Using mHealth applications for self-care – An integrative review on perceptions among adults with type 1 diabetes

Background Individually designed interventions delivered through mobile health applications (mHealth apps) may be able to effectively support diabetes self-care. Our aim was to review and synthesize available evidence in the literature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote diabetes self-care, as well as facilitators and barriers to their use. An additional aim was to review literature on changes in patient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care. Methods Quantitative and qualitative studies focusing on adults aged 18 years and over with type 1 diabetes in any context were included. A systematic literature search using selected databases was conducted. Data was synthesised using narrative synthesis. Results We found that features of mHealth apps designed to help promote and maintain diabetes self-care could be categorized into self-care data monitoring, app display, feedback & reminders, data entry, data sharing, and additional features. Factors affecting the use of mHealth apps reported in the literature were personal factors, app design or usability factors, privacy and safety factors, or socioeconomic factors. Quality of life and diabetes distress were the most commonly reported PROMs in the included studies. Conclusion We are unable to reach a conclusive result due to the heterogeneity of the included studies as well as the limited number of studies reporting on these areas among adults with type 1 diabetes. We therefore recommend further large-scale studies looking into these areas that can ultimately improve mHealth app use in type 1 diabetes self-care.publishedVersio

The use of life stories and its influence on persons with dementia, their relatives and staff - a systematic mixed studies review

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Implementation of nutritional guidelines in a university hospital monitored by repeated point prevalence surveys

Background/Objectives: Malnutrition is present in 20–50% of hospitalized patients, and nutritional care is a challenge. The aim was to evaluate whether the implementation of a nutritional strategy would influence nutritional care performance in a university hospital. Subjects/Methods: This was a prospective quality improvement program implementing guidelines for nutritional care, with the aim of improving nutritional practice. The Nutrition Risk Screening (NRS) 2002 was used. Point prevalence surveys over 2 years to determine whether nutritional practice had improved. Results: In total, 3604 (70%) of 5183 eligible patients were screened and 1230 (34%) were at nutritional risk. Only 53% of the at-risk patients got nutritional treatment and 5% were seen by a dietician. The proportion of patients screened increased from the first to the eighth point prevalence survey (P=0.012), but not the proportion of patients treated (P=0.66). The four initial screening questions in NRS 2002 identified 92% of the patients not at nutritional risk. Conclusions: Implementation of nutritional guidelines improved the screening performance, but did not increase the proportion of patients who received nutritional treatment. Point prevalence surveys were useful to evaluate nutritional practice in this university hospital. In order to improve practice, we suggest using only the four initial screening questions in NRS 2002 to identify patients not at risk, better education in nutritional care for physicians and nurses, and more dieticians employed. Audit of implementation of guidelines, performed by health authorities, and specific reimbursement for managing nutrition may also improve practice.publishedVersio

Enhancing the quality of oral nutrition support for hospitalised patients: a mixed-methods knowledge translation study. (The EQONS study)

Aim - To report a multi-faceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. Background - Malnutrition among hospitalised patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. Design - A mixed-method integrated knowledge translation study. Methods - The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. Findings - Statistically significant differences (Chi Square) were observed in self-reported confidence of nurses a) to assess patients using the Malnutrition Universal Screening Tool, b) to teach colleagues how to use the Malnutrition Universal Screening Tool and c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organisation) and macro (healthcare system) levels acted as barriers and enablers for change. Conclusion - Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition

Nutritional Nursing Care : Nurses’ interactions with the patient, the team and the organization

The overall aim of the thesis was to gain a deeper understanding of nutritional nursing care in municipal care and county council care, with specific focus on enteral nutrition (EN) in intensive care. Quantitative and qualitative methods were used. Telephone interviews regarding assessment of the nutritional status of patients were carried out with special medical nurses (CNs) (n = 14) in municipalities in one county and first line managers (CNs) (n = 27) in one county council. Registered nurses (RNs) in municipalities (n = 74) and county councils (n = 57) answered a questionnaire about nutritional assessment and documentation (I). RNs (n = 44) at three different intensive care units answered a questionnaire about responsibility, knowledge, documentation and nursing interventions regarding EN. Observations (n = 40) on nursing care interventions for patients with EN were carried out (II). RNs (n = 8), enrolled nurses (n = 4) (III) and patients (n = 14) (IV) were interviewed and nutritional nursing care was observed (III-IV) at an intensive care unit. The results showed that assessment of nutritional status was not performed on all patients, according to RNs/CNs. Malnourished patients were estimated to occur to a varied extent. Sixty-six percent of RNs/CNs answered that there were no guidelines for nutritional care and 13% that they did not know if there were any. RNs saw the VIPS model as a guide in nursing care, but also as an obstacle to information exchange (I). A majority of RNs answered that there were guidelines for EN. There were differences between the RNs’ opinions about their responsibility, knowledge and documentation. Deviations from recommended nursing care interventions occurred (II). The developed substantive theory of nurses (RNs and enrolled nurses) concerns and strategies of nutritional nursing care for patients with EN, includes the core category ”to have and to hold nutritional control – balancing between individual care and routine care” and the categories ”knowing the patient”, ”facilitating the patients’ involvement”, ”being a nurse in the team”, ”having professional confidence” and ”having a supportive organization”. In order for RNs and enrolled nurses to have a sense of control over the patients’ care in relation to nutrition, a balance between routine care and individual care was required (III). The developed substantive theory regarding the patients’ experiences of nutritional care includes the core category ”grasping nutrition during the recovery process”.  The core category is reflected in, and dependent on, the categories ”facing nutritional changes”, ”making sense of the nutritional situation” and ”being involved with nutritional care”. The patients alternated emotionally between worry, fear and failure, and relief and hope. The patients experienced a turning point and felt an improvement in their condition when their appetite returned, when the stomach and gut were functioning and when the feeding tube was removed (IV). The conclusion is that quality and safety in relation to nutritional nursing care is dependent on the interactions between the nurse and patient, between the nurse and the team, and the nurse and the organization

Care and Human Dignity : Theoretical and empirical perspectives on quality improvement work in the Church of Sweden with regard to funerals

The purpose of the thesis is firstly to assess the Church of Sweden in the light of current quality theories and systematic improvement methods, and secondly to develop methods and models for quality improvement work (using a systematic approach) within the Church of Sweden focusing on parish funeral activities. The thesis takes as its starting point the specific conditions of the church environment and a general, Christian and humansitic value orientation. Another starting point is the concept of processes and relations, and of a caring approach among parish co-workers. Improvements in processes and relationships were related (without financial analysis) to the cost of a lack of quality.The descriptive term quality improvement work includes both quality improvement and the areas of leadership, collaboration and organization. The empirical study was carried out in Täby Parish during the years 1997-2002 as a case study with an interactive approach. The staff and management of the parish were interviewed, as were 14 members of immediate family. A dialogue with undertakers was also maintained. It was a cyclical process with analysis/evaluation followed by strategic planning and action, and with critical reflection as a constant element. The researcher's role was shaped into a psychodynamic, learning approach. A number of factors were identified that form (1) a common basis (valid for all staff members) and (2) a specific parish quality improvement work in the area of funerals. It is when problems are tackled and suggestions for improvement are implemented, that quality improves, the church envitonment benefits, and the costs associated with a lack of quality are addressed. With the title of this thesis, Care and Human Dignity, the view is summarized that the Human Being is complex, and that dignity belongs to the Human Being's creative and lighter sides, that are expressed through care for others

Care and Human Dignity : Theoretical and empirical perspectives on quality improvement work in the Church of Sweden with regard to funerals

The purpose of the thesis is firstly to assess the Church of Sweden in the light of current quality theories and systematic improvement methods, and secondly to develop methods and models for quality improvement work (using a systematic approach) within the Church of Sweden focusing on parish funeral activities. The thesis takes as its starting point the specific conditions of the church environment and a general, Christian and humansitic value orientation. Another starting point is the concept of processes and relations, and of a caring approach among parish co-workers. Improvements in processes and relationships were related (without financial analysis) to the cost of a lack of quality.The descriptive term quality improvement work includes both quality improvement and the areas of leadership, collaboration and organization. The empirical study was carried out in Täby Parish during the years 1997-2002 as a case study with an interactive approach. The staff and management of the parish were interviewed, as were 14 members of immediate family. A dialogue with undertakers was also maintained. It was a cyclical process with analysis/evaluation followed by strategic planning and action, and with critical reflection as a constant element. The researcher's role was shaped into a psychodynamic, learning approach. A number of factors were identified that form (1) a common basis (valid for all staff members) and (2) a specific parish quality improvement work in the area of funerals. It is when problems are tackled and suggestions for improvement are implemented, that quality improves, the church envitonment benefits, and the costs associated with a lack of quality are addressed. With the title of this thesis, Care and Human Dignity, the view is summarized that the Human Being is complex, and that dignity belongs to the Human Being's creative and lighter sides, that are expressed through care for others

Care and Human Dignity : Theoretical and empirical perspectives on quality improvement work in the Church of Sweden with regard to funerals

The purpose of the thesis is firstly to assess the Church of Sweden in the light of current quality theories and systematic improvement methods, and secondly to develop methods and models for quality improvement work (using a systematic approach) within the Church of Sweden focusing on parish funeral activities. The thesis takes as its starting point the specific conditions of the church environment and a general, Christian and humansitic value orientation. Another starting point is the concept of processes and relations, and of a caring approach among parish co-workers. Improvements in processes and relationships were related (without financial analysis) to the cost of a lack of quality.The descriptive term quality improvement work includes both quality improvement and the areas of leadership, collaboration and organization. The empirical study was carried out in Täby Parish during the years 1997-2002 as a case study with an interactive approach. The staff and management of the parish were interviewed, as were 14 members of immediate family. A dialogue with undertakers was also maintained. It was a cyclical process with analysis/evaluation followed by strategic planning and action, and with critical reflection as a constant element. The researcher's role was shaped into a psychodynamic, learning approach. A number of factors were identified that form (1) a common basis (valid for all staff members) and (2) a specific parish quality improvement work in the area of funerals. It is when problems are tackled and suggestions for improvement are implemented, that quality improves, the church envitonment benefits, and the costs associated with a lack of quality are addressed. With the title of this thesis, Care and Human Dignity, the view is summarized that the Human Being is complex, and that dignity belongs to the Human Being's creative and lighter sides, that are expressed through care for others

Good in Providing Oral Care, but we Could be Better-Nursing Staff Identification of Improvement Areas in Oral Care

Introduction: Oral care to older people in short-term care units is a complex and challenging everyday practice for nursing staff. Oral care research and knowledge about prerequisites and obstacles is extensive. However, there is a lack of knowledge about how nursing staff in short-term care units describe their satisfaction about provided oral care in order to maintain older people's oral health. Objective: The purpose of this study was to describe how nursing staff perceive their satisfaction of oral care provided for older people in short-term care units and to identify oral care improvements. Methods: This study reports on the results of two open-ended questions that were part of a larger study. Informants (n = 54) were nursing staff working in the involved short-term care units in municipalities from both densely and sparsely populated regions in central and northern Sweden. The answers to the open-ended questions were analyzed using content analysis. Results: The analysis yielded one main category; "Working together to improve satisfaction with older people's oral care" and four subcategories: "Older people's oral health," " Consideration and respect for the older person's autonomy," "Having access to adequate products," and "Working together in the same direction." Conclusion: Identification of older people's oral health problems together with adequate nursing intervention will increase older people's health outcomes and quality of life. However, regardless of work role, the nursing staff might have difficulty changing their behavior or transforming intentions into actions. Oral care is a complicated and proactive practice that requires nursing staff's attention as well as both educational and organizational initiatives. Working in a supportive and collaborative relationship provides prerequisites for optimal oral care in short-term care units