Barbro Wadensten

Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden.

AIMnThe aim of this study was to investigate the prevalence of pain and pain assessment among inpatients in a university hospital.nnnBACKGROUNDnPain management could be considered an indicator of quality of care. Few studies report on prevalence measures including all inpatients.nnnDESIGNnQuantitative and explorative.nnnMETHODnSurvey.nnnRESULTSnOf the inpatients at the hospital who answered the survey, 494 (65%) reported having experienced pain during the preceding 24 hours. Of the patients who reported having experienced pain during the preceding 24 hours, 81% rated their pain >3 and 42.1% rated their pain >7. Of the patients who reported having experienced pain during the preceding 24 hours, 38.7% had been asked to self-assess their pain using a Numeric Rating Scale (NRS); 29.6% of the patients were completely satisfied, and 11.5% were not at all satisfied with their participation in pain management.nnnCONCLUSIONSnThe result showed that too many patients are still suffering from pain and that the NRS is not used to the extent it should be. Efforts to overcome under-implementation of pain assessment are required, particularly on wards where pain is not obvious, e.g., wards that do not deal with surgery patients. Work to improve pain management must be carried out through collaboration across professional groups.nnnRELEVANCE TO CLINICAL PRACTICEnUsing a pain assessment tool such as the NRS could help patients express their pain and improve communication between nurses and patients in relation to pain as well as allow patients to participate in their own care. Carrying out prevalence pain measures similar to those used here could be helpful in performing quality improvement work in the area of pain management.

Evidence-based practice: the importance of education and leadership

AIMnTo describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors.nnnBACKGROUNDnRegistered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance.nnnMETHODnAll 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire.nnnRESULTSnThe majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities.nnnCONCLUSIONSnThe present study highlights the value of education in research methods and the importance of supportive leadership.nnnIMPLICATIONS FOR NURSING MANAGEMENTnEducation is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.

Nurses' experiences of and opinions about using standardised care plans in electronic health records--a questionnaire study.

AIMnThe aim of the present study was to investigate nurses opinions about using standardised care plans in electronic health record and quality standards for clinical practice.nnnBACKGROUNDnFollowing introduction of an electronic health record, use of standardised care plans and quality standards has increased among nurses at two hospitals in Sweden. Understanding nurses opinions is important to continued development in this area. There are few previous studies on nurses opinions about standardised care plans.nnnDESIGNnSurvey.nnnMETHODnThe study was quantitative, descriptive and based on a questionnaire. The questionnaire included items on nurses knowledge of and opinions about standardised care plans and quality standards.nnnRESULTSnThe majority of the nurses were of the opinion that standardised care plans increase their ability to provide the same high-quality basic care for all patients. They also thought that a common standardised care plan across several professions would improve conditions for provision of high-quality care. The majority of the nurses also felt that the quality standards are a prerequisite of maintaining standardised care plans of high quality. There was no consensus on whether standardised care plans increase the risk of failing to notice patients individual problems. Most agreed that standardised care plans decrease documentation time as well as redundant documentation. The study showed that training is needed to teach nurses how to use standardised care plans in care provision.nnnCONCLUSIONSnThe nurses in the study had positive attitudes towards use of standardised care plans and felt that they could facilitate nursing practice.nnnRELEVANCE TO CLINICAL PRACTICEnUse of standardised care plans can improve nursing documentation and facilitate work for nurses. Moreover, it can support nurses in their use of evidence-based nursing methods. The present study shows that nurses have positive attitudes, which could facilitate continued use of standardised care plans.

Patient information and participation still in need of improvement: evaluation of patients’ perceptions of quality of care

AIMSnTo identify areas in need of quality improvement by investigating inpatients perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission.nnnBACKGROUNDnNursing managers play an important role in the development of high-quality care.nnnMETHODSnQuality of care was assessed using the Quality from the Patients Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP.nnnRESULTSnInadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors care than did patients with planned admissions.nnnCONCLUSIONnResults from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role.nnnIMPLICATIONS FOR NURSING MANAGEMENTnNursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.

Nurses' Workplace Distress and Ethical Dilemmas in Tanzanian Health Care:

The aim of this study was to describe Tanzanian nurses meaning of and experiences with ethical dilemmas and workplace distress in different care settings. An open question guide was used and the study focused on the answers that 29 registered nurses supplied. The theme, `Tanzanian registered nurses invisible and visible expressions about existential conditions in care, emerged from several subthemes as: suffering from (1) workplace distress; (2) ethical dilemmas; (3) trying to maintaining good quality nursing care; (4) lack of respect, appreciation and influence; and (5) a heavy workload that did not prevent registered nurses from struggling for better care for their patients. The analysis shows that, on a daily basis, nurses find themselves working on the edge of life and death, while they have few opportunities for doing anything about this situation. Nurses need professional guidance to gain insight and be able to reflect on their situations, so that they do not become overloaded with ethical dilemmas and workplace distress.

Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement

Aim nTo investigate registered hospital and nursing home nurses experiences of coordination and communication within and between care settings when older persons are transferred from nursing homes to hospital and vice versa. n nBackground nIt has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses experiences of communication and coordination within and between nursing homes and hospitals are uncommon. n nDesign nA descriptive study design with a qualitative approach was used. n nMethods nIn 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (nxa0=xa020). Data were analysed using content analysis. n nResults nNursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursing home registered nurses suggested increased collaboration to understand each others work situation better. n nConclusion nCommunication and coordination among hospital and nursing home registered nurses need to be furthered improved. Registered nurses coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursing care and unnecessary transfer and admission to hospital.AIMnTo investigate registered hospital and nursing home nurses experiences of coordination and communication within and between care settings when older persons are transferred from nursing homes to hospital and vice versa.nnnBACKGROUNDnIt has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses experiences of communication and coordination within and between nursing homes and hospitals are uncommon.nnnDESIGNnA descriptive study design with a qualitative approach was used.nnnMETHODSnIn 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.nnnRESULTSnNursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursing home registered nurses suggested increased collaboration to understand each others work situation better.nnnCONCLUSIONnCommunication and coordination among hospital and nursing home registered nurses need to be furthered improved. Registered nurses coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursing care and unnecessary transfer and admission to hospital.

Workplace distress and ethical dilemmas in neuroscience nursing.

This study concerns Swedish nurses experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting. Qualitative interviews were conducted with 21 nurses. The interview results were subjected to qualitative latent content analysis and sorted into 4 content areas: workplace distress, ethical dilemmas, managing distress and ethical dilemmas, and quality of nursing. Common workplace stressors were high workload and lack of influence. These were perceived to have negative consequences for the quality of nursing. Ethical dilemmas mainly concerned decision making on initiation or withdrawal of treatment, which was experienced as a troublesome situation where conflicts could arise. The nurses managed the distress and ethical dilemmas by accepting and adjusting to the situation and seeking support from colleagues. They also endeavored to gain new strength in their private lives.

Chinese Nurses' Ethical Concerns in a Neurological Ward

Our aim was to describe Chinese nurses experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients relatives lacked respect for the nurses skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.

Ethical Values in Personal Assistance: Narratives of People with Disabilities:

The aim of this study was to investigate the experiences of persons with severe functional disabilities who receive personal assistance in their homes, the focus being on their daily life in relation to the ethical principles represented in the Swedish Disability Act: autonomy, integrity, influence and participation. Qualitative interviews were performed with 26 persons and thereafter subjected to qualitative latent content analysis. The experiences of personal assistance were very much in accordance with the said principles, the most important factor being that one is met with understanding. The participants described situations in which their integrity was violated in that they were not treated as competent adults. This indicates the importance of future efforts in nursing to support personal assistants with ethical knowledge and supervision so that they can empower people with disabilities and thereby enable them to maintain their self-esteem and dignity.

Caregivers' job satisfaction and empowerment before and after an intervention focused on caregiver empowerment

AIMSnTo evaluate a training programme aimed at strengthening caregivers self-esteem and empowering them, and also to study correlations between psychological empowerment and job satisfaction.nnnBACKGROUNDnStructural and psychological empowerment have received increased attention in nursing management, yet few intervention studies on this topic, based on theoretical assumptions, have been conducted in elderly care.nnnMETHODnData on self-assessed psychological empowerment and job satisfaction were collected in an intervention (n = 14) and a comparison group (n = 32), before and after the intervention.nnnRESULTSnWhen compared over time in the respective groups, there were significant improvements in the intervention group regarding the factor criticism (job satisfaction scale). There were no statistically significant differences in the comparison group. Total empowerment and all factors of empowerment correlated positively with total job satisfaction. Six out of eight factors of job satisfaction correlated positively with total empowerment.nnnCONCLUSIONSnCaregivers perception of criticism can improve through an intervention aimed at strengthening their self-esteem and empowering them. Implications for nursing management Intervention focused on psychological empowerment and especially caregivers communication skills seems to be beneficial for caregivers. Recommendations are to increase the programmes length and scope and to include all staff at the unit. However, these recommendations need to be studied further.