Arun K. Sigurdardottir

Instruments to tailor care of people with type 2 diabetes

AIM This paper is a report of a study conducted to assess the effectiveness of an educational intervention for people with type 2 diabetes based on self-completed instruments to identify particular areas of self-care needs. BACKGROUND Diabetes is a demanding disease which requires self-care. Instruments that identify self-care needs or factors affecting self-care can be helpful to detect level of self-care, distress or knowledge among individuals with diabetes. METHODS Participants were randomized into intervention (n = 28) or control groups (n = 25). Both groups answered five validated instruments three times, at baseline and after 3 and 6 months, and biological measurements were conducted simultaneously. The intervention was based on an empowerment approach. The study started in November 2005 and lasted until March 2007. FINDINGS There was no statistically significant difference between groups in level of glycated haemoglobin postintervention as it reduced statistically significantly in both groups between baseline and 3 months but increased again after 6 months. There was no statistically significant difference between groups in body mass index reduction; the intervention group achieved a statistically significant body mass index reduction but this was unchanged in the control group. No statistically significant differences between groups were found in scores for empowerment, well-being and distress. There was a statistically significant difference between groups in knowledge postintervention. CONCLUSION Use of instruments to identify self-care needs can enable patient-tailored care as it allows direct focusing on issues that are challenging and of relevance for each individual. It seems to be feasible to use the telephone to conduct an empowering educational intervention after one meeting.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries.

BACKGROUND In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. OBJECTIVES To describe and compare the CMs role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. DESIGN A case study design. PARTICIPANTS AND SETTING A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). METHODS A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. RESULTS In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. CONCLUSIONS Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.

Clinical practice models in nursing education: implication for students' mobility.

BACKGROUND In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. AIMS The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. METHODS A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. RESULTS Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. CONCLUSIONS A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience.

Empowering knowledge and its connection to health-related quality of life: A cross-cultural study: A concise and informative title: Empowering knowledge and its connection to health-related quality of life.

AIMS Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty. METHOD This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden. RESULTS The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece. CONCLUSIONS Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

What is a good educator? A qualitative study on the perspective of individuals with coronary heart disease.

Background: Patient views are especially important in patient education, as patient involvement is essential. However, no empirical research clarifies what knowledge, skills and competencies are needed for health professionals to competently serve as a good educator according to the patients themselves. Aim: To explore what qualities patients with coronary heart disease perceive in a good educator. Methods: A qualitative research method, with semi-structured individual interviews, was used in this study. Purposeful sampling was used to recruit participants from a general hospital in Iceland and in Norway. The data were analysed using systematic text condensation. Results: The participants included 17 patients who had been through a percutaneous coronary intervention and participated in formal patient education after discharge from hospital. The patients saw a good educator as one who they feel is trustworthy and who individualizes the education to patients’ needs and context and translates general information to their personal situation in lay language. Building trust was dependent on the patients’ perceiving the educator to be knowledgeable and good at connecting with the individual patient, so that the patients feel they are being treated as a whole person with equality and respect. Conclusions: The patients perceived the capability of building trust and tailoring the education to the individual as the most prominent characteristics of a good educator. Training skills that facilitate patients’ trust, being observant of the patient and his learning needs and adjusting the patient education to individual needs and situations should be key objectives in health professionals’ training in patient education.

Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.

Bologna process, more or less: nursing education in the European economic area: a discussion paper.

Abstract The Bologna Declaration and the subsequent processes is the single most important reform of higher education taking place in Europe in the last 30 years. Signed in 1999, it includes 46 European Union countries and aimed to create, a more coherent, compatible, comparable and competitive European Higher Education Area. The purpose of this paper is to discuss the Bologna Declaration achievements in nursing education at 2010 within eight countries that first signed the Declaration on 1999. Researchers primarily identified national laws, policy statements, guidelines and grey literature; then, a literature review on Bologna Declaration implementation in nursing was conducted on the Medline and CINAHL databases. Critical analyses of these documents were performed by expert nurse educators. Structural, organizational, functional and cultural obstacles are hindering full Bologna Process implementation in nursing education within European Economic Area. A call for action is offered in order to achieve a functionally unified system within nursing.

Characteristics of nursing studies in diabetes research published over three decades in Sweden, Norway, Denmark and Iceland: a narrative review of the literature

Similarities and differences across borders of Nordic countries constitute a suitable context for investigating and discussing factors related to the development of diabetes nursing research over the last three decades. The present study reviewed the entire body of contemporary diabetes nursing research literature originating in four Nordic countries: Norway, Sweden, Denmark and Iceland. Our aims were (i) to catalogue and characterise trends in research designs and research areas of these studies published over time and (ii) to describe how research involving nurses in Nordic countries has contributed to diabetes research overall. The larger goal of our analyses was to produce a comprehensive picture of this research in order to guide future studies in the field. We conducted a narrative literature review by systematically searching Medline, Medline in process, EMBASE, CINAHL, PsycINFO and Cochrane databases. These searches were limited to studies published between 1979 and 2009 that had an abstract available in English or a Nordic language. Two researchers independently selected studies for analysis, leading to the inclusion of 164 relevant publications for analysis. In summary, Nordic nurse researchers have contributed to the development of new knowledge in self-management of diabetes in childhood, adolescence and adulthood, and to some extent also in the treatment and care of diabetes foot ulcers. Future research may benefit from (i) larger nurse-led research programmes organised in networks in order to share knowledge and expertise across national groups and borders, (ii) more multidisciplinary collaborations in order to promote patient-centred care and (iii) further research directed towards improving the dissemination and implementation of research findings. Using complex intervention designs and a mix of research methods will enrich the research.

Socioeconomic status and differences in medication use among older people according to ATC categories and urban–rural residency

Aims: To study how selected indicators of socioeconomic status and urban–rural residency associate with medication use in form of number of daily medications, polypharmacy, and medication use according to Anatomic Therapeutic Classification (ATC) system. Methods: Cross-sectional, population-based study among older community-dwelling Icelanders. Criteria for participation were: age ≥65 years, community-dwelling, and able to communicate verbally and to set up a time for a face-to-face interview. Information on medication use was obtained by interviews and by examining each person’s medication record. Medications were categorised according to ATC system. A questionnaire and the physical and mental health summary scales of SF-36 Health Survey were used to assess potential influential factors associated with medication use. Results: On average, participants (n=186) used 3.9 medications, and the prevalence of polypharmacy was 41%. No indicators of socioeconomic status had significant association to any aspects of medication use. Compared to urban residents, rural residents had more diagnosed diseases, were less likely to live alone, were less likely to report having adequate income, and had fewer years of education. Controlling for these differences, urban people were more likely to use medication from the B and C categories. Moreover, older urban men, with worse physical health, and greater number of diagnosed diseases used more medications from the B category. Conclusions: There are unexplained regional differences in medications use, from categories B and C, by older Icelanders. Further studies are needed on why urban residents used equal number of medications, or even more medications, compared to rural residents, despite better socioeconomic status and fewer diagnosed diseases.

Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes

Introduction: The increasing prevalence of diabetes worldwide entails an expected rise in the number of older individuals with diabetes needing nursing home placement. Internationally, a consistent lack of adherence to clinical guidelines has been identified in the care of older people. In this study, we therefore investigated whether diabetes management in a sample of nursing homes in Norway and Iceland was in accordance with clinical guideline recommendations. Methods: We used a descriptive cross-sectional study design to assess diabetes management in 12 nursing homes: eight in Norway and four in Iceland. Results: We identified 162 residents with diabetes. The diagnosis of diabetes was available for 100% of the residents in the nursing homes in Iceland and respectively for 81 and 51% of the residents in southwestern and northern Norway. Totally, 3% of the residents with diabetes had a treatment goal for blood glucose regulation (HbA1c) documented in their medical record, 48% had agreed individualized routines for blood glucose measurements and 37% had a HbA1c value measured within the past 6 months available in their medical record. Conclusion: This study has shown a significant discrepancy between diabetes guideline recommendations and clinical diabetes practice related to documenting the diagnosis and type of diabetes, the establishment of individualized treatment goals for HbA1c and the establishment of routines for blood glucose and HbA1c measurements in nursing homes in Norway and Iceland. The results indicate a potential for improvement and a need for more nurses with advanced competence within diabetes in nursing homes.