Anna Kristensson Ekwall

The experience of being next of kin to an older person in the last phase of life

OBJECTIVE The aim of the study was to investigate the experience of being next of kin to an older person in the last phase of life as narrated after the older persons death. METHOD Qualitative interviews were performed with the next of kin (n = 17) to people aged 75 years and older who had recently died and had received help and/or care from the municipality in the last phase of life. Eleven women and six men participated, of whom seven were spouses, nine were children, and one was a grandchild. The interviews were analysed using qualitative content analysis. RESULTS The experience of the next of kin could be understood as being a devoted companion during the transition toward the inevitable end, embracing the categories of living in the shadow of death; focusing on the needs of the dying person, making adjustments to everyday life; feeling the major responsibility; struggling with the health and social care system; and gaining strength from support. SIGNIFICANCE OF RESULTS Being next of kin to an old person at the end of life means being a devoted companion during the transition toward the inevitable end, including the feeling of bearing the major responsibility and the need to be acknowledged by professionals. This study points to the importance of having access to professional care when it is needed, to complement and support the next of kin when his or her own resources and strength falter. This also includes support to enable the next of kin to remain involved in the care of his or her loved ones, thereby fulfilling their own wishes.

Anxiety as a factor influencing satisfaction with emergency department care: perspectives of accompanying persons

AIM To measure levels of anxiety among people accompanying consumers to the emergency department and to explore how anxiety influences satisfaction with care. BACKGROUND When people seek treatment in an emergency department they are often accompanied by a next-of-kin, family member or friend. While the accompanying person plays a vital role in providing psycho-social support to consumers, little is known about how they perceive the quality of care. Learning more about how accompanying persons perceive care may inform the development of strategies to enhance communication processes between staff, consumers and accompanying persons. DESIGN; A prospective cross-sectional survey design. METHODS Data were collected from a consecutive sample of accompanying persons at one Australian metropolitan teaching hospital. Of all eligible individuals approached, 128/153 (83.7%) returned completed questionnaires. The questionnaire comprised a series of open- and close-ended questions about perceptions of medical need, urgency and satisfaction with the overall visit. Anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A). RESULTS There was a significant association between the accompanying persons levels of anxiety and satisfaction at point of discharge. In the satisfied group, mean VAS-A scores were 17.4 (SD 17.5) compared to 42.9 (SD 26.6) in the not satisfied group (p = 0.011). Moreover, those participants who were not satisfied with the visit did not show a significant reduction in VAS-A scores from triage to point of discharge. CONCLUSION The lower the level of anxiety reported by accompanying persons when leaving the emergency department, the more satisfied they are likely to be with their emergency department visit. Ultimately, well informed and confident accompanying persons are beneficial for ensuring quality patient support. RELEVANCE TO CLINICAL PRACTICE Asking accompanying persons about their anxiety level before discharge gives them the opportunity to pose clarifying questions and is, therefore, an effective way of improving their satisfaction with the emergency department visit.

Case managers for frail older people: a randomised controlled pilot study

AIM The aim was to test sampling and explore sample characteristics in a pilot study using a case management intervention for older people with functional dependency and repeated contact with the healthcare services as well as to investigate the effects of the intervention on perceived health and depressed mood after 3 months. The aim was also to explore internal consistency in the life satisfaction index Z, activities of daily living-staircase and Geriatric Depression Scale-20. METHOD This pilot study was carried out in a randomised controlled design with repeated follow-ups. In all, 46 people were consecutively and randomly assigned to either an intervention (n = 23) or a control (n = 23) group. Two nurses worked as case managers and carried out the intervention, which consisted of four parts. RESULT No differences were found between the groups at baseline. The results showed the participants had low life satisfaction (median 14 vs. 12), several health complaints (median 11) and a high score on the Geriatric Depression Scale (median 6) at baseline, indicating the risk of depression. No significant effects were observed regarding depressed mood or perceived health between or within groups at follow-up after 3 months. Cronbachs alpha showed satisfactory internal consistency for group comparisons. CONCLUSIONS The sampling procedure led to similar groups. The life satisfaction, functional dependency and symptoms of depression measures were reliable to use. No changes in perceived health and symptoms of depression were found after 3 months, indicating that it may be too early to expect effects. The low depression score is noteworthy and requires further research.

Psychometric properties of the consumer emergency care satisfaction scale: tested on persons accompanying patients in emergency department.

The aim of this study was to investigate construct validity and internal consistency of a modified version of the Consumer Emergency Care Satisfaction Scale used on persons accompanying emergency department patients. The sample comprised 128 persons. The results showed satisfactory reliability, and an exploratory factor analysis revealed 3 factors: caring, teaching, and clinical competence. The modified version of this scale seems feasible and may be a useful tool for measuring satisfaction in persons accompanying patients in the emergency department.

Patient satisfaction with ambulance care services: survey from two districts in southern Sweden.

INTRODUCTION One of several quality indicators that are relevant to study is patients satisfaction with health care in the ambulance services. Regular measurements of patient satisfaction in this field have not been carried out previously and a validated method of measurement is lacking. PURPOSE This study aimed to measure patient satisfaction with health care in the ambulance services in Region Skane, southern Sweden. METHOD Data collection was performed by a patient questionnaire, Davis Consumer Emergency Care Satisfaction Scale© (CECSS). The study was conducted in two of the regions ambulance districts, and 40 patients (20 informants from each of the two sites) were included in the study. RESULTS Of the included patients 67% were women (n=27) and 33% men (n=13) with an average age of 65.6years (r=22-87). Informants average time of care in the ambulance was 31 min (r=12-75). A majority of the responses (93.1%) showed the most positive response option on each question position. CONCLUSION The present study shows that patients within ambulance care in the region of southern Sweden were pleased with the care received and the competence of the ambulance staff, and the patients experienced a high level of psychological and physical sense of security.

Testing a Swedish version of the Consumer Emergency Care Satisfaction Scale in an emergency department and 2 observation wards.

The aim was to investigate the construct validity and internal consistency of the Swedish version of the Consumer Emergency Care Satisfaction Scale. The sample comprised 157 persons from an emergency department and an observation ward. The results showed satisfactory reliability, and an explorative factor analysis revealed 3 factors: Caring, Teaching, and Clinical Competence. The Swedish version of the scale seems reliable and may be a useful tool for measuring satisfaction in different acute care settings.

Compensating, controlling, resigning and accepting-older person's perception of physical decline.

It is important to know about how frail older people experience their physical decline and how they adapt to their bodily changes so that the health system can design preventive interventions targeting this group early on in the disability process.The aim of this study was to explore how older people perceive their physical decline. The study is qualitative in design and based on interviews with older persons, who were in an acute care process. Fourteen people, five men and nine women, aged 74 � 92 years (mean 81 years) were included in the study. Content analysis was used. The main finding was that physical decline was marked as occurring in two dimensions. One dimension was the physical decline and its impact on the individuals physical body (labelled individual body). The other dimension was the impact on the body in its environmental context such as the home or the society (labelled contextual body). The strategies for adapting constituted the two sub-themes, which were labeled compensating/controlling and accepting/resignation. The strategies were executed both on an intellectual level and practical level. For healthcare workers striving to increase physical activity, knowledge about how closely related self-image and physical ability are is useful when helping the frail older people. Increasing coping strategies for handling the general life situation may be a useful way of increasing physical activity and making it feel meaningful, despite the persons frail health situation with limited physical and sometimes psychological resources.

The meaning of significant others’ encounter with the ambulance clinicians in a non-emergency care context

The ambulance service is often summoned by a significant other. Therefore the ambulance clinician is expected to establish a trusting relationship with her/him and not focus solely on the patient. The aim of this study was to illuminate the meaning of significant others’ encounter with ambulance clinicians in a non-emergency ambulance care context, where patients were triaged to a level of care below that of the Accident and Emergency Department. The design was inductive. We used the phenomenological hermeneutic method developed by Lindseth and Norberg. Eleven significant others were interviewed using an open-ended method. A structural analysis resulted in a total of seven themes, covering the meaning of being de-burdened or the absence of de-burdening. When de-burdened, the significant other was empowered, irrespective of the outcome of the medical assessment and triage process. In the absence of de-burdening, the significant other felt inferior, petty, de-powered and not taken seriously by the ambulance clinicians. The majority of ambulance assignments are considered non-emergency care. The ambulance clinicians are the first to encounter significant others in these situations and therefore have a huge obligation to understand and handle their basic needs.

Thresholds for minimum data set quality indicators developed and applied in icelandic nursing homes.

A modified Delphi method was used to determine thresholds for Minimum Data Set quality indicators for Icelandic nursing homes. The thresholds were then applied to quality outcomes in Icelandic nursing homes for the year 2009. The thresholds indicate areas of good or poor care and can be used for planning services. Icelandic nursing homes seem to be doing best in incontinence and nutritional care. However, improvement is needed in care practices for depression, medication, and activity.

Hospital admission in older persons presenting with dizziness in the Emergency department.

One of the most frequent chief complaints among older persons presenting in the emergency department (ED) is dizziness. Nurses in the ambulance and in the ED play an important role in managing these patients. The challenge in the ED or ambulance is to, with limited diagnostic equipment; decide the correct level of care. The aim of this study was to identify factors that differed between those who were admitted to hospital and those who were not among older persons (65+) presenting in the ED with dizziness. The method was a retrospective journal audit. The sample consisted of persons (n=166) aged 65+ presenting in the ED with dizziness. Factors that were more frequent among those admitted to hospital were arriving with ambulance, priority and number of medications and high age. Forty percent of the dizzy patients were admitted to the hospital, 50% among those arriving with ambulance and 24% of the walk-in patients. Among the 166 patients included in the study because of dizziness, 64 different discharge diagnoses emerged, illustrating the complex nature of dizziness as a symptom. The results from this study can help the ambulance or ED nurse doing the first assessment with limited information and initiating the management, knowing what factors that are more frequent in older persons being admitted when presenting with dizziness.