Cultural diversity between hospital and community nurses: implications for continuity of care

Introduction: Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. <br /><br />Challenges: In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. <br /><br />Discussion: We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future

Interference of Postoperative Pain on Women's daily Life after Early Discharge from Cardiac Surgery

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory–Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important

Trajectories of illness perceptions in persons with chronic Illness: An explorative longitudinal study

Accurate illness perceptions are essential to the self-management of chronic illness. This study explored trajectories of illness perceptions in persons with morbid obesity (n = 53) and persons with chronic obstructive pulmonary disease (n = 52) following a patient education course. Participants completed the Brief Illness Perception Questionnaire five times over a 1-year period. Repeated measures analysis of variance was employed. Over time, obese participants perceived shorter illness duration, fewer consequences, less emotional stress, and more personal control. Chronic obstructive pulmonary disease participants had initial increases in personal control and understanding, but these changes were not maintained throughout the follow-up period

Betydningen av pilotundersøkelse før validering av oversatte instrumenter

Sykepleiere har uttrykt behov for et instrument for vurdering og oppfølging av etterlevelse av helseråd for hjertesviktpasienter. I USA er det utviklet to spørreskjemaer som tar sikte på å vurdere etterlevelse av helseråd innenfor rammen av saltfattig mat og å ta medisiner som forordnet. Disse instrumentene ble oversatt til norsk. To pilotundersøkelser ble gjennomført med hensikt å sikre kulturell tilpasning av instrumentene og kartlegging av rekrutterings- og datasamlingsprosedyre. Kulturell tilpasning av instrumentene ble gjort gjennom et fokusgruppeintervju med fire pasienter. Kartlegging av ønskede prosedyrer for rekruttering av pasienter, og elementer i datasamlingsprosessen ble gjennomført med strukturerte intervju og åpne spørsmål med 16 pasienter. Fokusgruppeintervjuet resulterte i noen endringer i formuleringer. Det strukturerte intervjuet avdekket sentrale elementer: Under halvparten av informantene ville ha svart på et tilsendt spørreskjema. De ville heller bli intervjuet enn å fylle ut svarene selv. Et entydig funn var at de ikke ville delta om det dreide seg om forpliktelser til flere undersøkelser eller tester. Deltagelse måtte helst skje i forbindelse med et sammenfallende ærend på sykehuse

Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behavior in persons with chronic illness. Longer-term trajectories have not been previously explored. Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course. Design: The study design was a longitudinal, comparative cohort study with five time points during a one year follow-up, using repeated measures analysis of variance. Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year. Main outcome measure: The General Self-Efficacy Scale (GSE) was the main outcome. Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory. Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across tim

A 1-year follow-up study exploring the associations between perception of Illness and health-related quality of life in persons with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease with an increasing prevalence worldwide. Its potential consequences, including reduced function and reduced social participation, are likely to be associated with decreased health-related quality of life (HRQoL). However, illness perceptions and self-efficacy beliefs may also play a part in determining HRQoL in persons with COPD. The aim of this study was to explore the relationships between illness perceptions, self-efficacy, and HRQoL in a sample of persons with COPD in a longitudinal perspective. The context of the study was a patient education course from which the participants were recruited. Data concerning sociodemographic variables, social support, physical activity, illness perceptions, general self-efficacy, and HRQoL were collected before the course started and 1 year after completion. Linear regression was used in the analyses. The results showed that less consequences and less symptoms (identity) were associated with higher physical HRQoL (PCS) at baseline and at 1-year follow-up. Less emotional response was similarly associated with higher mental HRQoL (MCS) at both time points. Lower self-efficacy showed a borderline significant association with higher PCS at baseline, but was unrelated to MCS at both time points. Self-efficacy showed no influence on the associations between illness perceptions and HRQoL. In conclusion, the study showed that specific illness perceptions had a stable ability to predict HRQoL in persons with COPD, whereas self-efficacy did not. The associations between illness perceptions and HRQoL were not mediated by self-efficac

Rasch analysis of the Sense of Coherence scale in a sample of people with morbid obesity - A cross-sectional study

Background: The prevalence of morbid obesity is an increasing health problem in most parts of the world and is related to lower quality of life. Sense of coherence, or the perception that the world is meaningful and predictable, is considered a promising health resource for changing behaviour and adopting a healthier lifestyle. Thus, a valid and reliable instrument for measuring sense of coherence is needed to further research and clinical efforts in this area. The purpose of the study was to examine the psychometric properties of the 13-item Sense of Coherence scale and its sub-dimensions (Comprehensibility, Manageability, and Meaningfulness) in a sample of people with morbid obesity using a Rasch analysis approach. Methods: Data were collected cross-sectionally in Norway in 2009 from 142 patients attending a mandatory patient education course for patients with morbid obesity on a waiting list for treatment. Participants completed a socio-demographic questionnaire and the 13-item Sense of Coherence scale at the beginning of the course. Evidence of rating scale functioning, internal scale validity, person-response validity, person-separation reliability and differential item functioning of the 13-item version were explored. The scale’s three sub-dimensions were also evaluated. Results: A 12-item version of the scale demonstrated the best fit to the Rasch model and increased the variance explained without reducing the separation index. The three sub-dimensions demonstrated good fit but lacked unidimensionality and person-separation reliability. The Meaningfulness sub-dimension showed better psychometric properties than the Comprehensibility and Manageability sub-dimensions. Conclusion: A 12-item version of the Sense of Coherence scale has better psychometric properties than the original 13-item version among persons with morbid obesity. Further studies should explore whether these questionable validity findings for the 13-item scale generalize to other populations and examine whether including other items from the longer 29-item version may improve the psychometric properties of an abbreviated Sense of Coherence measure

Being “on the alert” and “a forced volunteer”: a qualitative study of the invisible care provided by the next of kin of patients with chronic heart failure

Background: Relatives’ support is an important factor in how well people with chronic heart failure (CHF) manage their illness and everyday life. Deepening professionals' understanding of the content of relatives’ invisible care activities, often characterized as care burden, is necessary to strengthen support services. Objective: To explore the next of kin’s experiences of invisible care and the inherent responsibilities in caring for a relative with CHF. Design, setting, and methods: Relatives were recruited from CHF outpatient clinics and home care services. Seventeen women and two men were interviewed, age range 45–83 years; 12 were partners, and seven were daughters. The qualitative interviews were taped and transcribed and thematic cross-case analyses were performed. Results: Two main themes were revealed. The first, “being on the alert”, refers to a perceived need, real or assumed, to be aware day and night, whether present with the patient or not, that occupies the mind, emotions, and body. The second theme, “being a forced volunteer”, refers to two different dimensions: relatives'’ own perceptions of responsibility with regard to the patient's needs; and voiced or silent expectations from the patient, family members, and health personnel that the relative will help the patient. Both findings appeared to have positive and negative impacts on the relationship with the patient. Conclusion: The identified themes reflect how challenging being a next of kin of CHF patients can be. The results may deepen professionals’ understanding of the relatives’ invisible care burden and the importance of their subjective task-related feelings. More studies on invisible care and the attendant responsibilities are needed and also on relatives’ inherent resources

Rasch analysis of the General Self-Efficacy Scale in a sample of persons with morbid obesity

Background: Self-efficacy is needed for effectuating lifestyle changes, and it is therefore an important target related to health. The purpose of this study was to evaluate the psychometric properties of the General Self-Efficacy Scale (GSE) using Rasch analysis in a sample of adults with morbid obesity. Methods: A convenience sample of adults with morbid obesity was recruited from patient education courses. A total of 141 participants completed the GSE and a demographic questionnaire at the beginning of the course. The statistical approach included analysis of rating scale function, item fit to the Rasch partial credit model, unidimensionality, aspects of person-response validity, person-separation reliability, and differential item function. A version omitting items with poor fit to the Rasch model was also evaluated. Results: The rating scale did not advance monotonically for item #2 in the original 10-item version, and the first three GSE items did not demonstrate acceptable goodness-of-fit to the Rasch model. In a 7-item version omitting these three items, the rating scale functioned well for all items, and all items demonstrated good fit to the Rasch model. Both the 10-item and 7-item versions of the GSE partially met the criteria for unidimensionality. Neither version met the criterion for person response validity, although the results were slightly better for the 7-item than for the 10-item version. Both versions of the GSE demonstrated the ability to separate the respondents into three distinct levels of general self-efficacy. Several items had differential item function in relation to age, education or work status, but there were fewer in the 7-item version. Conclusions: For adults with morbid obesity, a 7-item version of the GSE seems to have better psychometric properties than the original 10-item version

Er det samsvar i registreringene når sykepleiere og studenter screener pasienter for ernæringsstatus?

Studiens bakgrunn: I nylig publiserte nasjonale faglige retningslinjer for forebygging og behandling av underernæring anbefales at alle pasienter skal screenes for ernæringsmessig risiko. Hensikt: Å teste interrater reliabiliteten (IRR) ved bruk av screeninginstrumentene Nutrition Rating Scale 2002 (NRS2002) og Subjective Global Assessment Tool (SGA) i spesialisthelsetjenesten. Metode: Sykepleiere og sykepleiestudenter fikk opplæring i bruk av aktuelle screeninginstrumenter. De fylte ut instrumentene uavhengig av hverandre, og IRR ble kalkulert med Kappa (K) test. Alle voksne hospitaliserte pasienter som var inneliggende på kirurgiske-, medisinske-, geriatrisk- eller akutte avdelinger som hadde sykepleiestudenter ble inkludert. Resultat: Til sammen 220 pasienter ble kartlagt gjennom ett døgn. Pasientene var >18 år, og innlagt på somatiske klinikker som hadde sykepleiestudenter. IRR mellom sykepleiere og studenter var lav, med en K=0,54 med NRS2002 og K=. 0,51 med SGA. Sykepleierne vurderte 34,3 prosent av pasientene som risikoutsatte med NRS 2002, og 33 prosent som risikoutsatte med SGA. Det var god overensstemmelse i sykepleiernes vurdering av risikoutsatthet med de to instrumentene (K= 73). Konklusjon: IRR mellom sykepleiere og studenter i registrering av underernæring med NRS 2002 og SGA var moderat. Det er behov for videre forskning for å få mer kunnskap om bakgrunnen for manglende overensstemmelse i skåringer ved bruk av disse instrumentene.Background: Pressure ulcers (PU) are common, but preventable, adverse events with serious consequences for patients’ health outcome, well-being and resource utilization. PU prevalence data from Norwegian hospitals is limited. The purpose of this study was to describe the PU prevalence, classification and preventive interventions using a standardized method developed by the European Pressure Advisory Panel (EPUAP). Method: Four teams of two nurses examined 85 patients ≥15 years on four wards at a university hospital on a single registration day. PU was graded by the EPUAP classification system. The EPUAP form was utilized including general and clinical data, Braden Scale, skin examination and preventive measures. Findings: PU prevalence was 17,6 % including grade 1 and 7,1 % including grade 2–4. The heels and sacrum were the most common PU location. Among patients in need of pressure ulcer prevention ( BS<17 or PU) 37.5% were without a pressure reducing mattress in bed, 90% were without pressure reduction in chair and none of the patients had planned regular repositioning in bed or chair. Conclusion: A PU prevalence of 17,6 % is comparable to rates reported in other hospitals. Relatively few patients with increased risk received adequate preventive care. Results indicate PU prevalence studies in Norwegian hospitals are warranted and may contribute to improvement of patient care. Key words: pressure ulcer, prevention, cross sectional stud