Birgitta Klang

Hip fracture and pressure ulcers – the Pan‐European Pressure Ulcer Study – intrinsic and extrinsic risk factors*

Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8·8% and 55% have been reported. There are few studies focusing on the specific patient‐, surgery‐ and care‐related risk indicators in this group. The aims of the study were

The use and efficacy of coping strategies and coping styles in a Swedish sample.

This paper presents Swedish reference values for the Jalowiec Coping Scale (JCS-60), a questionnaire measuring the use and efficacy of coping strategies. The strategies are grouped in eight coping styles. The sample used was randomly selected from a Swedish urban population. The sample consisted of 268 individuals (135 men and 133 women), divided into three age-groups, 26-40, 41-55 and 56-70 years. There were no significant differences between the three age-groups or between men and women when comparing the total scores for use and efficacy on the JCS-60. No significant differences were found between the genders within each age-group. The most commonly used coping styles were the confrontational, the optimistic and the self-reliant. The least used style was the fatalistic. Men, as compared with women, used the confrontational and self-reliant coping styles more while women used the supportive coping style more than men. The youngest age-group used the emotive coping style more, compared with the other age groups. Cronbachs alpha for the total scores indicates acceptable reliability. The results of this study may be useful as Swedish reference values for comparison with the research results of studies on patients.

Thoughts on death and dying when living with haemodialysis approaching end of life

AIMS AND OBJECTIVES To describe inner thoughts and feelings relating to death and dying when living with haemodialysis approaching end of life. BACKGROUND Patients who undergo maintenance haemodialysis suffer a significant symptom burden and an impaired quality of life. The high mortality rate in these patients indicates that about one-fourth of them are in their last year of life, suggesting the presence of death and dying in the haemodialysis unit. DESIGN A qualitative descriptive design was used. Methods.  A total of 31 qualitative interviews were conducted with eight patients (aged 66-87) over a period of 12 months. Qualitative content analysis was used to analyse data. RESULTS The analysis revealed 10 subthemes that were sorted into three main themes. Being aware that death may be near comprises being reminded of death and dying by the deteriorating body, by the worsening conditions and deaths of fellow patients, and by knowing haemodialysis treatment as a border to death. Adapting to approaching death comprises looking upon death as natural, preparing to face death, hoping for a quick death and repressing thoughts of death and dying. Being alone with existential thoughts comprises a wish to avoid burdening family, lack of communication with healthcare professionals and reflections on haemodialysis withdrawal as an hypothetic option. CONCLUSIONS Living with haemodialysis approaching, the end of life involves significant and complex existential issues and suffering, and patients are often alone with their existential thoughts. RELEVANCE TO CLINICAL PRACTICE Nurses and other healthcare professionals in haemodialysis settings need to combine technical and medical abilities with committed listening and communication skills and be open to talking about death and dying, with sensitivity to individual and changeable needs.

Are the symptoms and severity of head injury predictive of clinical findings three months later

Aim: To describe symptoms and functional disabilities 3 mo after a minimal, mild or moderate head injury in children, and to analyse relationships between these and initial symptoms and management documented at the time of the injury. Methods: The sample consisted of all children (0–15 y) admitted to an emergency department during a 1‐mo period with a history of head injury. Data were collected from the medical records at the time of the injury, and questionnaires about symptoms/change and functional problems 3 mo after the injury. Results: Symptoms and functional problems were reported in 35% of the children 3 mo after a head injury. Documented altered consciousness (in children less than 5 y) and disorientation (in children 5 y of age or older) at the emergency department were correlated with changes in behaviour at 3 mo. The initial duration of unconsciousness was not predictive of subsequent behaviour. Conclusion: The difficulties in predicting outcomes in head‐injured children, especially younger ones, indicate the need for a follow‐up appointment in order to identify children with special needs. Further studies are needed regarding the early signs and symptoms in different age groups.

Nurses' and patients' communication in smoking cessation at nurse-led COPD clinics in primary health care

Background Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. Objective To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. Methods A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. Results Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communication was mainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. Conclusion The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. Practice implications To make patients more active, the nurses need more education and continuous training in motivational communication.

Satisfactory Reliability among Nursing Students using the Instrument PVC ASSESS to Evaluate Management of Peripheral Venous Catheters

Purpose Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. Methods PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n=4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n=3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohens kappa coefficient (κ) were calculated. Results For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (<0.70) for two items: “adherence of inner dressing to the skin” and “PVC location.” In 81% of the items, κ was between moderate and almost perfect: moderate (n=5), substantial (n=3), almost perfect (n=5). For edema at insertion site and two items on PVC dressing, κ was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the κ ranged between moderate and almost perfect (0.41-1) in 90%-95%. Conclusions PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.