Development of a short form of the questionnaire quality from the patient’s perspective for palliative care (QPP-PC)

Purpose: Patients’ views on quality are important to improve person-centered palliative care. There is a lack of short, validated instruments incorporating patients’ perspectives of the multidisciplinary palliative care services. The aim of this study was to develop a short form of the instrument Quality from the Patient’s Perspective for Palliative Care (QPP-PC) and to describe and compare patients’ perceptions of the subjective importance (SI) of care aspects and their perceptions of care received (PR). Methods: A cross-sectional study was conducted in Norway including 128 patients (67% response rate) in four palliative care contexts. The QPP-PC, based on a person-centered theoretical framework, incorporating the multidisciplinary palliative care, comprises 4 dimensions; medical–technical competence, physical–technical conditions, identity-oriented approach and sociocultural atmosphere, 12 factors (49 items) and 3 single items. The instrument measures SI and PR. Development of the short form of the QPP-PC was inspired by previously published methodological guidelines. Descriptive statistics, paired t-tests, confirmatory factor analysis and Cronbach’s α were used. Results: The short form of QPP-PC consists of 4 dimensions, 20 items and 4 single items. Psychometric evaluation showed a root-mean-square error of approximation (RMSEA) value of 0.109 (SI). Cronbach’s α values ranged between 0.64 and 0.85 for most dimensions on SI scales. Scores on SI and PR scales were mostly high. Significantly higher scores for SI than PR were present for the identity-oriented approach dimension, especially on items about information. Conclusion: RMSEA value was slightly above the recommended level. Cronbach’s α was acceptable for most dimensions. The short form of QPP-PC shows promising results and may be used with caution as an indicator of person-centered patient-reported experience measures evaluating the multidisciplinary palliative care for patients in a late palliative phase. However, the short version of QPP-PC needs to be further validated using new samples of patients.publishedVersio

Healthcare professionals’ perceptions of palliative care quality in a combined acute oncology-palliative care unit: A cross-sectional study

It is a challenge to ensure high-quality palliative care. The aim was to investigate the perceptions of health care professionals (HCPs) working in a combined acute oncology-palliative care unit regarding the quality of the palliative care received by the patients and how important the care was to the patients. A Swedish total-survey cross-sectional study including 41 HCPs (54% response rate) was conducted with the 52 items Quality from the Patient’s Perspective – Palliative Care instrument, answered in two different ways: as actual care received and subjective importance. The STROBE-checklist was used. The areas for improvements were related to symptom relief, spiritual and existential needs, information, patient participation, continuity of care, care planning, cooperation and coordination of care, as subjective importance scores were higher than corresponding scores for care received (p ≤ .025). Providing high-quality palliative care alongside curative treatments for cancer patients is known to be challenging and could explain the results in this study. Implementation of a person-centred palliative care model based on the hospice philosophy could be a solution.publishedVersio

Preferences for home care to enable home death among adult patients with cancer in late palliative phase - a grounded theory study

Background: The wish to be cared for and to die at home is common among people with end‑stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the preferences for home care over time to enable home death among adult patients with cancer in the late palliative phase. Methods: A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n= 15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously. Results: The findings are presented as a conceptual model of patients’ preferences for care to enable home death. The core category “Hope and trust to get the care I need to die at home” showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five categories were related to the core category. The categories “being in the present”, “be safe and in charge” and “be seen and acknowledged” describe the patients’ preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: “reliable, compassionate and competent healthcare personnel” and “timely, predictive, continuous and adaptive organisation”. Conclusion: An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person‑centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person‑centred care model and the use of advanced home care plans with continued re‑evaluation for patients’ preferences of home care were proposed measures to enable home death. Keywords: Patients’ preferences, Cancer, Palliative care, End‑of‑Life (EOL) Care, Home death, Grounded TheorypublishedVersio

A descriptive study of Swedish women with symptoms of breast inflammation during lactation and their perceptions of the quality of care given at a breastfeeding clinic

BACKGROUND: Women's perceptions of quality of care during episodes of breast inflammation have been scantily explored. It was the objective of the present study to describe a cohort of breastfeeding women with inflammatory symptoms of the breast during lactation regarding demographical variables, illness history and symptoms at first contact with a breastfeeding clinic and to explore their physical health status, psychological well-being and perceptions of quality of care received, at a six-week postal follow-up. METHODS: This is a descriptive study set at a midwife-led breastfeeding clinic in Sweden, which included a cohort of women with 210 episodes of breast inflammation. The women had taken part in a RCT of acupuncture and care interventions and were recruited between 2002 and 2004. Of the total cohort, 176 (84 %) responded to a postal questionnaire, six weeks after recovery. RESULTS: Of the 154 women for whom body temperature was recorded at the first visit, 80 (52%) had fever ranging from 38.1°C to 40.7°C. There was no significant difference between those with favourable outcomes (5 or less contact days) and those with less favourable outcomes (6 or more contact days) for having fever or no fever at first contact. Thirty-six percent of women had damaged nipples. Significantly more women with a less favourable outcome (6 or more contact days) had damaged nipples. Most women recovered well from the episode of breast inflammation and 96% considered their physical health and 97% their psychological well-being, to be good, six weeks after the episode. Those whose illness lasted 6 days or more showed less confidence in the midwives and in the care given to them. Twenty-one (12%) women contacted health care services because of recurring symptoms and eight of the 176 responders (4.5%) were prescribed antibiotics for these recurring symptoms. A further 46 women (26% of the responders) reported recurring symptoms that they managed without recourse to health care services. CONCLUSION: Initial fever may not be indicative of outcomes for women with inflammatory breast symptoms and treatment by antibiotic therapy may be necessary less often than has been supposed. Women who are also suffering from damaged nipples may need special attention. Those with protracted symptoms were less satisfied with care and showed less confidence in caregivers. International research collaboration might help us find the optimal level of antibiotic therapy for this group of women. This is an important consideration for the global community

Opplevelse av brukermedvirkning i sykehus

Hensikt: Å få økt kunnskap om hvordan pasienter innlagt i sykehus på grunn av forverring av KOLS har erfart å medvirke i helsehjelpen. Når pasienter får nødvendig kunnskap om sin sykdom bidrar det til medvirkning. Det foreligger lite kunnskap om brukermedvirkning fra norske sykehusavdelinger, og hvordan og ved hvilke anledninger pasientene skal kunne medvirke. Metode: Studien har en kvalitativ, beskrivende design. Kvalitativt forskningsintervju ble benyttet som datasamlingsmetode. Analysen er inspirert av Malteruds systematiske tekstkondensering.  Resultater: Informantene erfarte medvirkning når de var tydelige på egne behov og bevisst egen kunnskap, mens de opplevde at pustebesvær, manglende krefter og lav tiltro til egen erfaring hemmet medvirkning. Pasientene opplevde at sykepleierne fremmet deres medvirkning ved å vise omsorg og forståelse, ved at de var kjent for pasienten og hadde tid. Travelhet og mangel på respekt ble erfart som et hinder for medvirkning.Konklusjon: Informantenes opplevelse av medvirkning hang sammen med faktorer både hos dem selv og hos sykepleier. Pasientene bør utfordres til å være aktive og ha tiltro til egen kunnskap, og sykepleierne bør bli mer lyttende. Både pasientrollen og hjelperollen må endres slik at sykepleier og pasient blir mer likeverdige partnere

Opplevelse av brukermedvirkning i sykehus

Dette er forfatters arbeidsversjon av artikkelen. Den er ikke fagfellevurdert slik den foreligger her. Artikkelen ble publisert i Nordisk tidsskrift for helseforskning: http://www.ub.uit.no/baser/septentrio/index.php/helseforsk/indexHensikt: Å få økt kunnskap om hvordan pasienter innlagt i sykehus på grunn av forverring av KOLS har erfart å medvirke i helsehjelpen. Når pasienter får nødvendig kunnskap om sin sykdom bidrar det til medvirkning. Det foreligger lite kunnskap om brukermedvirkning fra norske sykehusavdelinger, og hvordan og ved hvilke anledninger pasientene skal kunne medvirke. Metode: Studien har en kvalitativ, beskrivende design. Kvalitativt forskningsintervju ble benyttet som datasamlingsmetode. Analysen er inspirert av Malteruds systematiske tekstkondensering. Resultater: Informantene erfarte medvirkning når de var tydelige på egne behov og bevisst egen kunnskap, mens de opplevde at pustebesvær, manglende krefter og lav tiltro til egen erfaring hemmet medvirkning. Pasientene opplevde at sykepleierne fremmet deres medvirkning ved å vise omsorg og forståelse, ved at de var kjent for pasienten og hadde tid. Travelhet og mangel på respekt ble erfart som et hinder for medvirkning. Konklusjon: Informantenes opplevelse av medvirkning hang sammen med faktorer både hos dem selv og hos sykepleier. Pasientene bør utfordres til å være aktive og ha tiltro til egen kunnskap, og sykepleierne bør bli mer lyttende. Både pasientrollen og hjelperollen må endres slik at sykepleier og pasient blir mer likeverdige partnere

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

<p>Abstract</p> <p>Background</p> <p>The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.</p> <p>Methods</p> <p>In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.</p> <p>Results</p> <p>Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, <it>Staphylococcus aureus </it>(<it>S. aureus</it>), Group B streptococci (GBS) and <it>Enterococcus faecalis</it>. More women with mastitis had <it>S. aureus </it>and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured <it>S. aureus </it>and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 10⁷cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).</p> <p>Conclusion</p> <p>Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.</p

Health care staffs’ perception of patient safety culture in hospital settings and factors of importance for this

Vitenskapelig, fagfellevurdert artikkelMany hospital patients are affected by adverse events. Managers are important when improving safety. The perception of patient safety culture varies among health care staff. Health care staff (n = 1023) working in medical, surgical or mixed medical-surgical health care divisions answered the 51 items (14 dimensions) Swedish Hospital Survey on Patient Safety Culture (S-HSOPSC). Respondents with a managerial func- tion scored higher than non-managers for 11 of 14 dimensions, indicating patient safety culture strengths for a majority of dimensions. Enrolled nurses and staff with experience > 10 years also scored high for several dimensions. The 12 dimensions and sample characteristics explained 49% and 26% of the vari- ance for the outcome dimensions Overall Perceptions of Safety and Frequency of Incident Reporting, re- spectively. RNs, ENs and physicians have different views on patient safety culture. Hospital Management Support and Organisational Learning is some im- portant factors influencing patient safety culture. Bridging the gap in health care staff’s perceptions of safety in order to improve patient safety is of utmost importance. Managers have the responsibility to fos- ter patient safety culture at their workplace and can thus benefit from results when improving safety for patients