tidal volume, breathing frequency, end-inspiratory plateau pressure, and PEEP were recorded. Compliance of the respiratory system was calculated; F(IO2), blood pressure, and pulse rate were registered; and P(aO2), P(aCO2), pH, and base excess were measured. Measurements were repeated 15 and 60 min after the filter exchange. In addition, a bench test was performed with a precision test lung with similar compliance and resistance as in the clinical study. RESULTS The exchange of the filter took 3.5 ± 1.2 s (mean ± SD). There was no significant change in P(aO2) (89 ± 16 mm Hg at baseline vs 86 ± 16 mm Hg at 15 min and 88 ± 18 mm Hg at 60 min, P = .24) or in compliance of the respiratory system (41 ± 11 mL/cm H2O at baseline vs 40 ± 12 mL/cm H2O at 15 min and 40 ± 12 mL/cm H2O at 60 min, P = .32). The bench study showed that auto-triggering by the ventilator when disconnecting from the expiratory circuit kept the tracheal pressure above PEEP for at least 3 s with pressure controlled ventilation. CONCLUSIONS This study showed that a short disconnection of the expiratory ventilator circuit from the ventilator during filter exchange was not associated with any significant deterioration in lung function 15 and 60 min later. This result may be explained by auto-triggering of the ventilator with high inspiratory flows during the filter exchange, maintaining airway pressure.
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Bohlin S, Fröjd C, Wanhainen A, Björck M. Change in Smoking Habits After Having Been Screened for Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2014; 48:138-43. [DOI: 10.1016/j.ejvs.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
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Nyholm L, Lewén A, Fröjd C, Howells T, Nilsson P, Enblad P. The use of nurse checklists in a bedside computer-based information system to focus on avoiding secondary insults in neurointensive care. ISRN Neurol 2012; 2012:903954. [PMID: 22844615 PMCID: PMC3403171 DOI: 10.5402/2012/903954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/23/2012] [Indexed: 11/30/2022]
Abstract
The feasibility and accuracy of using checklists after every working shift in a bedside computer-based information system for documentation of secondary insults in the neurointensive care unit were evaluated. The ultimate goal was to get maximal attention to avoid secondary insults. Feasibility was investigated by assessing if the checklists were filled in as prescribed. Accuracy was evaluated by comparing the checklists with recorded minute-by-minute monitoring data for intracranial pressure-ICP, cerebral perfusion pressure CPP, systolic blood pressure SBP, and temperature. The total number of checklist assessments was 2,184. In 85% of the shifts, the checklists were filled in. There was significantly longer duration of monitoring time at insult level when Yes was filled in regarding ICP (mean 134 versus 30 min), CPP (mean 125 versus 26 min) and temperature (mean 315 versus 120 min). When a secondary insult was defined as >5% of monitoring time spent at insult level, the sensitivity/specificity for the checklist assessments was 31%/100% for ICP, 38%/99% for CPP, and 66%/88% for temperature. Checklists were feasible and appeared relatively accurate. Checklists may elevate the alertness for avoiding secondary insults and help in the evaluation of the patients. This concept may be the next step towards tomorrow critical care.
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Affiliation(s)
- Lena Nyholm
- Department of Neuroscience/Neurosurgery, Uppsala University, 751 85 Uppsala, Sweden
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Wadensten B, Fröjd C, Swenne CL, Gordh T, Gunningberg L. Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. J Clin Nurs 2011; 20:624-34. [PMID: 21320191 DOI: 10.1111/j.1365-2702.2010.03482.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital. BACKGROUND Pain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients. DESIGN Quantitative and explorative. METHOD Survey. RESULTS Of the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain >3 and 42.1% rated their pain >7. Of the patients who reported having experienced pain during the preceding 24 hours, 38.7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29.6% of the patients were completely satisfied, and 11.5% were not at all satisfied with their participation in pain management. CONCLUSIONS The result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups. RELEVANCE TO CLINICAL PRACTICE Using a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.
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Affiliation(s)
- Barbro Wadensten
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Fröjd C, Swenne CL, Rubertsson C, Gunningberg L, Wadensten B. Patient information and participation still in need of improvement: evaluation of patients' perceptions of quality of care. J Nurs Manag 2011; 19:226-36. [PMID: 21375626 DOI: 10.1111/j.1365-2834.2010.01197.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS To identify areas in need of quality improvement by investigating inpatients' perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission. BACKGROUND Nursing managers play an important role in the development of high-quality care. METHODS Quality of care was assessed using the Quality from the Patients' Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP. RESULTS Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors' care than did patients with planned admissions. CONCLUSION Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.
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Affiliation(s)
- Camilla Fröjd
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Fröjd C, Lampic C, Larsson G, Birgegård G, Essen LV. Patient attitudes, behaviours, and other factors considered by doctors when estimating cancer patients’ anxiety and desire for information. Scand J Caring Sci 2007; 21:523-9. [DOI: 10.1111/j.1471-6712.2007.00507.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fröjd C, Larsson G, Lampic C, von Essen L. Health related quality of life and psychosocial function among patients with carcinoid tumours. A longitudinal, prospective, and comparative study. Health Qual Life Outcomes 2007; 5:18. [PMID: 17428340 PMCID: PMC1852299 DOI: 10.1186/1477-7525-5-18] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/11/2007] [Indexed: 12/25/2022] Open
Abstract
Background The aim was to investigate HRQoL and psychosocial function among patients with carcinoid tumours, longitudinally and prospectively, and to compare HRQoL among patients with carcinoid tumours to that of the Swedish general population. The aim was also to investigate the prevalence of distress during the first year after diagnosis. Methods At four assessments during the first year after diagnosis, HRQoL was measured by the EORTC QLQ-C30 3.0, anxiety and depression by the HADS, and prevalence, and worst aspects of distress by an interview guide. ANOVA was performed in order to study changes over time with regard to HRQoL, anxiety and depression. Comparisons regarding HRQoL between patients and the Swedish population were made by the use of one-sample t-tests and changes over time regarding the prevalence of distress was investigated by means of Cochran's Q. Results High levels of physical-, emotional-, cognitive-, and social function and somewhat lower levels of role function and global quality of life were reported at all assessments. Role- and emotional function increased over time. Patients reported lower role function and global quality of life and more problems with fatigue and diarrhoea than the Swedish general population, at all assessments. Fatigue, limitations to work and pursue daily activities, and worry that the illness will get worse were among the most prevalent aspects at all assessments. At all assessments the majority reported worrying about the family's situation, the ability to care for the family, and worrying before the check-up. Conclusion It is concluded that HRQoL and psychosocial function among patients with carcinoid tumours remains stable during the first year, that the patients report a lower HRQoL than the Swedish general population, and that a majority of the patients report a number of aspects of emotional distress. In the clinical care, it should be considered that the majority of patients report not only fatigue and diarrhoea but also worries about their prognosis, their families, tests, and examinations. Efforts to reduce these worries should be made.
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Affiliation(s)
- Camilla Fröjd
- Department of Public Health and Caring Sciences, Psychosocial oncology, Uppsala University, Uppsala, Sweden
| | - Gunnel Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Claudia Lampic
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Caring Sciences and Sociology, Gävle University, Sweden
| | - Louise von Essen
- Department of Public Health and Caring Sciences, Psychosocial oncology, Uppsala University, Uppsala, Sweden
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Fröjd C, Von Essen L. Is doctors' ability to identify cancer patients' worry and wish for information related to doctors' self-efficacy with regard to communicating about difficult matters? Eur J Cancer Care (Engl) 2006; 15:371-8. [PMID: 16968320 DOI: 10.1111/j.1365-2354.2006.00670.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aims were to investigate whether: (A) doctors' ability to identify patients' worry about prognosis/wish for information about disease and treatment is related to doctors' self-efficacy with regard to communicating about difficult matters and patients' satisfaction with a consultation/hope to live a good life in spite of the disease; and (B) patients and doctors agree on how much worry/wish for information a patient experiences/wishes. Sixty-nine patients with carcinoid and 11 doctors participated. Ability to identify worry/wish for information was estimated by posing questions to doctors/patients concerning how much worry/information a patient experienced/wished during a consultation. Doctors' self-efficacy was measured by nine questions, patients' satisfaction and hope by two questions. When doctors show good ability to identify wish for information, they report higher self-efficacy (t = 3.5, d.f. = 67, P < 0.001) than when they show less good ability. Patients finding the consultation very satisfying meet doctors reporting higher self-efficacy than patients finding the consultation satisfying (t = 2.26, d.f. = 65, P < 0.05). Doctors fail to identify patients who report less worry/wish more information than the average patient. The findings underscore the importance of further enhancing doctors' self-efficacy with regard to communicating about difficult matters and ability to identify patients who are less worried/wish more information than the average patient.
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Affiliation(s)
- C Fröjd
- Department of Public Health and Caring Sciences, Section of Caring Sciences, University of Uppsala, Uppsala, Sweden.
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