Background: Radiographers’ ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer’s work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession.

Aim: The aim was to describe the radiographer’s areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions.

Method: A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden.

Ethical issues: The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives.

Results: The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers’ skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient’s immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient.

Conclusions: The study highlights the different areas of the radiographer’s unique professional competence. The findings provide insight into the radiographer’s profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer’s work encompasses a variety of components – from caring for the patient to handling and checking the technical equipment.

The overall aim of this prospective observational study with a salutogenic approach was to investigate bone mineral density (BMD) and BMD changes in the heel bone, in a group of healthy women, in relation to physiological factors and lifestyle behaviours over a two-year period as well as investigating the women’s view of their lifestyle behaviours. Data were collected in 1999 (T1) and 2001 (T2). Healthy young women (n=152) filled in a structured questionnaire, BMD measurements were performed by a heel bone scanner (DEXA), and deoxypyridinoline (U-DPD) was measured. Data were analysed by means of simple and multiple linear regression and logistical regression. Data were collected by means of qualitative interviews with eleven of the informants, and grounded theory was used as the method of analysis. Of the participants, 62% had decreased/unchanged bone density, and 38% had increased their bone density over the 2 years. Use of oral contraceptives (OC) and alcohol consumption were associated with an increased risk of negative BMD changes. Self-reported poor health was associated with decreased BMD. Smokers had lower BMD although OC seemed to moderate the negative impact of smoking probably related to bone turnover. Irrespective of smoking and OC, self-reported sleep satisfaction explained 3% of the variability in BMD change. Time spent outdoors was associated with BMD change irrespective of smoking and OC use. Women with OC induced regular menstruation had higher BMD than women with naturally regular menstruation. OC use in combination with smoking was linked to high alcohol consumption and higher frequency of self-reported body weight reduction. There was a positive association between a high level of physical activity, body weight and BMD. When the sample was divided according to underweight (BMI <19), normal weight (BMI 19-24) and overweight (BMI >24), cross-sectional body weight was of no significance for the prediction of BMD (T2). Among underweight women, DPD (T1) explained 46.3% of the variability in BMD (T2), and a high level of physical activity had a negative impact on BMD. Among overweight women, the difference in time spent outdoors during winter between T1 and T2 was the single most important factor for BMD levels, and self-reported sleep satisfaction was associated with increased BMD. The women’s (N=11) views on lifestyle behaviours were characterised by a number of interrelated dimensions; motivation, goals, actions and strategies. Women with a relaxed outlook on life had increased BMD while women with a rigid outlook on life had decreased their BMD irrespective of smoking and physical activity. Respondents who had a rigid outlook on life viewed actions such as lifestyle habits as a means to an end, where the goal of, for example, physical activity was a way of staying slim. For respondents with a relaxed outlook on life, the enacted lifestyle behaviours, such as physical activity, were a goal in themselves. It was hypothesised that women with a relaxed outlook on life were more satisfied with their sleep, and the whole quantitative sample (n=152) was divided into two groups according to self-reported sleep satisfaction. The result from the comparative analysis showed that women who were more satisfied with their sleep were significantly more likely to have healthier lifestyle behaviours, better physical and psychological subjective health, and were more likely to have increased BMD. In conclusion, time spent outdoors may moderate the negative influence of smoking on BMD, while motivation and sleep may be salutary factors associated with improved BMD. A tentative bio-psychosocial salutary model of the association between motivation, outlook on life, sleep, lifestyle behaviours and BMD is presented.

AIM: The aim of this study was to describe the perceptions of lifestyle among women of retirement age. BACKGROUND: Women go through many transitions during their lives, which impact on their lifestyle and possibly their outlook on life. Family circumstances such as motherhood and marital status change over time and the menopause is also likely to influence their view of life. METHOD: Data were collected through interviews with 20 women, aged 61-70, selected by means of strategic sampling. The interviews were analysed using a phenomenographic approach. FINDINGS: Three structural aspects emerged: being healthy as life turns out, living life in their own way, and taking care of everyday life. The women described lifestyle as a means of being healthy, having an active role in society, being content with what one has and the need to adapt oneself to limiting circumstances. Lifestyle was also associated with being in charge and making one's own choices in life based on one's own values. They reported that they were independent and made decisions about their life. The informants considered that lifestyle was an asset that helped them to cope with everyday life and to make the most of each day. CONCLUSION: Lifestyle is a tool that requires independence, the right to self-determination over everyday life and adjustment to limitations in order to ensure the psychological well-being of women of retirement age. Further research is needed in order to delineate the possible association between lifestyle and psychological well-being.

The objective of the study was to investigate bone mineral density and bone turnover among female students aged 16-24 years in relation to lifestyle factors, such as dietary habits and physical activity, as well as physiological factors, such as age, body weight, and menstrual pattern. Female college and university students (n = 218) were given a validated questionnaire with 34 questions concerning diet, recreational physical activity, alcohol, smoking, menstrual pattern, weight gain and loss. Bone mineral density (BMD) measurements were performed using a heel bone scanner (DEXA). Deoxypyridinoline (DPD) levels were measured in urine samples. The data were analyzed by linear regression and multiple regression analysis. The mean BMD was 0.568 g/cm2. Multiple regression showed that hormonal age was a better predictor of high BMD and low bone mineral turnover than chronological age. The best model predicting high BMD was composed of physical activity, regular menstruation, hormonal age and body weight. Smoking, alcohol consumption and current calcium intake did not contribute to the model. A negative association between BMD and DPD was found, indicating an enhanced bone remodeling. A correlation was found between DPD and hormonal age, chronological age, sugar intake and time with irregular menses. In multiple regression analysis, hormonal age, high sugar intake and weight loss were the factors best predicting DPD. BMD was positively influenced by a healthy lifestyle, including a physically active life and healthy dietary habits without dieting. Our study shows that hormonal age is a stronger BMD predictor than chronological age. Menstrual disturbances might be an indication of a risk for low BMD and might therefore be a reason for measuring BMD among young females.

Achievement of a high peak bone mass is considered a pivotal preventive strategy against future osteoporotic fractures. The ostensible interaction between physiology and lifestylefor the development of bone mass over time is sparsely outlined among young women. The aim of this study was to follow bone density and bone resorption over time among healthy young women in relation to lifestyle factors and to evaluate the perceived influence of other factors. Data were collected in 1999 and in 2001. Healthy young women (n=152) were given a structured questionnaire, a heel bone scanner (dual X-ray absorptiometry) performed bone mineral density measurements and deoxypyridinoline was measured in urine. Data were analyzed by linear, multiple and logistic regression analysis. Mean bone mineral density (BMD) was 0.562 g/cm2 (+/-0.090). Bone density at baseline was the best predictorfor the bone density atfollow-up. Bone density at baseline together with smoking and alcohol (dichotomized) accounted for 86.5% of the variation in bone density 2 years later. Of the participants 62% had decreased/unchanged bone density and 38% had increased their bone density from 1999 to 2001. Use of oral contraceptives or alcohol at baseline was associated with an increased risk of belonging to the group who decreased their bone density. Deoxypyridinoline was not a strongpredictor to bone density and all potential predictors of deoxypyridinoline had a minor influence (<10%). In conclusion, lifestyle behaviors such as use of oral contraceptives, smoking and alcohol consumption seem to have a negative influence on BMD development among young women and warrant further scrutiny.

BACKGROUND: Only limited information is available on healthy young women's perspective of their own lifestyle behaviours. By lifestyle behaviours, e.g. smoking and physical activity, individuals have the possibility to influence bone mineral density (BMD). The aim of this study was to generate a theoretical model of lifestyle behaviours among young women with different BMD changes. METHODS: Data were collected by interviewing with 11 women, and the material was analysed by means of the grounded theory. FINDINGS: Two core categories were generated: (i) the respondents' outlook on life and (ii) their life situation. The respondents' outlook on life was either 'rigid' or 'relaxed'. Respondents who had a rigid outlook on life adjusted with others and had a decreased BMD while those with a relaxed outlook on life were doing things for fun and had an increased BMD level. Life situation also consisted of two categories: 'stagnation' and 'development'. Respondents in a static life situation did not pursue any active actions while in a developing life situation, the respondents were actively striving towards a goal. Four dimensions which characterized the respondents' outlook on life in relation to their life situation emerged: subordinating and enduring with a decreased BMD level or compromising and discerning with an increased BMD level. CONCLUSION: It seems as if the outlook on life has a greater influence than the acted lifestyle behaviour for bone development. Further research is needed to generalize the findings of this study and to explore the importance of the outlook on life among women of all ages.

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.

The aim was to investigate, by means of a salutogenic approach, bone mineral density (BMD) and changes in BMD over a two-year period in a group of women in relation to lifestyle behaviours and to explore their perceptions of these behaviours. The method used was multiple and sequential triangulation. Over the two years, 62% had decreased/unchanged BMD, while 38% had increased their BMD. Self-rated sleep satisfaction explained 3% of the variability in BMD and women who reported greater satisfaction with their sleep were more likely to have a healthier lifestyle. Time spent outdoors may moderate the negative influence of smoking. Women's views on lifestyle behaviours were characterised by a number of interrelated dimensions; motivation, goals, actions and strategies. Women with a relaxed outlook on life had increased BMD while women with a rigid outlook on life had decreased their BMD irrespective of smoking and physical activity. Women with a rigid outlook on life viewed actions such as lifestyle habits as a means to an end while respondents with a relaxed outlook on life, the enacted lifestyle behaviours were a goal in themselves. Motivation and sleep may be salutary factors associated with improved BMD. A tentative bio-psychosocial salutary model of the association between motivation, outlook on life, sleep, lifestyle behaviours and BMD is presented.

The aim of this study was to describe middle-aged women's perceptions of lifestyle and how it was experienced in their daily lives. Interviews with 15 women selected using network sampling were analysed using a phenomenographic approach. Lifestyle was perceived as either 'handle life', describing a framework of how everyday life should manifest itself in different areas of life, or 'relate to life' implying accepting life as it is and making the best of it based on previous experiences. In terms of providing preventive and health-promoting guiding, it is essential that nurses have an insight into people's reasoning to support them to improve health or deal with illness.

The aim of this study was to describe young women’s perceptions of lifestyle and how it was experienced in their daily lives. Traditionally, the outlook on illness and health is pathogenic, i.e. preventing illness and disease in order to achieve health, by focusing lifestyle behaviors such as physical activity and smoking. Lifestyle based on a salutary perspective cannot be measured or observed from the outside but must be described by the individual since lifestyle is an aspect of one’s life situation. Little is known about how lifestyle is perceived and what it means in ordinary people’s lives. Data were collected through interviews with 25 women selected by strategic sampling and analyzed using a phenomenographic approach. Three structural aspects emerged: enjoying life, living life, and balancing everyday life. Women described how they used lifestyle as a tool for achieving a sense of satisfaction, relaxation and happiness in everyday life. Lifestyle was also perceived as a never-ending balancing act between different personal needs and the expectations of others and society. It involved how the women used their time or lack of time as effectively as possible in order to organize their day. Lifestyle seems to be a tool in which intrinsic behaviors may be central to enhance quality of life and health. Intrinsic behaviors should be encouraged in salutary health promotion work.

The objective of the study was to explore the influence of menstrual irregularities, oral contraceptives and smoking on bone mineral density (BMD) development and bone turnover with time. Healthy young women (n = 118) were divided into four categories: (a) women neither smoking nor using oral contraceptives; (b) women who were smokers; (c) women using oral contraceptives; (d) women who were smoking and using oral contraceptives. They responded to a validated questionnaire with 34 questions concerning lifestyle and the Sense of Coherence scale (SOC). BMD was measured by dual energy x-ray absorptiometry (DEXA). Deoxypyridinoline (DPD) was measured in urine. Data were analyzed by multiple linear regression analysis. Among smokers, BMD level decreased during a 2-year period and smoking was associated with a larger negative change in BMD. Use of oral contraceptives moderated the negative impact of smoking. Women using oral contraceptives at baseline and with regular bleeding induced by contraceptive pills had a significantly higher BMD at baseline and at follow-up. They also had lower SOC than women who had natural regular bleedings. Use of oral contraceptives in combination with smoking was linked to high alcohol consumption and higher frequency of self-reported body weight reduction, which reduced the negative BMD change in this category. DPD level and difference were strongly associated with estrogen influence. It is concluded that smokers without OCs had a negative BMD development and BMD in young women with irregular menstruations seems to be improved by OC.

AIMS AND OBJECTIVES: To identify and describe nursing actions performed by nurses that create a sense of good nursing care in patients with wet age-related macular degeneration.

BACKGROUND: People who suffer from wet age-related macular degeneration risk central vision loss. Treatment with antivascular endothelial growth factor is the only available option at present that preserves vision and no definitive cure currently exists. Patients feel that they are compelled to accept this treatment because they might otherwise become blind.

DESIGN: An explorative and descriptive design based on the critical incident technique was used.

METHOD: Interviews with 16 Swedish patients who all had received intravitreal treatment for wet age-related macular degeneration.

RESULTS: Two main areas of good nursing care were identified: 'Being perceived as an individual' and 'Being empowered'. The first area was divided into two categories: being respectful and being engaged. Being respectful was observed when nurses had a benevolent attitude towards their patients and answered questions kindly and politely. Patients saw themselves as individuals when nurses were available for conversation and focused on them. The second area was divided into two categories: encouraging participation and creating confidence. Encouraging participation refers to when nurses provided information continuously. Nurses instilled confidence and trust in their patients by keeping promises and by being honest.

CONCLUSIONS: A respectful interaction between patients and caregivers is necessary for patients to obtain beneficial health care.

RELEVANCE TO CLINICAL PRACTICE: Patient interviews revealed important information about nursing actions that created a sense of good nursing care in patients with wet age-related macular degeneration. Nurses acknowledged people as individuals and created trust by building partnerships and sharing decision-making. To address each patient's concerns, nurses need to prioritise each patient's narrative and participation by documenting agreements in their medical record.

BACKGROUND: Menopause is a biopsychosocial phenomenon encompassing the transition in a woman's life from being fertile to infertile. Although menopause may result in extremely unpleasant physical symptoms there is evidence of a low rate of reported menopausal symptoms amongst women in Asian cultures. Women's experiences, views, and responses to menopause which influences women's daily life and well-being, may vary between different societies and cultures. This study aimed to explore and describe menopausal experiences among women in Sri Lanka.

METHODS: A qualitative exploratory research was conducted among postmenopausal women of 46-55 years of age in the western province of Sri Lanka. Individual interviews with a purposive sample of 20 women were conducted, and data analysis was done using manifest and latent content analysis.

RESULTS: The results consist of an overall theme, "Menopause is a natural stage of aging" and three categories "Entering a new stage", "Managing menopause" and "Not the end of life" which emerged from 34 codes. The overall theme highlights that changes in menopause were experienced as a natural change in life, with health problems that are normal for this change and handled with different self-care practices. The category "Entering a new stage" describes the women becoming aware of menopause and its bodily changes. The category "Managing menopause" describes women's experiences of being able to find their own remedies to ease the menopausal symptoms and by engaging in religious activities and focusing on interaction with people. The category, "Not the end of life" describes women's views of themselves as still valuable because menopause was experienced as a natural part of their lives.

CONCLUSION: Women in Sri Lanka managed menopausal problem mainly on their own as they viewed the menopause as a natural stage of aging risking unnecessary suffering and failure to detect preventable complications. Enabling support groups for menopausal women and improving on their health-seeking behaviour by encouraging them to take part in screening for cervical and breast cancer would improve their condition. Further information on additional hormone therapy with a, subsequent follow-up and evaluation by community health nurses and/or midwives, would facilitate Sri Lankan women's transition to menopause.

AIM AND OBJECTIVES: To explore the experiences and views of nurses who provide non-pharmacological therapies for chronic pain management in palliative care.

BACKGROUND: Nursing expertise in palliative care is essential in providing pain relief to patients with chronic diseases. Examinations of the use of non-pharmacological therapies for chronic pain management in palliative care have revealed what non-pharmacological therapies have been used, but there is insufficient knowledge regarding nurses' attitudes, views, and experiences regarding pain therapies in this context.

DESIGN: A qualitative descriptive design was chosen.

METHODS: Data were collected through individual interviews in a purposive sample with 15 nurses to ensure maximum variation. The data were analyzed using qualitative content analysis. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS: The analysis yielded four categories, as follows: "Building and sustaining favorable therapeutic relationships" involved the creation of trust and a solid relationship; in "recognizing the diversity of patients' needs," person-centered care is expressed as being vital for individualized non-pharmacological pain management; "incorporating significant others" describes how nurses can help to ease the patient's pain by identifying positive encounters with family members or friends; and in "recognizing the existence of barriers," nurses highlight vulnerable groups such as children, for whom nurses require special education to enable optimal non-pharmacologic pain management.

CONCLUSION: The unique knowledge that nurses gain about the patient through the nurse-patient relationship is central and crucial for successful non-pharmacological pain management.

RELEVANCE TO CLINICAL PRACTICE: This study emphasizes the need for nurses to get to know their patient and to be open and sensitive to patients' descriptions of their unique life situations, as this provides the necessary knowledge for optimal care and pain management. Nurses should be encouraged and given the opportunity to attend specialized training in palliative care and pain management.

Aim:

To describe patients' experiences of intravitreal injections for wet macular degeneration.

Method:

16 informants, aged 62–89 years (11 women and _five men) were interviewed after a treatment period of intravitreal injections (IVI). The first question was open ended: ‘Can you please describe, in as much detail as possible, your experiences of the period when you received three IVI?’. Qualitative content analysis was employed to analyse the transcribed interviews.

Results:

The main theme demonstrated that the patients submitted themselves to and allowed the process to run its course. Four categories emerged: handing over responsibility — they placed their trust in the healthcare professionals; being given an opportunity — they appreciated that action was taken; enduring discomfort — they endured physical discomfort and mental unease; having nothing to lose — they accepted the treatment offered.

Conclusions:

It is necessary to strengthen patient participation during IVI treatment. The ophthalmic nurse can inform the patient about the effects of the treatment in a pedagogical manner. Patient participation can be strengthened by increased knowledge of the treatment effects.

Purpose: The aim was to identify and describe nursing actions performed by nursing staff in which patients with wet age-related macular degeneration (AMD) experience good nursing care.

Method: An explorative and descriptive qualitative design based on the Critical incident technique (CIT) was used. A strategic sample of 16 patients, aged 61-87 years (eleven women and five men) with wet AMD who received intravitreal treatment were interviewed.

Results: Two main areas of good nursing care was identified during intravitreal treatment Being perceived as an individual and Creating confidence during visits, each area contained two categories. The two categories in the area Being perceived as an individual were; acting respectfully and being engaged. Acting respectfully was perceived when the nursing staff had a benevolent attitude and answered questions kindly and polite. The patients considered to be seen as an individual when the nursing staff were available for conversation and were present. The two categories in the area Creating confidence during visits were; encourage participation and inspiring confidence. Encouraging participation was perceived when the nursing staff continuously provided information. The nursing staff created confidence and trust by keeping promises and being honest.

Conclusion: The interaction in the encounter between patient and caregiver is fundamental for patients' experience of good nursing care. It emphasise the importance of personal centred care even though the time for each patient is limited and the nursing staff have a demanding schedule. It would be desirable with specific guidelines for care of patient who gets intravitreal treatment. Without specific guidelines makes it difficult to implement person centred care and more quality time would benefit the patient.

BACKGROUND:

Stroke is a life-changing event for both stroke survivors and their family caregivers. After receiving acute care at the hospital, family members are expected to take care of stroke survivors at home and to continue treatment and rehabilitation. The new role of "informal caregiver" is a challenge that creates many difficulties for family caregivers that are not explicit in the Sri Lankan context.

OBJECTIVES:

This study aimed at exploring family caregivers' experiences of providing informal care for dependent stroke survivors.

METHODS:

The sample was chosen by purposive sampling with a maximum variation by age, ethnicity, religion, educational level, relationship, and monthly income. Ten informal family caregivers to stroke survivors with hemiplegia who had been treated at the National Hospital of Sri Lanka participated in in-depth interviews analyzed using conventional content analysis.

RESULTS:

Qualitative content analysis of data resulted in an overriding theme, "Caring with love, against all odds," along with four categories, "Life alterations," "Lack of resources," "Compassionate care," and "Coping strategies." Although the increased workload, restricted social life, physical problems, and knowledge and financial deficits were challenging for the family caregivers, self-strength and supportive social networks helped them to compassionately care for their stroke survivor.

CONCLUSIONS:

The phenomenon of family caregivers providing informal care for stroke survivors was explicated as compassionate care, notwithstanding numerous difficulties. The findings motivate further research and strategies to minimize family caregivers' burden and facilitate the positive aspects of caregiving to promote the health and well-being of both stroke survivors and their families.

Nurse assistant has as first-line caregivers in care of older people, a unique opportunity to encourage physical activity and exercise in older people. Hence,the staff’s perceptions about physical activity and exercise among older persons are essential. The aim of this study was to describe how nurse assistants in their work perceived physical activity and exercise for older people over 65 receiving home care and home help services. Method: Data were collected through interviews with 19 nurse assistants selected by strategic sampling and analysed using a phenomenographic approach. Results: The findings show two different perceptions of physical activity: “physical activity is to move “as everyday movements that older people did in activities of daily living andoutdoors activities and “physical activity is to make an effort” which older people makes handling their daily living and outdoors activities or struggling to be less inactive with healthy activities. Three differen tperceptions of exercise emerged: “exercise as physical activity” as movements that could be done either through an individual exercise programs from physiotherapist or by activities of daily life such as dressing, cleaning or shopping; “exercise as rehabilitation” as part of the rehabilitation processor as a prescription to follow and “exercise as an agent” enhancing health and well being of older people principally related to the mobility or enhancing older people’s social activities. Conclusion: By describing nurse assistants perceptions of physical activity and exercise among older people, this study provides information about two different approaches used by nurse assistants inhome help services. Nurse assistants have two different approaches towards the older person: a health promoting approach and a preventive approach. An educational awareness about the different approaches could enable staff to engage and support the older person to be physically active and to exercise regularly. A supportive organisation with flexibility and a closely collaboration between social services and health professionals could facilitate and strengthening a health promoting and a preventive approach by nurse assistant.