Patient safety and falls: a qualitative study of home care nurses in Norway

Artikkelen rapporterer fra en studie hvor hensikten var å utforske sykepleieres erfaringer med pasientsikkerhet knyttet til fall blant hjemmeboende eldre som er avhengig av hjemmesykepleie.This study explored patient safety and falls, based on the experiences of home care nurses. Four focus group interviews were conducted with 20 home care nurses. The data were analyzed by content analysis. This study identified the following four themes: (i) patient safety was not viewed as primary prevention; (ii) the lack of investigation into causes of falls; (iii) the frailty of older people who can no longer live at home independently and safely; and (iv) patient autonomy versus patient safety. In this study, we showed that home care nurses felt that healthcare personnel were more concerned with the treatment of falls, rather than fall prevention. In addition, home care nurses rarely focused on falls before they occurred. The patient’s autonomy was placed before patient safety. This study illustrates that home care nurses might be more aware of fall prevention in clinical practice. Additional research is recommended to shed more light on this topic

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients

<p>Abstract</p> <p>Background</p> <p>Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV₁%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.</p> <p>Methods</p> <p>This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV₁%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used.</p> <p>Results</p> <p>Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV₁%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV₁%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%–51%).</p> <p>Conclusion</p> <p>Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.</p

Does an integrated care intervention for COPD patients have long-term effects on quality of life and patient activation? A prospective, open, controlled single-center intervention study

Background Implementation of the COPD-Home integrated disease management (IDM) intervention at discharge after hospitalizations for acute exacerbations of COPD (AECOPD) led to reduced hospital utilization during the following 24 months compared to the year prior to study start. Aims To analyze the impact of the COPD-Home IDM intervention on health related quality of life, symptoms of anxiety and depression, and the degree of patient activation during 24 months of follow-up and to assess the association between these outcomes. Methods A single center, prospective, open, controlled clinical study. Changes in The St. George Respiratory Questionnaire (SGRQ), the Hospital anxiety (HADS-A) and depression (HADS-D) and the patient activation measure (PAM) scores were compared between the patients in the integrated care group (ICG) and the usual care group (UCG) 6, 12 and 24 months after enrolment. Results The questionnaire response rate was 80–96%. There were no statistically significant differences in the change of the SGRQ scores between the groups during follow up. After 12 months of follow-up there was a trend towards a reduction in the mean HADS–A score in the ICG compared to the UCG. The HADS-D scores remained stable in the ICG compared with an increasing trend in the UCG. Clinically significant difference in the PAM score was achieved only in the ICG, 6.7 (CI95% 0.7 to 7.5) compared to 3.6 (CI95% -1.4 to 8.6) in the UCG. In a logistic regression model a higher HADS-D score and current smoking significantly increased the odds for a low PAM score.publishedVersio

Distinct pain profiles in patients with chronic obstructive pulmonary disease

Background: Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients. Objectives: The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL). Patients and methods: A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity. Results: Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the “high probability of pain” group, while 29% were in the “moderate probability of pain” group. For the worst pain severity, 37% were in the “moderate pain” and 39% were in the “mild pain” groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale. Conclusion: Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.publishedVersio

Исследование тепловых характеристик в виброаппарате - утилизаторе отработавшего топлива АЗС

Purpose: Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and symptom burden in people with COPD.Patients and methods: In this cross-sectional study with 225 participants diagnosed with COPD grades II&ndash;IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables.Results: Higher symptom burden was significantly associated with worse scores in all self-management domains (p&lt;0.003), except for self-monitoring and insight (p=0.012). Higher disease severity (p=0.004) and numbers of comorbidities (p&lt;0.001) were associated with more emotional distress, and women scored higher than men on positive and active engagement in life (p=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities (p=0.006) and self-monitoring and insight (p&lt;0.001), and participation in organized physical training was associated with higher score in health-directed activities (p&lt;0.001). The final models explained 3.7%&ndash;31.7% of variance (adjusted R2) across the eight heiQ scales.Conclusion: A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD.<br /

The relationships of self-efficacy, physical activity, and paid work to health-related quality of life among patients with chronic obstructive pulmonary disease (COPD)

This is an article originally published in the Journal of Multidisciplinary Healthcare; 2014:7 239–24; it was published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License.Purpose: Although chronic obstructive pulmonary disease (COPD) primarily affects the lungs, it is regarded as a systemic disorder associated with comorbidity and physical deterioration, which often results in reduced levels of health-related quality of life (HRQoL). Self-efficacy is an important concept in self-management, which is vital for improving HRQoL in patients with COPD. The purpose of this study was to examine how general self-efficacy, leisure time physical activity, and sociodemographic variables such as employment status are related to the physical and mental health components of HRQoL in patients with COPD. Patients and methods: In this cross-sectional study, 97 COPD patients (54.6% male, mean age 64.6 years, standard deviation [SD] 9.5) beginning a pulmonary rehabilitation program completed three self-report questionnaires: the short form (SF)-12v2 Health Survey as a measure of HRQoL; the General Self-Efficacy Scale; and a standardized instrument measuring regular leisure time physical activity. Results: The physical health component median score was 31.3 (interquartile range [IQR] 16.3) and the mental health component median score was 45.9 (IQR 21.5). Two sets of linear regression analyses were performed, one predicting physical health and the other predicting mental health. The first analysis showed that better physical health was directly related to being in paid work (P-value ,0.001), but was not significantly related to age, sex, marital status, education, work status, physical activity, or self-efficacy. In the second analysis, better mental health was directly related to living with a partner, being physically active, and having higher self-efficacy (P-value ,0.001). Conclusion: The findings suggest that general self-efficacy has differential relationships to the two dimensions of HRQoL. Our results indicate that general self-efficacy, physical activity, and paid work might be important factors for improving HRQoL of persons with COPD, and should be taken into consideration in pulmonary rehabilitation

Energirike smoothies til pasienter i sykehjem

Bakgrunn: Eldre pasienter i sykehjem er utsatt for å bli underernærte, og det har vist seg at energirike smoothies kan være et supplement til energirik og næringstett mat for å forebygge og behandle underernæring. Hensikt: Å utforske hvilke erfaringer helsepersonell hadde med energirike smoothies til eldre pasienter i sykehjem. Metode: Studien innbefatter tre kvalitative fokusgruppeintervjuer av helsepersonell fra to ulike sykehjem. Resultat: Enkelte pasienter fikk halsbrann, obstipasjon og kvalme når de hadde inntatt smoothies. Pasienter som var underernærte, gikk ikke opp i vekt, og det er usikkert hvorvidt pasientene inntok mer frukt i tiden de fikk smoothies. Informantene var enige om at smoothies ga pasientene energi, noe som førte til at enkelte ble overaktive. For å få kontroll over inntak av energi, næring og væske er det nødvendig med individuelle nærings- og drikkelister. Konklusjon: Smoothies kan gi halsbrann, kvalme og forstoppelse, og de som var underernærte, la ikke på seg. Å tilberede individuelt tilpassete smoothies vil bidra til at ønsker og behov for væske og næringsstoffer blir ivaretatt