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  • 1. Arvidsson, Susann
    et al.
    Bergman, Stefan
    Arvidsson, Barbro
    Fridlund, Bengt
    Bengtsson Tops, Anita
    Linneuniversitetet.
    Experiences of health-promoting self-care in people living with rheumatic diseases2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 6, p. 1264-1272Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases.

    BACKGROUND: People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases.

    METHOD: The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases.

    FINDINGS: The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized.

    CONCLUSION: In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices.

  • 2.
    Beeckman, Dimitri
    et al.
    Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University and Research Staff, Nursing Department, University College Arteveldehoge-school.
    Schoonhoven, Lisette
    Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre.
    Fletcher, Jacqui
    School of Nursing and Midwifery, University of Hertfordshire, Hatfield.
    Furtado, Kátia
    Community Nursing Specialist Centro de Saúde de Arronches, Portalegre.
    Gunningberg, Lena
    Nursing Research and Development Surgery Division, Uppsala University Hospital.
    Heyman, Hilde
    Nursing Home Sint Bartholomeus, Antwerp.
    Lindholm, Christina
    Kristianstad University College, Department of Health Sciences.
    Paquay, Louis
    Wit-Gele Kruis van Vlaanderen, Brussels.
    Verdú, José
    Department of Community Nursing, Preventive Medicine, Public Health and History of Science, School of Nursing, University of Alicante.
    Defloor, Tom
    Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University.
    EPUAP classification system for pressure ulcers: european reliability study2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 60, no 6, p. 682-691Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. Background. Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research. Despite everyday use of the European Pressure Ulcer Advisory Panel system, its reliability has been evaluated in only a limited number of studies. Methods. A survey was carried out between September 2005 and February 2006 with a convenience sample of 1452 nurses from five European countries. Respondents classified 20 validated photographs as normal skin, blanchable erythema, pressure ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar with the use of the European Pressure Ulcer Advisory Panel classification scale. Results. Pressure ulcers were often classified erroneously (kappa = 0.33) and only a minority of nurses reached a substantial level of agreement. Grade 3 lesions were regularly classified as grade 2. Non-blanchable erythema was frequently assessed incorrectly as blanchable erythema. Furthermore, the differential diagnosis between moisture lesions and pressure ulcers appeared to be complicated. Conclusion. Inter-observer reliability of the European Pressure Ulcer Advisory Panel classification system was low. Evaluation thus needs to focus on both the clarity and complexity of the system. Definitions and unambiguous descriptions of pressure ulcer grades and the distinction between moisture lesions will probably enhance clarity. To simplify the current classification system, a reduction in the number of grades is suggested.

  • 3.
    Berg, Agneta
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Care Research and Development Unit, Kristianstad College for Health Professions.
    Welander Hansson, Ulla
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap.
    Hallberg R, Ingalill
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap.
    Nurses' creativity, tedium and burnout during 1 year of clinical supervision and implementation of individually planned nursing care: comparisons between a ward for severely demented patients and a similar control ward1994In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 20, no 4, p. 742-749Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to study creativity and innovative climate, tedium and burnout among the nurses on two wards during 1 year of systematic clinic supervision combined with the implementation of individualized care on an experimental ward (EW) for severely demented patients, as compared with a similar control ward (CW) EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned, documented and evaluated The intervention was evaluated by means of the Creative Climate Questionnaire, Burnout Measure and the Maslach Burnout Inventory Creativity and innovative climate improved significantly among the EW nurses (n= 19) in eight out of 10 factors during the year of intervention while there was no change on the control ward (n= 20) Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care It also increases nurses' creativity, which, in turn, may benefit patient care The findings of this study point to the necessity for a support system that focuses on the work itself, i e the nursing care Individualized planned care and systematic clinical supervision may offer this kind of support.

  • 4.
    Blomqvist, Kerstin
    Department of Nursing, Lund University.
    Older people in persistent pain: nursing and paramedical staff perceptions and pain management2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 41, no 6, p. 575-584Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Persistent pain is a common problem for older people. Knowledge about how nursing and paramedical staff perceive these people and what they do to relieve the pain seems scarce. AIM: To explore nursing and paramedical staff perceptions of older people in persistent pain and their day-to-day management of pain. METHODS: Interviews in Swedish with 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists were collected from February to May 2000. The analysis was based on their stories (n = 150) about older people in persistent pain who received help in their own homes or in special accommodation. A typology of staff perceptions of pain in older people was developed. Activities to manage pain were examined using content analysis. RESULTS: Respondents perceived the pain as real, exaggerated, trivial, care-related, endured, concealed, self-caused or inarticulate. Older people perceived as exaggerating the pain, those with care-related and self-caused pain evoked frustration in the staff, while those perceived as enduring their pain evoked satisfaction. Various strategies to manage pain were used: no activity, medication, mediating contacts, distracting activities, physical therapies, mobility, work in a gentle way, rest or relieving pressure on body part, and communication concerning pain. The activities differed between the types, as well as between staff with different professional backgrounds. CONCLUSION: Care and treatment provided by staff should be based on older people's needs rather than on staff attitudes and preferences. The typology revealed that staff perceived older people in pain as a heterogeneous group and that their perceptions affected the pain-relieving activities that were offered. It seems urgent to address how to handle pain in older people who never complain and those who complain a great deal, as well as how to handle pain in people with impaired communicative ability. Reflective discussions on feelings related to different individuals are needed.

  • 5.
    Blomqvist, Kerstin
    et al.
    Department of Nursing, Lund University.
    Edberg, Anna-Karin
    Department of Nursing, Lund University.
    Living with persistent pain: experiences of older people receiving home care2002In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 40, no 3, p. 297-306Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. AIM: To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. METHODS: Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. FINDINGS: Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. CONCLUSION: This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.

  • 6.
    Bolejko, Anetta
    et al.
    Department of Health Sciences, Lund University.
    Brodersen, John
    Research Unit and Section for General Practice, Institute of Public Health, University of Copenhagen.
    Zackrisson, Sophia
    Department of Medical Imaging and Physiology, Skåne University Hospital Malmö.
    Wann-Hansson, Christine
    Faculty of Health and Society, Malmö University.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Psychometric properties of a Swedish version of the Consequences of Screening: Breast Cancer questionnaire2014In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, no 10, p. 2373-2388Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate the psychometric properties of a questionnaire addressing psychosocial consequences of false-positive mammographic screening.

    BACKGROUND: The Consequences of Screening - Breast Cancer and Lung Cancer questionnaires target psychosocial consequences of false-positive cancer screening. The Consequences of Screening - Breast Cancer questionnaire and ten items not considered lung cancer specific from the Lung Cancer questionnaire have been adapted for use in mammographic screening in Sweden, but remain psychometrically untested.

    DESIGN: Instrument development paper with psychometric cross-sectional and test-retest design.

    METHODS: Twelve scales of a Swedish questionnaire version were tested by the Rasch model and traditional psychometric methods. Women with false-positive (Group I, n = 640) and negative (Group II, n = 802) screening mammography responded to the study questionnaire and the Nottingham Health Profile during 2009-2011.

    RESULTS: Iterative analyses resulted in nine scales demonstrating Rasch model fit, but all scales exhibited poor targeting with relatively large floor effects. Corrected item-total correlations exceeded the recommended criterion. Score differences between Groups I and II and correlations with Nottingham Health Profile sections followed an expected pattern. Cronbach's α and test-retest reliability was acceptable for group-level assessments for ten and seven scales, respectively.

    CONCLUSIONS: Five scales (Sense of dejection, Anxiety, Behavioural, Sleep and Existential values) of the Swedish questionnaire version demonstrated the best psychometric properties. Other scales should be used more cautiously. Although filling an important gap, causes of concern were identified across scales. The questionnaire should therefore be considered for group-level assessments rather than for measurement of individual degrees of psychosocial consequences.

  • 7.
    Jakobsson, Liselotte
    et al.
    Centre of Caring Sciences, Lund University.
    Rahm Hallberg, Ingalill
    Centre of Caring Sciences, Lund University.
    Lovén, Lars
    The Surgical Clinic, Central Hospital, Kristianstad.
    Experiences of micturition problems, indwelling catheter treatment and sexual life consequences in men with prostate cancer2000In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 31, no 1, p. 59-67Article in journal (Refereed)
    Abstract [en]

    Men with prostate cancer (n=25) were interviewed, focusing on experiences of micturition problems, indwelling catheter treatment and sexual life consequences. Narrations were found to be practical and technical descriptions rather than emotional, and experiences were described with reduction and negligence regarding personal well-being and the impact of problems. Phenomenological-hermeneutic analysis was used and findings ordered in subthemes and themes of meaning. Micturition problems, catheter treatment and sexual life problems were all phenomena that radically affected the clients’ autonomy and life quality and changed the life continuum. Impact from the disease was either accepted or not and related to what had already been borne in life. Experiences were linked together, each of them giving rise to feelings of physical deterioration and fear of ridicule, and hidden from others. Maintaining self-image and social role was important and connected with the degree of perceived deprivation of life content. Responsibility for medical decisions was left to professionals while everyday problems with micturition, catheters and sexual life were regarded as the men’s sole responsibility. Findings were interpreted to mean that comparing the personal situation with that of others worse off made the life situation look better. The clinical implication of this study was that because the men came forward with their problems when given time to talk in their own way these areas should be given time and interest in the nursing care. Interpretation did not provide a unified picture of problems. Thus, nurses will have to seek men’s individual experience actively and give legitimacy to patients’ problems by opening up opportunities to speak about otherwise concealed problems. Then it may be possible to provide solutions that may ease the men’s burdens.

  • 8.
    Lindh, Inga-Britt
    et al.
    Kristianstad University, School of Health and Society.
    Severinsson, Elisabeth
    Faculty of Health Sciences, Vestfold University College, Tønsberg.
    Berg, Agneta
    Kristianstad University, School of Health and Society.
    Nurses' moral strength: a hermeneutic inquiry in nursing practice2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 9, p. 1882-1890Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study to interpret nurses' experiences of moral strength in practice. Background. Moral strength is said to be beneficial in providing nursing care for patients, thereby contributing to high qualitative care. However, few studies focus on the meaning of nurses' moral strength. Methods. This study included eight Registered Nurses working in different aspects of health care in southern Sweden. Individual interviews were conducted in 2006 and 2007. We recorded, transcribed verbatim, and interpreted the interviews by a method grounded in hermeneutics. Findings. Three themes were interpreted on three different levels: the action level as 'having courage to act on one's convictions', the relational level as 'being attentive and recognizing vulnerability', and the existential level as 'facing the unpredictable'. Overall, moral strength was understood as a driving force to be someone special in the care of patients, i.e. someone who makes a difference. Conclusion. The value of nurses' moral strength in patient care should be recognized. Attention must be given to aspects outside the individual, e.g. professional and institutional processes that influence the work environment. Clinical team supervision can help make such processes visible and supportive.

  • 9.
    Pajalic, Zada
    et al.
    Kristianstad University, Department of Health Sciences.
    Karlsson, Siv
    Department of Rehabilitation Medicine, Central Hospital Kristianstad.
    Westergren, Albert
    Department of Rehabilitation Medicine, Central Hospital Kristianstad.
    Functioning and subjective health among stroke survivors after discharge from hospital2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 54, no 4, p. 457-466Article in journal (Refereed)
    Abstract [en]

    Existing Activities of Daily Living scales were expanded and found to relate to a participation scale and a subjective health scale. Using these scales in nursing care has the potential to correct current bias towards functions and activities by broadening the focus to include the social as well as the physical.

  • 10.
    Persson, Lena
    et al.
    Lund University.
    Rahm Hallberg, Ingalill
    Lund University.
    Ohlsson, Ola
    Department of Medicine, Central Hospital, Kristianstad.
    Survivors of acute leukaemia and highly malignant lymphoma: retrospective views of daily life problems during treatment and when in remission1997In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 25, no 1, p. 68-78Article in journal (Refereed)
    Abstract [en]

    Fifty-four former patients, in remission after acute leukaemia or highly malignant lymphoma, responded to a questionnaire covering physical problems, view of help received, who was most helpful during the treatment phase, and the impact of the disease and treatment on their current life. Energy loss and nutritional problems were most troublesome during the treatment phase, signifying many other physical problems. Patients with acute leukaemia had more problems, and thought the care was worse than did patients with highly malignant lymphoma. Serious physical problems correlated with low satisfaction with practical help received, indicating that the nurses failed to meet the needs of those suffering the most. Reduced psychological and sexual energy persisted in remission, showed no correlation with the extent of physical  problems during the treatment phase, but correlated with current existential problems and sensitivity to infections, with a great need for intimate help and counselling and with a low Sense of Coherence. Family relationships were said to have improved, while work and finances were negatively affected. The results indicate that nursing care should actively focus physical problems, especially the energy loss and nutritional problems. The overwhelming fatigue hinders the patient to take care of physical aspects for her/him self, and may be overlooked by nurses since their motor capability seem intact. The long term effect of the illness means reduced psychological and sexual energy and high degree of existential problems and sensitivity to infections, which indicates the importance of follow-up care and perhaps especially for counselling for the long-term reactions with disturbed equilibrium. 

  • 11.
    Suhonen, R.
    et al.
    Finland.
    Charalambous, A.
    Cypern.
    Berg, Agneta
    Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Platform for Collaboration for Health.
    Katajisto, J.
    Finland.
    Lemonidou, C.
    Grekland.
    Patiraki, E.
    Grekland.
    Sjövall, K.
    Lund University.
    Stolt, M.
    Finland.
    Older cancer patients' perceptions of care guality - an international study2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no S1, p. 29-29Article in journal (Refereed)
    Abstract [en]

    Background: Cancer is considered as chronic condition, especially in the older people. Prevalence of cancer is especially high in the Nordic countries and Mediterranean countries. People with cancer are a common patient group in the healthcare system.

    Introduction: User perspective, such as patient assessments of care and care quality are central in developing healthcare services. These assessments have a high value in time when there are reforms in social and healthcare services. One core principle in these reforms is patient-centeredness. Earlier studies have shown that older patients differ from other age-based patient groups in their assessments of care quality elements. They were reported to be more positive in their evaluations.

    Aim: The aim of this study was to analyse cancer patients’ perceptions of patient-centered quality and individuality in care and trust in nurses, and to compare these perceptions between patients in the working age and older people. The research questions were: To what extent cancer patients perceive their care is patient-centered quality care, individualised and do they trust in nurses? Are there differences between older cancer patients and those in working age in their perceptions of person-centered quality of care, individuality in care and trust in nurses?

    Materials and methods: The study employed a cross-sectional comparative survey design. Data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four countries: Greece, Cyprus, Sweden and Finland. The following instruments were used: The Oncology Patients perceptions of the Quality of Nursing Care Scale (OPPQNCS), the Individualised care Scale (ICS-patient) and Trust in Nurses. The data were divided into two sub-samples based on age (cut point 65 years): Older patients (n = 209) and patients in the working age (n = 387). Data were analysed statistically using cross-tabulation and chi-square statistics, or paired samples t-test.

    Results: In this study cancer patients’ perceptions about individualization and coordination of care, support of individuality and perceived individuality in care were only moderate. Proficiency and responsiveness as part of care quality were reported well realised. Trust in nurses was strong. Older patients and those patients in the working age did not differ in their perceptions of either patient-centered quality of care, individualised care or trust in nurses.

    Conclusions: The results of this study point out topics that need development in order to provide individualised and patient-centered nursing care. Contradictory to many earlier study results, age was not associated with cancer patients’ assessment.

  • 12.
    Suhonen, Riitta
    et al.
    Department of Nursing Science, University of Turku.
    Papastavrou, Evridike
    Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol.
    Efstathiou, Georgios
    Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol.
    Lemonidou, Chryssoula
    Faculty of Nursing, National and Kapodistrian University of Athens.
    Kalafati, Maria
    Faculty of Nursing, National and Kapodistrian University of Athens.
    da Luz, Maria Deolinda Antunes
    Unidade de Investigacão e Desenvolvimento em Enfermagem, Escola Superior de Enfermagem de Lisboa.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University.
    Berg, Agneta
    Kristianstad University, School of Health and Society. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Acaroglu, Rengin
    Florence Nightingale School of Nursing, Istanbul University.
    Sendir, Merdiye
    Florence Nightingale School of Nursing, Istanbul University.
    Kanan, Nevin
    Florence Nightingale School of Nursing, Istanbul University.
    Sousa, Valmi D.
    The University of Kansas School of Nursing, Kansas City.
    Katajisto, Jouko
    Department of Social Sciences, Statistics Unit, University of Turku.
    Välimäki, Maritta
    Department of Nursing Science/Hospital District of Southwest Finland, University of Turku.
    Leino-Kilpi, Helena
    Department of Nursing Science/Hospital District of Southwest Finland, University of Turku.
    Nurses' perceptions of individualized care: an international comparison2011In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 9, p. 1895-1907Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. Background. Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. Methods. A descriptive comparative survey was used to sample orthopaedic surgical nurses (n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. Results. Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. Conclusions. Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area.

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