The demands on the healthcare staffs’ competence and performance are increasing. Evidence based nursing should be carried out with a scientific knowledge and approach in order to secure patients safety. The staff at a surgical clinic noticed that a great number of their patients suffered from nausea post operatively.

*        Objectives: to evaluate the effects of the implementation of a programme for post surgical nausea, for patients that had elective surgery in the abdominal and intestinal areas.

Method: The study had a quantitative, descriptive, pre- and post comparative design. A questionnaire was used at two occasions, before (the control-group) and after (the intervention-group) the implementation of a programme for post surgical nausea.

Results: Significant differences were observed in that the intervention-group experienced fewer problems with nausea and vomiting post operatively in comparison to the control-group.

The aim of the study was to capture the older persons' experiences in relation to foodand meals in ordinary housing.

Method:Semi-structured interviews, with twelve older persons, on the basis of the instrument

"Seniors in the community: Risk Evaluation for Eating and Nutrition, Version II" (SCREEN II). The interviews were analyzed with manifest and latent content analysis.

Results:Respondents described how past life largely influenced their current experiences and views on food and meals. Increased reliance and need for support arose frequently in connection with a major change in the life situation. The results showed that the SCREEN II is useful for measuring the risk of malnutrition under Swedish conditions.

Conclusions: Older people's knowledge about good and nutritious food as well as individual needs for self-determination and feeling involved should be considered in planning and development efforts related to food and meals in ordinary housing. SCREEN II can be considered as an appropriate instrument to use in the context of preventive home visits, in order to identify risk factors that can cause malnutrition. Further research in larger samples is needed.

Denna rapport äe en redogörelse för hur Sjuksköterskeprogrammet vid Högskolan Kristianstad har arbetat med att utveckla, pröva och införa en klinisk slutexamination i programmets sista termin. Hela processen har genomförts inom ramen för ett nationellt samarbete mellan flera lärosäten. Det samarbetet har nu fastlagts och modellen börjar införas i landet.

En enkätutvärdering som genomförts under vårterminen 2006 vid Högskolan Kristianstad redovisas i sin helhet i rapporten. Slutsatsen som kan dras av utvärderingen är att examinationen genomfördes väl och att deltagarna var nöjda. I enskilda fall hade funnits möjlighet att ställa högre krav på studenterna eftersom den valda patienten hade få omvårdnadsbehov.

Efter hand som alla bedömande sjuksköterskor och examinerande adjunkter får mera erfarenhet av examinationsformen räknar vi med att kontinuerligt kunna förbättra modellen.

Objective: The aim of the study was to describe how patients who have undergone surgery due to oesophageal or gastric cancer experience the postoperative information before and after discharge from hospital.

Methods:  Eleven patients were interviewed. Interviews were tape-recorded, transcribed and latent content analysed.

Results:  Even though the patients describe being satisfied with the care at the hospital, many patients experienced the postoperative information as partly insufficient. Postoperative information helped patients experience control in their daily life, made them feel secure in the new life situation and confident about the future. The patients described needing information from several different sources at the hospital and after discharge.

Conclusion:  Information is fundamental to enable patients to manage their new life situation. It is a challenge for health care professionals to both standardise the postoperative information and individualise the information according to the needs of each individual. Studies are needed of implementation of an information program enabling patients to feel in control, secure and confident about the future.

The aim of this study was to make an assessment of fall risk among persons in hospitals and among those living in special accommodation (long-term care).

Method: Nurse students collected the data during their clinical education at hospitals and in special accommodations in 2008 and 2010. Staff and clinical teachers participated also with the data collection. By participating in the study the students got training in how to provide information to the staff and patients/residents, collect data, and compile results and to give feed-back about the findings to the department. The assessment of fall risk was done using the Downton Fallrisk Index (risk of fall >3 points). Both years all patients/residents were there were nurse students were asked to participate, in the study.

Results: In the entire sample the prevalence of fall risk in year 2008 was 73% an in year 2010 was 69%. The mean score in the Downton Fallrisk Index in year 2008 was 3,7 and in year 2010 it was 3,5. At the hospitals in year 2008 and 2010 it was 66% and 58% respectively that had risk of fall while the corresponding prevalence in the special accommodations was 86% and 85%. The average time to carry out the assessment of fall risk was 10 minutes (median). The majority of the students agreed that the questions in Downton were relevant, easy to understand and that the answer alternatives also were easy to understand.

The majority of the students 2008 and 2010 (2008, course 6: 76% respectively course 16: 65% and in 2010, course 6: 38% respectively course 16: 61%) stated that they received better scientific-knowledge, through participating in the study. It is of importance too note that the course 6 students in 2010 did not receive any verbal information before the study, which probably negatively influenced the experience of contributing in the study.

Conclusion: In special accommodations the prevalence of fall was higher than in hospitals. The Downton Fallrisk Index seems to bee a useful and simple instrument to use. In general the nursing students experience is positive to participate in a real research project. However, a pre-requisite for the positive experiences from participating is most likely that they get, verbal information goof before participating in the study.

Summary: The aim of this study was to explore the prevalence of eating difficulties and malnutrition among persons in hospitals and among those living in special accommodations (long-term care). In addition the aim was to, within special accommodations, explore how different interventions could affect the precision in nutritional care and the occurrence of underweight/overweight, both from a short as well as a long-term perspective.

Methods: Nurse students collected the data during their clinical education at hospitals and in special accommodations in years 2005, 2007, and 2009. Staff and clinical teachers participated also with the data collection. By participating in the study the students got training in how to provide information to the staff and patients/residents, collect data, and compile results and to give feed-back about the findings to the department. Underweight and overweight was assessed from BMI. Undernutrition risk was assessed based on: unintentional weight loss, low BMI, and/or the occurrence of eating difficulties. Assessments were also made regarding what nutritional care the care recipients got. In the special accommodations interventions with study circles (two municipalities), nutritional care policy (one municipality) and in four municipalities no specific intervention was made. The prevalence of overweight was 39-42%.

Results: In hospitals the prevalence of moderate/high undernutrition risk was 27-28% and if also those with little risk were included the prevalence was 60-63%. Between 4-7% were provided with protein- and energy enriched food, 25-30% got oral supplements or similar and 12-13% needed eating assistance.

In special accommodations the prevalence of moderate/high undernutrition risk was 27-35% and if also those with little risk were included the prevalence was 65-70%. The prevalence og overweight was 30-33%. Between 4-14% were provided with protein- and energy enriched food, 11-19% got oral supplements or similar and 47-50% needed eating assistance. Within the special accommodations it was shown that the intervention with study circles lead to improvements in the precision of nutritional care (protein- and energy enriched food and/or oral supplements) and a lower prevalence of underweight was seen, at least shortly after that the intervention was finished. In the same way the anchoring and implementation of the nutritional care policy resulted in improvement in the nutritional care. These improvements remained however also a long time after the implementation. 

Most of the students (81%) experienced that they did get better understanding for research by participating in the study, more than half (53%) thought that their interest in assessment of eating and nutrition increased and 67% that their knowledge about eating and nutrition increased.

Conclusion: Many patients and residents are at risk of becoming undernourished. This demands that adequate measures are taken to prevent or treat undernutrition. Such measures can be protein- and energy-dense food and oral supplements or similar. In the special accommodations can study circles for the staff lead to improvements in the nutritional care for more residents in a short-term perspective and by implementing a nutritional care policy also long-term positive effects are likely to be achieved. Combining study circles with implementation of nutritional care policies can be the focus for new studies.

In general the nursing students experience it as positive to participate in a real research project.

The aim of the study was to map out pain and pain treatment among patients in hospitals and persons in special accommodations as well as in ordinary living.

Method: Nurse students collected the data during their clinical education at hospitals and in special accommodations or in ordinary living. Also the clinical teachers helped out with supporting the students during data collection. The students made assessments of pain where they had their clinical practice during the spring 2009. The students got, though collecting data, a training in how to provide information to the staff and patients/residents, compile results and to give feed-back about the findings to the department. The study was not conducted as a total survey, in other words was a selection of respondents that were included in the results.

Results: In total 419 assessments of pain was made and 35% of respondents reported long standing pain and 14% reported acute pain. The respondents with long standing pain were older (76 years and 69 years respectively), more women (67% and 53% respectively) and more were in special accommodations or in ordinary living (37% and 17% respectively) than among those with acute pain. The respondents with acute pain more often agreed with that the staff asked about if he/she had pain (84% and 73% respective) while the respondents with long standing pain to a greater extent agreed with that they tried to hide their own pain (acute pain: 43% resp. long standing pain: 59%). The most common strategies to handle the pain among those with acute pain was to ask for something to alleviate the pain (84%), lie down and rest (78%) or to try thinking on something else (64%) while it among those with long standing pain was to lie down and rest (83%), ask for something to alleviate the pain (73%) or to try thinking on something else (70%). Of the students that collected the data and reported the findings to the staff 51 also evaluated their participation in the study. Of these, 74% experienced that their understanding for research increased, 51% that their interest för pain assessment had increased and 55% that their knowledge about pain had increased.

 Conclusion:

Long standing pain was most common among women and elderly persons. The strategies used among the participants for making staff aware about the pain, and the strategies to handle once own pain differed depending on weather the pain was acute or long standing. Participating in the data collection and other research activities has a positive effect for nursing students understanding for research and to some extent for their interest in the area under study.

This report describes the initial stages of the Swedish adaptation of "Seniors in the community: Risk evaluation for eating and nutrition, Version II" (SCREEN II) that has been developed by Heather Keller.

Aim

The aim with this project was to evaluate study circles with focus on eating and nutrition from different perspectives.

Method

Several different methods have been used, for instance did participants in the study circles continuously evaluate their experiences (structured form), comparisons between the first study circles and the later ones were made, comparisons between participants and non-participants were also made, undernourishement and care actions were surveyed before and after implementation of study circles and finally a focus group interview was made with project leaders, participants and study circle leaders.

Results and conclusions

When comparing the early study circles with later ones it was shown that a full day study circle leader education gave a better outcome than a short introduction to leading study circles. It was also indicated that by systematically carrying through study circles by the time it is created a better climate at the place of work which also contributes to a more positive view on what the study circles bring about to oneself and to the team. A metaphor for this could be that the study circles create “circles on the water”, i.e. more study circles with the same focus at the working place – the better results.

When comparing the views from persons that participated in study circles and those who did not it was shown that attitudes and knowledge with respect to food and mealtimes were affected in some aspects in a positive way among those that had participated in a study circle.

In comparisons between three interventions, i.e. no intervention, implementation of a policy document and implementation of study circles to increase the competence among the staff it was concluded that a combination of study circles and implementation of a policy document for screening and treatment/prevention of undernourishment might be the intervention that can give the best outcome by increasing the precision in nutritional care and decreasing the number of residents having a low BMI. In the same way the precision might increase if there is a specific focus on what method to use for detecting undernutrition risk and on what actions that should be taken for persons being at risk for undernutrition. In any intervention it is important to also consider residents being overweight or being at risk for developing overweight.

In total it was 592 persons divided on 71 study circles that participated. Of those it was 98% that regarded the content in the study circles as very interesting/interesting, 94% thought that the content was very relevant/relevant and 92% that the degree of difficulty was just right/easy. When the participants self rated their knowledge about eating and nutrition as it was before and after having participated in the study circle a significant improvement was seen. Before participating it was 72% that thought they had enough/great knowledge and afterwards it was 96%.

The focus group interview showed that study circles contributed to that the staff contemplated eating and nutrition in an equivalent way, prerequisites for and effects from study circles could be described and the need for a continuation was stressed. Many results was shown that are important to consider when implementing study circles as an intervention for improving eating, mealtimes and nutrition. Some of the results confirm what has been shown in the continuous evaluations described above. The study circles were regarded as an outstanding pedagogic method by getting the staff from the same unit to focus on a specific area and setting goals adapted to the working place context. It was expressed that one person alone has difficulties to achieve changes in an organisation, a group has better chances, and if many groups/teams have gone through the same study circles one becomes stronger and have a better chance to achieve changes, one gets the same view.

It was also clear that homogenous groups were to prefer instead of heterogeneous groups, i.e. the participants should come from the same working place. It was also a huge advantage that staff from the kitchens participated. The communication between the staff at the wards and the staff in the kitchens improved, and that was one of the main gains achieved with the intervention.

The study circle seems to be the ideal pedagogic method to achieve improvements in meal, mealtimes and nutrition in special accommodations. One person has little chance to achieve changes at the ward but together the chances increase. It is also described as difficult to alone transform the knowledge from an education day to the own context. Of course, the choice between study circles or any other education must also depend on the aim of the education and of participating in it.