The ward atmosphere important for the psychosocial work environment of nursing staff in psychiatric in-patient care

<p>Abstract</p> <p>Background</p> <p>The nursing staff working in psychiatric care have a demanding work situation, which may be reflected in how they view their psychosocial work environment and the ward atmosphere. The aims of the present study were to investigate in what way different aspects of the ward atmosphere were related to the psychosocial work environment, as perceived by nursing staff working in psychiatric in-patient care, and possible differences between nurses and nurse assistants.</p> <p>Methods</p> <p>93 nursing staff working at 12 general psychiatric in-patient wards in Sweden completed two questionnaires, the Ward Atmosphere Scale and the QPSNordic 34+. Data analyses included descriptive statistics, the Mann-Whitney <it>U</it>-test, Spearman rank correlations and forward stepwise conditional logistic regression analyses.</p> <p>Results</p> <p>The data revealed that there were no differences between nurses and nurse assistants concerning perceptions of the psychosocial work environment and the ward atmosphere. The ward atmosphere subscales Personal Problem Orientation and Program Clarity were associated with a psychosocial work environment characterized by Empowering Leadership. Program Clarity was related to the staff's perceived Role Clarity, and Practical Orientation and Order and Organization were positively related to staff perceptions of the Organizational Climate.</p> <p>Conclusions</p> <p>The results from the present study indicate that several ward atmosphere subscales were related to the nursing staff's perceptions of the psychosocial work environment in terms of Empowering Leadership, Role Clarity and Organizational Climate. Improvements in the ward atmosphere could be another way to accomplish improvements in the working conditions of the staff, and such improvements would affect nurses and nurse assistants in similar ways.</p

Perceived Stress among Nursing Staff in Psychiatric Inpatient Care: The Influence of Perceptions of the Ward Atmosphere and the Psychosocial Work Environment.

The aims of this study were to investigate (1) perceived stress as felt by the nursing staff working in psychiatric inpatient care, (2) possible differences between nurses and nurse assistants, and (3) associations among individual characteristics, the ward atmosphere, the psychosocial work environment, and perceived stress. Ninety-three members of the nursing staff completed three instruments-one each measuring perceived stress, the ward atmosphere, and the psychosocial work environment. There were no differences among the staff groups concerning perceived stress. Multivariate analysis showed that the ward atmosphere factor "Involvement" and the psychosocial work environment factor "Role Clarity" were indicators of perceived stress. Improvements in these factors could help to prevent stress among the staff

Vacuum-assisted wound closure versus alginate for the treatment of deep perivascular wound infections in the groin after vascular surgery

BackgroundVacuum-assisted wound closure (VAC) therapy may heal wounds faster than conventional dressings after surgical debridement of perivascular groin infections after vascular surgery.MethodsPatients with deep infected wounds (Szilagyi grade III) were surgically revised and left open for secondary healing, then randomized to either VAC or alginate (Sorbalgon) therapy, between February 2007 and November 2011. To test the hypothesis, it was calculated that 42 patients needed to be included (90% power, 5% level of significance). It was decided to perform an interim analysis after inclusion of 20 patients.ResultsAmong 66 patients undergoing groin revision, 20 patients were included in this study. Patients were randomized to VAC (n = 10) or alginate (n = 10). The two groups were comparable in patient and wound characteristics. Time to full skin epithelialization was significantly shorter in the VAC group (median, 57 days) compared with the alginate group (median, 104 days; P = .026). The number of positive wound cultures of bacteria and C-reactive protein values decreased equally in both groups between surgical revision and day 21. One femur amputation was performed in each group as a consequence of the groin infection, one patient died during the in-hospital stay in the alginate group, and none died in the VAC group.ConclusionsVAC achieves faster healing than alginate therapy after wound debridement for deep perivascular wound infections in the groin after vascular surgery. This finding does not allow further inclusion of patients from an ethical point of view, and this study was, therefore, stopped prematurely

Psychometric properties of the disease-specific health-related quality of life instrument VascuQoL in a Swedish setting

Background: Traditional outcome measures in peripheral arterial disease (PAD) provide insufficient information regarding patient benefit. It has therefore been suggested to add patient-reported outcome measures. The main aim of this study was to validate the Swedish Vascular Quality of Life questionnaire (VascuQoL) version, a patient-reported PAD-specific health-related quality of life (HRQoL) instrument. Methods: Two-hundred PAD patients were consecutively recruited from two university hospitals. Out of the 200 subjects, 129 had intermittent claudication and 71 had critical limb ischemia. Mean age was 70 +/- 9 y and 57% of the participants were male. All patients completed SF-36 and VascuQoL at the vascular outpatient clinic, when evaluated for invasive treatment. Risk factors and physiological parameters were registered. Construct validity was tested by correlation analysis versus SF-36 and was also assessed with multitrait/multi-item scaling analysis (MTMI). Sensitivity analysis regarding disease severity identification was performed. Reliability was assessed with Cronbach's alpha and responsiveness by standardized response mean (SRM) calculations. Results: Significant correlations were demonstrated between relevant subscales of VascuQoL and SF-36. MTMI showed acceptable construct validity, but some scaling-errors. VascuQoL significantly (p < 0.001) discriminated claudicants from critical limb ischemia patients. Cronbach's alpha was 0.94 and SRM 1.02 (sum score). Conclusions: The Swedish version of VascuQoL is valid and quantifies central aspects of HRQoL in PAD patients. Sensitivity analysis showed high ability to differentiate between disease severity and SRM illustrated excellent responsiveness. The relative abundance of items however makes use in the everyday clinical setting somewhat difficult

A comparison of the Nottingham Health Profile and Short Form 36 Health Survey in patients with chronic lower limb ischaemia in a longitudinal perspective

BACKGROUND: Different generic quality of life instruments such as the Nottingham Health Profile (NHP) and the Short Form 36 Health Survey (SF-36) have revealed conflicting results in patients with chronic lower limb ischaemia in psychometric attributes in short-term evaluations. The aim of this study was to compare the NHP and the SF-36 regarding internal consistency reliability, validity, responsiveness and suitability as outcome measures in patients with lower limb ischaemia in a longitudinal perspective. METHODS: 48 patients with intermittent claudication and 42 with critical ischaemia were included. Assessment was made before and one year after revascularization using comparable domains of the NHP and the SF-36 questionnaires. RESULTS: The SF-36 was less skewed and more homogeneous than the NHP. There was an average convergent validity in three of the five comparable domains one year postoperatively. The SF-36 showed a higher internal consistency except for social functioning one-year postoperatively and was more responsive in detecting changes over time in patients with intermittent claudication. The NHP was more sensitive in discriminating among levels of ischaemia regarding pain and more able to detect changes in the critical ischaemia group. CONCLUSION: Both SF-36 and NHP have acceptable degrees of reliability for group-level comparisons, convergent and construct validity one year postoperatively. Nevertheless, the SF-36 has superior psychometric properties and was more suitable in patients with intermittent claudication. The NHP however, discriminated better among severity of ischaemia and was more responsive in patients with critical ischaemia

LIVING WITH PERIPHERAL ARTERIAL DISEASE Quality of life and the patients' view of meaning

The overall aim of this thesis was to investigate quality of life and the meaning of living with peripheral arterial disease (PAD) before and after revascularization in a long-term and methodological perspective. The sample in the first study consisted of 142 patients with PAD who were planned for a revascularization. Quality of life (QoL) assessment with the Nottingham Health Profile (NHP) was made before, 6 months, 12 months and up to 4 years after revascularization. The second study included 90 patients with PAD. QoL assessment was made before and one year after revascularization using comparable domains of NHP and the Short Form 36 Health Survey (SF-36) questionnaires. The third study comprised interviews with 24 patients with PAD about their experiences of living with PAD and the influence on activities of daily living (ADL). In the fourth study 14 patients who had undergone revascularizations were interviewed after 6 months and 2½ years about the long-term experiences of living with PAD and the recovery following revascularization. QoL was improved 6 and 12 months after revascularization in patients with intermittent claudication (IC) in energy, pain, emotional reactions and physical mobility, while those with critical limb ischaemia (CLI) had improvements in pain and sleep. The improvement in pain was particularly evident for both groups and remained significantly improved up to 4 years after revascularization. Patients with CLI, however, deteriorated significantly with regard to physical mobility between 12 months and 4 years. Being a woman and belonging to the critical ischaemia group was significantly associated with a low QoL. The SF-36 was less skewed, more homo¬geneous and showed higher internal consistency except for social functioning one year postoperatively than the NHP. There was an average convergent validity in three of the five comparable domains one year after revascularization. NHP was more sensitive in discriminating among levels of ischaemia regarding pain and more able to detect changes in the critical ischaemia group. Interviews with PAD patients revealed that living with PAD meant carrying a hard-to-bear physical, social and emotional burden, and struggling for relief. The experience of burden was interpreted in the following themes representing consequences and strategies for gaining control in daily life: (I) being limited by the burden; (II) striving to relieve the burden; (III) accepting and adapting to the feeling of burden. The long-term experience of living with PAD meant gradually becoming aware of having a chronic disease. This awareness was interpreted in the following themes representing the transition from being in an acute phase of the PAD to the recovery after revascularization and entering a chronic phase of PAD: (I) becoming better but not cured; (II) recapturing control over life; (III) reappraising meaning in life. In conclusion, revascularization results in improved QoL and functional ability and patients with PAD have durable benefits with regard to pain up to as many as 4 years after revascularization. The degree to which QoL was durable over time seems to depend on the severity of the disease and gender. Although NHP and SF-36 had acceptable degrees of reliability, convergent and construct validity, their long-term sensitivity was not satisfactory in detecting areas such as the social and emotional influences which were evident problems in the interviews. However, using both quantitative and qualitative methods made it possible to reflect different aspect of PAD and the factors that have a positive or negative influence on QoL. Patients? ability to adapt to their chronic disease played an important role in achieving a period of less disruption and greater stability. The patients had to become aware of having a chronic disease by themselves, which probably meant a delayed transition towards health within illness and normality. Patients with PAD present a complex situation which requires a comprehensive view where information and education may be important complementary interventions which can affect QoL and the ability to perform ADL in a positive direction

Portfolio - ett verktyg för lärandeprocessen under erksamhetsförlagd utbildning i sjuksköterskeprogrammet?

Bakgrund: Under den verksamhetsförlagda utbildningen (VFU) i sjuksköterskeprogrammet används ofta reflektion som ett sätt att träna studenten i att vara en reflekterande praktiker dvs. en sjuksköterska som kan binda samman teori och praktik. Det är dock inte en självklarhet att kunna reflektera utan det är snarare en förmåga som måste utvecklas. Dessutom varierar såväl omfattning som vilka modeller som används för reflektion och oftast sker ingen form av dokumentation av de reflektioner som gjorts. En portfolio är egentligen en samling av alster men kan också fungera som ett redskap för att förtydliga progression i lärandeprocessen och löpa som en ”röd tråd” genom utbildningen. Att använda sig av portfoliometodiken skulle kunna vara ett sätt att följa studenternas lärandeprocess och ge möjlighet till att arbeta mer strukturerat med skriftlig reflektion. Syfte: Denna studie avser att utifrån studenters, handledares och lärares perspektiv beskriva hur reflektion används i lärandeprocessen under VFU i sjuksköterskeprogrammet samt deras inställning till att arbeta med reflektion kopplat till portfolios. Metod: Studien har en kvalitativ design där 5 fokusgruppsintervjuer har genomförts med studenter (7 st), handledare (2 st), kliniska lärare (3) och universitetsadjunkter (3). Intervjuerna har transkriberats ordagrant och kommer att analyseras med hjälp av innehållsanalys Resultat: Den första preliminära analysen visar på betydelsen av reflektion för både studenter, handledare och lärare. Det framkom också att det finns olika former av reflektion såsom (1) här och nu, (2) avslutande, sammanfattande, eller (3) en speciell reflektionsstund ex då ett speciellt tema tas upp. Det fanns till övervägande del en positiv inställning till portfoliometodiken som sågs som ett tänkbart pedagogiskt verktyg för reflektion i VFU. Portfolion ansågs också möjliggöra en visualisering av lärandeprocessen för alla parter. Det fanns dock även en del farhågor i grupperna såsom att arbetet med portfolion inte fick bli en belastning och att det var bra om portfolion utgick från de befintliga dokument som används idag. Likaså upplevdes det som viktigt att reflektionerna som var kopplade till portfolion gavs en tyngd, kändes betydelsefulla och efterfrågades av handledare och lärare. Det fanns annars en risk att ingen skulle bry sig om att använda den och skriva i den och det hela skulle rinna ut i sanden. Sammanfattningsvis gav dock alla grupper uttryck för att användande av reflektion kopplat till portfolio kändes mer modernt och att det kändes angeläget att något sådant infördes i VFU:n