The aim of this study was to illuminate nurses' experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses' actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses' experiences showed that the nurses found it difficult to reach the patients' reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients' situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients' irritation and anger. The results were more successful when the strategies were derived from the nurses' interpretation of the patients' situation and the nurses paid attention to the patients and confirmed them.

Background

Old people's life situation when receiving municipal help and care in their last period of life is sparsely investigated from their own perspective.

Objective

The aim of this study was to investigate the experiences of aspects that bring about a good life in the last phase of life among people (75+ years) receiving municipal care.

Participants

Older people living in a municipality in Southern Sweden being 75 years or older, receiving help and/or care from the municipality, and having a life-threatening disease and/or receiving palliative care were asked to participate. In all 17 people, 10 women and 7 men, aged 78–100 years were included.

Methods

Qualitative interviews, with the emphasis on their present life situation especially what brought about a good life, were performed. The interviews were analysed using qualitative content analysis.

Results

The experience was interpreted to be Turning inwards to come to peace with the past, the present and approaching death while being trapped by health complaints. Six categories embraced the experience of aspects that constitute a good life in the last phase of life: Maintaining dignity, Enjoying small things, Feelings of “being at home”, Being in the hands of others, trying to adjust, Still being important for other people and Completing life while facing death.

Conclusion

This study confirm theories suggesting that the last phase of life in old age meant focusing inwards, reflecting on the entire life as a way of completing it as well as enjoying small things and also viewing oneself in the perspective of contributing to the future. It also indicated that this phase of life meant being trapped by health complaints and functional limitations. The struggle to maintaining dignity as opposed to being in the hands of others implies that the concept of palliative care may be useful as a framework for providing nursing care to very old people, especially at the end of life.

BACKGROUND: Palliative care should be provided, irrespective of setting to all patients facing a life-threatening illness and to their families. The situation and needs of older people differ from those of younger people since they often have several co-existing diseases and health complaints. This implies an extensive need for care and for longer periods of palliative care. The main providers of palliative care for older people are nurse assistants, who are also those with the shortest education. AIM: The aim of this study was to illuminate nurse assistants' experience of palliative care for older people in residential care. DESIGN: The study had an explorative, descriptive design. SETTINGS: Thirteen residential care units in three different districts in a large city in southern Sweden. PARTICIPANTS: Twenty-five nurse assistants selected to represent variations in age, gender workplace and work experience. METHODS: Data were collected from six focus-group interviews and subjected to content analysis to gain an understanding of the phenomenon. RESULTS: The nurse assistants described palliative care as a contrast to the everyday care they performed in that they had a legitimate possibility to provide the care needed and a clear assignment in relation to relatives. Palliative care also meant having to face death and dying while feeling simultaneous that it was unnatural to talk about death and having to deal with their own emotions. They emphasised that they were in need of support and experienced leadership as invisible and opaque, but gained strength from being recognized. CONCLUSION: In order to support nurse assistants in providing high quality end-of-life care, more focus is needed on the trajectory of older peoples' dying, on the importance of involving relatives throughout the period of care provision, and on support when encountering death and dying. There is also a need for engaged care leaders, both registered nurses and managers, to recognize the work of nurse assistants and to support care provision for older people within the framework of palliative care philosophy.

In this study the aim was, through interviews, to disclose 13 nurses personal knowledge about the patients, themselves, and care provision, using a phenomenological-hermeneutic analysing method. Caring for people with severe dementia meant an intertwined life world emanating from making and doing together and the delicate interpretative work that the care provision required. The intertwined life world consisted of the interaction between the nurses and the patients separate lives, their common life and the environment, culminating in mutual dependency. Making together signifies the relationship being based on the nurses knowledge and skills as nurses i.e. the task they had to perform. Doing together signifies the relationship being based on the oneness of the nurses and the patients with severe dementia as ordinary human beings. The delicate interpretation process required, to adapt care to the individual patient, was based on knowledge about the patients personality, life history and disease progression in combination with the nurses interpretation of the current situation. The nurses searched for meaning and that, in turn, meant that the patients inner world was determined by the nurses and thus the patient was seen as being in their hands. It seems important to further understand the human aspects of both the nurse and the patient and to examine this dynamic, ongoing, vulnerable interpretation process, critically, in order to achieve high quality nursing care for the patients with severe dementia, and an experience of well-being in nurses everyday working lives.

Interviews with six couples, persons with Parkinson's disease and their partners, were tape-recorded, transcribed and analysed using manifest and latent content analysis. The couples' experiences could be interpreted as Being in the light and Being in the shade of support, with internal variations for the patients and their partners. The narratives also revealed that the disease meant a transition of roles in their relation seen in different patterns: From unity towards unity, From unity towards distance and From distance towards unity. The results indicate that there is a need for more specialised and individually adjusted support.

Sixty-six randomly selected older adults and their contact nurses participated in interviews based on standardised assessments of pain and open-ended questions focusing how pain was expressed and recognised. The sample included older adults with normal as well as cognitively impaired function. Seventy-nine percent of older adults with normal cognition were often in pain. Contact nurses assessed pain in 57% of cognitively impaired older adults. The content in the statements showed that pain recognition was a communicative interactive process based on verbal and non-verbal expressions. The process comprised attempts to understand the cause and intention of the expression and to verify the presence of pain. Changes in mood, facial expressions and physiological responses were described less often by older adults than by their nurses. Contact nurses of cognitively impaired older adults judged immobility as the source of pain, that it was possible to see when the person was in pain and that pain was expressed by paralinguistic and body language more often than contact nurses of cognitively healthy older adults. Characteristics of nurses and older adults could facilitate or hinder pain recognition. The findings indicate a need for reflective discussions in the staff group focusing on how to perform systematic assessments of verbal and non-verbal expressions and of hindrances and facilitators for recognising pain in older adults.

OBJECTIVE: To describe and compare self-reported health complaints, overall and health-related quality of life and to investigate how health complaints, age, gender, marital status, living and dwelling conditions and socio-economy predicted overall and health-related quality of life.

DATA AND METHOD: A sample of 469 persons (aged 75-99) responded to a postal questionnaire. Multiple linear regression analysis was used to examine possible predictors.

RESULT: Self-reported health complaints such as pain, fatigue and mobility impairment significantly predicted low overall and health-related quality life. Women had significantly lower overall and health-related quality of life than men, and a significantly higher degree of self-reported health complaints. The regression models had more similarities than differences, implying that the overall quality of life instrument were sensitive to physical influences only supposed to be detected by health-related quality of life instruments. Several of the health complaints predicting low quality of life are amenable for being relieved by nursing care. In the care of older people nurses need to assess for several health complaints simultaneously and be aware of their possible interaction when outlining interventions. Nurses are able to facilitate early detection of health complaints negatively affecting quality of life by implementing more pro-active preventive work as well as a higher degree of thorough and systematic assessments. It also seems important to consider that older woman's and men's needs for high quality of life may differ.

Background: Providing high quality nursing care for patients with malignancies is complex and driven by many factors. Many of the associations between nursing care quality, trust, health status and individualized care remain obscure. Objective: To empirically test a model of association linking hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses. Design: A cross-sectional, exploratory and correlational study design was used. Settings: This multi-site study was conducted in cancer care clinics, in-patient wards of five tertiary care hospitals in Cyprus, Finland, Greece and Sweden. Sample: Out of 876 hospitalized patients with a confirmed histopathological diagnosis of cancer approached to participate in the study in consecutive order, 599 (response rate 68%) agreed to participate and the data from 590 were used for path analysis. Methods: Data were collected in 2012-2013 with the Individualized Care Scale-Patient (ICS-Patient), the Oncology Patients' Perceptions of Quality Nursing Care Scale (OPPQNCS), the Euro-Qol (EQ-5D-3L) and the Trust in Nurses Scale. Data were analysed statistically using descriptive and inferential statistics. Mplus version 7.11 was used to determine the best Trust model with path analysis. Results: Although the model fit indices suggested that the hypothesized model did not perfectly to the data, a slightly modified model which includes the reciprocal path between individualized care and nursing care quality demonstrated a good fit. Conclusion: A model of trust in nurses was" developed. Health status, individualized care, and nursing care quality were found to be associated with trust. The model highlights the complexity of caring for cancer patients. Trust in nurses is influenced by the provision of individualized care. Generating and promoting trust requires interventions, which promote nursing care quality, individuality and patients' health status. 

AIM: To identify important predictors among lifestyle behaviours and physiological factors of bone mineral density (BMD) in relation to body mass index (BMI) among young women over a 2-year period. DESIGN, SAMPLE AND MEASUREMENTS: Data were collected in 1999 and 2001. Healthy young women (n=152) completed a questionnaire. BMD measurements were performed by DEXA in the calcaneus. The women were subdivided into three categories according to baseline BMI. RESULTS: Baseline bodyweight explained 25% of the variability in BMD at follow-up in the BMI<19 category, and high physical activity seemed to hinder BMD development. In the BMI>24 category, a difference in time spent outdoors during winter between baseline and follow-up was the single most important factor for BMD levels. Overweight women with periods of amenorrhoea had lower BMD than overweight women without such periods. CONCLUSIONS: Predictors and lifestyle behaviours associated with BMD are likely to be based on women of normal weight. BMI should be considered when advising on physical activity, since high physical activity seems to impair BMD development among underweight young women, possibly due to energy imbalance. Among overweight women, sleep satisfaction is the greatest predictor associated with BMD change and may indicate better bone formation conditions. Energy balance and sleep quality may be prerequisites of bone health and should be considered in prevention.

OBJECTIVE: The aim of the study was to investigate the level of agreement between the needs assessment made by professional on the one hand, and the older person's views on the other. A further aim was to explore if the estimations made by the professional were systematically lower or higher compared to the views of the older person.

PARTICIPANTS: The study included 152 individuals, 65+, who received public care and services in southern Sweden. The concept public care and services include home help, home nursing care, rehabilitation and special accommodation.

METHODS: Standardised needs assessments were performed by home help officers, registered nurses and one physiotherapist. Subsequently to the needs assessment, the older person's view was collected in a personal interview. Standardised assessment form was used covering items about demographic data, functional ability, health complaints, adaptation in housing, public and informal care. The concept informal care includes care from spouse and children. Cohen's Kappa was used for analysis of level of agreement and Chi-square tests for differences in estimation.

RESULTS: Level of agreement for dependency in instrumental activities of daily living (IADL) and personal activities of daily living (PADL) varied between good (kappa=0.78) and moderate (kappa=0.43). Poor agreement was found for occurrence of dizziness (kappa(w)=0.17) and fair agreement for impaired hearing (kappa(w)=0.27), urinary incontinence (kappa(w)=0.38), pain (kappa(w)=0.21), anxiety (kappa(w)=0.37) and depressed mood (kappa(w)=0.37). Older persons reported more health complaints than in the professional's assessments, significantly lower estimation was found for incontinence and vision. Level of agreement for provided public care at home (home help and home nursing care) was poor, for informal care it varied between very good and moderate.

CONCLUSIONS: Needs assessments appeared to focus on older persons ADL, cognition and informal care, while health complaints and social needs were less in focus. A more comprehensive view including preventive and palliative approach may improve quality of life for older persons receiving care and service.

BACKGROUND: Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.

OBJECTIVES: The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.

DESIGN: This study had an international, multisite, prospective, cross-sectional, exploratory survey design.

SETTINGS: The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.

PARTICIPANTS: Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.

METHODS: Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.

RESULTS: Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.

CONCLUSIONS: The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

BACKGROUND: Although individualised nursing care is considered a core value in nursing in different countries, international comparative studies in this area are rare. In Western countries, common hospitalised patients, e.g. orthopaedic patients, often perceive health care as impersonal rather than individualised; a term which may also have different connotations in different cultures. OBJECTIVES: To describe and compare orthopaedic and trauma patients' perceptions of individuality in their care in four European countries. DESIGN: A cross-sectional comparative study. SETTINGS: 24 orthopaedic and trauma wards in 13 acute care hospitals. PARTICIPANTS: Data were collected from orthopaedic and trauma patients in Finland (n=425, response rate 85%), Greece (n=315, 86%), Sweden (n=218, 73%) and UK (n=135, 58%) between March 2005 and December 2006. METHODS: Questionnaire survey data using the Individualised Care Scale (ICS) were obtained and analysed using descriptive and inferential statistics including frequencies, percentages, means, standard deviations, 95% confidence intervals (CI), one-way analysis of variance (ANOVA), chi2 statistics and univariate analysis of covariance (ANCOVA). RESULTS: Patients perceived that nurses generally supported their individuality during specific nursing interventions and perceived individuality in their care. There were some between-country differences in the results. Patients' individuality in the clinical situation and in decisional control over their care were also generally well supported and taken into account. However, patients' personal life situation was not supported well through nursing interventions and these patients perceived lower levels of individualised care. CONCLUSIONS: North-South axis differences in patients' perceptions of individualised care may be attributed to the way nursing care is defined and organised in different European countries. Differences may be due to the differences in regional samples, and so no firm conclusions can be made. Further research will be needed to examine the effect of patient characteristics' and health care organisation variables in association with patients' perceptions of individualised care.