A registry study of oral health problems and preventive interventions among older persons receiving municipal healthcare - PROSENIOR

AIM

The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care.

DESIGN

Cross-sectional register study.

METHODS

Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (≥65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed.

RESULTS

A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

Swedish registered nurses' perceptions of caring for patients with intellectual and developmental disability: A qualitative descriptive study

Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.

Nurses' experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach

BACKGROUND

Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs' experiences of nursing patients with IDD.

METHOD

We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations.

RESULTS

We included eighteen published studies from eight countries involving 190 RNs. The RNs' experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs' experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group.

CONCLUSION

Lack of awareness and knowledge are likely breeding grounds for the 'otherness' that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face.

TRIAL REGISTRATION

PROSPERO 2017: CRD42017077703.

Disclosure of abuse among female patients within general psychiatric care - a cross sectional study

BACKGROUND

Experiences of abuse are common among women in general psychiatric care. Even so, there are to our knowledge no previous national or international studies exploring disclosure in a general psychiatric setting of female patient's experiences of abuse to staff or to formal and informal networks. This study aimed to explore women's disclosure of experiencing physical, emotional and/or sexual abuse during their most recent contact with staff at a general psychiatric clinic. The study also aimed to determine whether the women have previously disclosed abuse to anyone.

METHODS

A consecutive sampling of eligible female patients at a general psychiatric clinic in an urban area of southern Sweden answered the NorVold Abuse Questionnaire, NorAQ, a self-administrated questionnaire. NorAQ has previously been used and further developed to compare the prevalence of abuse in women present in gynecological outpatient settings in the five Nordic countries. Seventy-seven women with experiences of abuse participated in the research. Descriptive statistics were used to analyse the data.

RESULTS

Most respondents did not disclose their experiences of abuse to staff at the general psychiatric clinic. Women with experiences of physical abuse (n = 40), emotional abuse (n = 37) and sexual abuse (n = 37) chose not to disclose their experiences. Respondents disclosed abuse more often to others than to staff.

CONCLUSIONS

Our findings indicated the importance of including routine questions concerning abuse experiences as a natural part of female patients' medical history.

The life course of women who have experienced abuse - a life chart study in general psychiatric care

The life chart offers rich information that provides a broader picture of the lives of women who have experienced abuse. Life charts could be useful for nurses identifying women in general psychiatric care who have experienced abuse. Despite experiences of abuse and stressful events during childhood, there were only a few indications of them receiving support in the life charts. Many of the women had as adults been in contact with or received care at numerous healthcare services. Violence against women is a worldwide problem and has an impact on the lives of women and girls. The study aims to investigate the life course of women within psychiatric care who have experienced abuse. The women's resources, stressful events, experience of abuse, perpetrators, mental ill health, and care and support throughout the life course are also highlighted. Eleven women who had all sought general psychiatric care in an urban area in Sweden participated. A computer software program was used for constructing life charts for each participant, and manifest content analysis was used to analyse the data. The women's social status and resources differed, and some of them spoke of only experiencing few stressful events growing up, while others described a stressful childhood. All of the women had been abused sometime during their life course, and most of the perpetrators were known to the women. Even so, the women had seldom disclosed their childhood abuse. As adults, the women were diagnosed with psychiatric diagnoses, and suicidal behaviour increased. The life chart offers rich information and a broader picture of the life history of women who experienced abuse as well as constituting a tool useful for identifying women with experiences of abuse.

The duality of suffering and trust: abused women's experiences of general psychiatric care--an interview study

AIMS AND OBJECTIVES

To elucidate how women subjected to physical, emotional and/or sexual abuse experience the care provided at a general psychiatric clinic after the disclosure of abuse.

BACKGROUND

Violence against women is a major global public health issue, which has an impact on women's lives and mental health as well as generating frequent hospital admission.

DESIGN

Qualitative design with an inductive approach.

METHODS

Interviews with nine women who were recipients of general psychiatric care and had disclosed experiences of abuse to a member of staff were conducted. Qualitative inductive content analysis was used.

RESULTS

The overall theme emerging from the narratives, 'dependency as a reality containing a duality of suffering and trust,' links the categories together. Each subcategory is presented in relation to the categories 'being belittled,' 'being misinterpreted' and 'being cared for.' Experiences of care as caring and noncaring were found in the narratives. Caring could include situations experienced as the women being acknowledged and listened to, situations where staff approached and supported the women in a sensitive way. Experiences of noncaring were when the abuse was disregarded, and when the women were not believed in, were left with burdens of guilt and were offended. A noncaring environment focused primarily on the diagnosis, and the experienced abuse was seen as secondary.

CONCLUSIONS

Abused women are subjected to psychiatric environments where staff are divided into groups of those who believed in and supported the abused women and those who regarded experiences of abuse as a secondary issue and focused on the mental disorder.

RELEVANCE TO CLINICAL PRACTICE

This study provides knowledge of how abused women experience the care provided at a general psychiatric clinic after the disclosure of abuse.

Experiences of the implementation of clinical practice guidelines--interviews with nurse managers and nurses in hospital care

The implementation of clinical practice guidelines (CPGs) has become an increasingly common element of clinical care, but little qualitative research has been conducted in real-life clinical settings. The aim was to elucidate experiences and factors of importance for the implementation of CPGs in hospital care. Twenty interviews were conducted, audio-taped and transcribed verbatim. A manifest and latent content analysis was performed to interpret the text. A system of subcategories related to five categories and one overall theme were developed. The data reveal that the implementation of CPGs is continuous processes of creating reliable and tenable routines that involve all staff members and expect to lead to better and safer patient care as well as to increased knowledge and confidence among staff. The process is initiated by internal or external demands and represents a way to keep abreast of knowledge development. Several factors facilitate the implementation and have an influence on the use and compliance with CPGs. To increase support for and willingness to use the CPG, it appears important to involve all staffs in the implementation process as well as to follow up and give feedback continuously to staff and management. It seems necessary to evaluate the process to supervise compliance with CPGs and to balance priorities and costs. Evaluation can also demonstrate importance of the application.

Factors and Conditions that Influence the Implementation of Standardized Nursing Care Plans

Rationale and Aim:

There is a lack of evidence about how to successfully implement standardized nursing care plans (SNCP) in various settings. The aim of this study was to use the “Promotion Action on Research Implementation in Health Services framework” (PARIHS) to explore important factors and conditions at hospital wards that had implemented SNCPs.

Method:

We employed a retrospective, cross-sectional design and recruited nurses from four units at a rural hospital and seven units at a university hospital in the western and southern region of Sweden where SNCPs had been implemented. Outcome was measured by means of a questionnaire based on the PARIHS-model.

Result:

In total, 137 nurses participated in the study. The main factors that had motivated the nurses to implement SNCPs were that they were easy to understand and follow as well as corresponding to organisational norms. The SNCPs were normally based on clinical experience, although research more frequently formed the basis of the SNCPs at the university hospital. Internal facilitators acted as important educators, who provided reminders to use the SNCP and feedback to the SNCP users. The patient experience was not considered valuable. Those who claimed that the implementation was successful were generally more positive in all measurable aspects. The use of SNCPs was rarely evaluated.

Conclusions:

Clinical experience was considered important by the nurses, while they attributed little value to the patient experiences. Successful implementation of research based SNCPs requires internal facilitators with knowledge of evidence-based nursing.

Developing an instrument for evaluating implementation of clinical practice guidelines: a test-retest study

RATIONALE AND AIMS

This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire.

METHOD

A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Services (PARIHS)-model, influence the success of implementation. Thirty-nine health professionals at one of the hospitals included in the survey completed the questionnaire on two occasions within a mean time of 5.5 weeks. The test-retest reliability was analysed by means of Cohen's Kappa and percentage concordance.

RESULTS

Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values, 13 items show moderate and two fair agreement.

CONCLUSIONS

The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.

Evaluating Psychiatric Nurses' Awareness of Evidence-Based Nursing Publications

BACKGROUND

Research has shown that nurses lack skills to find and appraise research literature, lack time and organisational support to utilise research, and need user-friendly research material to implement evidence-based health care in practice. In Sweden, the concept of evidence-based health care has been introduced by The Swedish Council on Technology Assessment in Health Care (SBU), a concept which the nursing profession quickly adopted. This study was initiated synchronously with the publication of two reports on evidence-based nursing (EBN) in psychiatric care.

AIM

To investigate the dissemination and awareness of literature on EBN among psychiatric nurses in Sweden, and more specifically whether nurses were aware of the EBN reports.

METHODS

A postal questionnaire was used with a prospective pre-post design. A questionnaire was constructed and distributed to the members in The National Association of Psychiatric Nurses at two occasions--before publication of the two reports and 1 year post-publication. The questionnaire was initially circulated to 2,294 nurses. The response rate for the first distribution was 82% and for the second 72%.

RESULTS

Although the results demonstrate an increase in awareness concerning the concept of EBN and access to literature between data collection, there were still many nurses who reported no access to the literature. The reported use of literature in practice was scarce; however, findings demonstrated an increase in opinion about the value of using literature in practice.

CONCLUSIONS

The findings of this study demonstrate that the dissemination of literature in EBN, as well as EBN literature in psychiatric care, still requires considerable development to assure its use in practice.

IMPLICATIONS

The diffusion and dissemination of evidence-based literature within nursing must be guided by a structured plan followed by concrete examples of its implication(s) for practice.

Outcomes of evidence-based clinical practice guidelines: a systematic review

OBJECTIVES

This study aimed to investigate whether evidence-based clinical practice in health care improves outcomes for patients, personnel, and/or organizations.

METHODS

A systematic review of studies was conducted with various quantitative and qualitative methods up to the Spring of 2002. Protocols were used in quality assessment. Data synthesis is descriptive in a narrative form.

RESULTS

Of 305 assessed articles, eight studies were included. The outcomes in the included studies were related to the experiences of patients and personnel and to organization concerning changed patient care and resource utilization. Because the included studies are heterogeneous in design, focus of research area, and scientific quality, the scientific foundation for the findings is weak. There is some support that evidence-based clinical practice guidelines, when put to use, improve outcomes (i) for patients--less likelihood of showing worsening of skin condition and disruption of skin condition improves more rapidly for infants; (ii) for personnel--support in daily work situation; and (iii) for organizations--decreased admission rates and length of stay, less resource utilization and reduced costs.

CONCLUSIONS

There is a need for further research as the findings are based on a rather limited number of studies. There is a tendency toward support for the idea that outcomes improve for patients, personnel, or organizations if clinical practice in health care is evidence-based, that is, if evidence-based clinical practice guidelines are used, although these findings could be specific to the settings and context of the studies reported in this systematic review.