Doris Bohman

Case managers for older persons with multi-morbidity and their everyday work – a focused ethnography

BackgroundModern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences.MethodsThe study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis.ResultsAn overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy.ConclusionsFindings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.

Swedish nurses’ perception of nursing research and its implementation in clinical practice: a focus group study

Background:  Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses’ perception of nursing research and its implementation in a clinical context. Method and sample:  A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard’s description of content analysis. Findings:  The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs’ views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background – the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Conclusion:  Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs’ views of nursing research and its implementation. Hence, it might well be that the RNs’ educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour.

The work of case managers as experienced by older persons (75+) with multi-morbidity – a focused ethnography

BackgroundComplex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons’ (75+) with multi-morbidity experiences of case managers.MethodsThe study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012–2013.ResultsThe data revealed four themes illustrating the older persons’ experiences of case managers:1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present.ConclusionsThis study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Challenges of conducting experimental studies within a clinical nursing context

In recent years, several distinguished scholars have advocated for nursing research that may carry strong evidence for practice. Their advocacy have highlighted that nursing science has reached a point where as nurse researchers we need to develop the questions we ask and design studies that have the power to produce solid, translational, evidence-based knowledge. To do so, we need to carry out experimental tests on complex, everyday nursing interventions and activities. We also need to create public space to present accounts of our endeavours pursuing this type of design in clinical practice. This paper will discuss some of the most important insights gained from conducting a quasi-experimental study in which the aim was to investigate the effect of a theory-based intervention, targeting knowledge and attitudes among registered nurses regarding cancer pain management. The importance of careful practical and methodological planning is emphasised, and the need for participation-friendly interventions is discussed.

Prevalence of unknown and untreated arrhythmias in an older outpatient population screened by wireless long-term recording ECG

Purpose With longer life expectancies, the prevalence of arrhythmias is increasing; thus, there is a need for new methods to screen the older outpatient population. This population-based study describes the prevalence of arrhythmias in 200 outpatients aged ≥66 years. We also investigated the feasibility of wireless long-term recording (LTR) using the ECG-BodyKom®. Methods Two hundred elderly persons aged 66–93 years were recruited from the Swedish National Study on Aging and Care in 2010–2013, and data were collected via wireless LTR ECG-BodyKom. Results Screening with the LTR ECG revealed that persistent atrial fibrillation (AF) occurred in 10% of the outpatient population aged ≥66 years. Paroxysmal AF occurred in 5.5% of the population, with no difference between younger (60–80 years) and older (>80 years) elderly participants. Furthermore, all patients with paroxysmal AF had a CHA2DS2VASc score of ≥2 and were therefore potential candidates for follow-up and medical examination. LTR ECG-BodyKom can be considered a feasible method to screen for arrhythmias in older outpatient populations. This simple method requires little of the user, and there was high satisfaction with the equipment and a good overall experience wearing it. Conclusion The increasing occurrence of arrhythmias in the older population, as well as the high number of untreated cases of arrhythmias such as persistent AF and paroxysmal AF, poses a challenge for health care. Therefore, it is essential to develop effective strategies for their prevention and treatment.

European Academy of Nursing Science and the Swedish Society of Nursing Summer Conference 2017: The Future Direction of European Nursing and Nursing Research

Osteoporosis is highly prevalent worldwide and is associated with increased risk of low trauma fracture (LTF) [1], increased morbidity and mortality [2]. Major advances in diagnosis, management and BMC Nursing 2017, 16(Suppl 1):32 Page 3 of 11 prevention of secondary fractures have occurred [3] but implications for acute nursing care are less well documented. This project investigated practitioners’ experiences of caring for people with osteoporosis, knowledge of the disease, explored implications for moving and handling, reported patients’ care experiences, and developed education for frontline staff.We welcome all high quality abstracts related to the following three conference themes: Methodological innovations moving beyond the established; Researching nursing interventions moving beyond the “uniqueness” of nursing; Humanitus – returning to the essential principles of clinical nursing care. Online submission opens 16th of August, 2016 on www.swenurse.se Submission deadline is 18th of November, 2016 Call for Abstracts – The 2017 European Conference in Nursing and Nursing Research Fo to : W er n er N ys tr an d

European Academy of Nursing Science and the Swedish Society of Nursing Summer Conference 2017: The Future Direction of European Nursing and Nursing Research: Malmö, Sweden. 04-05 July 2017

Osteoporosis is highly prevalent worldwide and is associated with increased risk of low trauma fracture (LTF) [1], increased morbidity and mortality [2]. Major advances in diagnosis, management and BMC Nursing 2017, 16(Suppl 1):32 Page 3 of 11 prevention of secondary fractures have occurred [3] but implications for acute nursing care are less well documented. This project investigated practitioners’ experiences of caring for people with osteoporosis, knowledge of the disease, explored implications for moving and handling, reported patients’ care experiences, and developed education for frontline staff.We welcome all high quality abstracts related to the following three conference themes: Methodological innovations moving beyond the established; Researching nursing interventions moving beyond the “uniqueness” of nursing; Humanitus – returning to the essential principles of clinical nursing care. Online submission opens 16th of August, 2016 on www.swenurse.se Submission deadline is 18th of November, 2016 Call for Abstracts – The 2017 European Conference in Nursing and Nursing Research Fo to : W er n er N ys tr an d

An online learning module improves specialist palliative care nurses’ pain assessments and patient-reported pain

Commentary on : Phillips JL, Heneka N, Hickman L, et al. Impact of a novel online learning module on specialist palliative care nurses’ pain assessment competencies and patients’ reports of pain: Results from a quasi-experimental pilot study. Palliat Med 2014;28:521–9.[OpenUrl][1][CrossRef][2][PubMed][3] Inadequate assessment has been identified as a factor contributing to unrelieved pain. This is especially true in specialist cancer and palliative care settings where pain is common.1 ,2 In Australia, services are expected to routinely assess pain … [1]: {openurl}?query=rft.jtitle%253DPalliat%2BMed%26rft_id%253Dinfo%253Adoi%252F10.1177%252F0269216314527780%26rft_id%253Dinfo%253Apmid%252F24685649%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1177/0269216314527780&link_type=DOI [3]: /lookup/external-ref?access_num=24685649&link_type=MED&atom=%2Febnurs%2F18%2F4%2F122.atom

Existing and evolving in two minds : beliefs in relation to health and illness expressed by older South Africans

The aim of the study was to illuminate beliefs in relation to health and illness expressed by older Africans within the context of a society in transition – South Africa. An ethnographic research approach influenced by the interpretive phenomenological tradition was selected to gain an understanding of the participants’ experiences. A focused ethnographic design was employed, using group and individual in-depth interviews and participant observations. Sixteen elderly persons (ten females and six males) from Hammanskraal, a rural area north of Pretoria were involved in the research. The findings illuminate a world understanding, where body and mind are inseparable and relationships provide the foundation for improving and maintaining health and being cured from illness. The ongoing transition that the elderly in South Africa experience influences health and illness beliefs, with a need to adapt to existing parallel health care systems, Western biomedicine and African traditional medicine. As the study draws attention to the importance of caring for the elderly to be contextualised, it is recommended that the care of the elderly be applied to the unique needs of the individual involved. Failure to do so may otherwise have severe consequences such as an apparent high risk of developing stereotypes, which can lead to cultural misunderstandings, prejudice and discrimination.