Gun Nordström

The first year as a graduate nurse – an experience of growth and development

AIM The aim of this paper was to illuminate how recently graduated nurses experience their first year as a nurse. BACKGROUND Graduate nurses are expected to identify themselves as members of an interdisciplinary team, to feel comfortable in chaos and to make and defend decisions. By graduation nurses expect to have the necessary competence to perform nursing. Recently graduated nurses lack competence, especially relating to leadership. DESIGN A qualitative design was chosen and 12 nurses working in hospitals and home care were individually interviewed. METHOD The interviews were transcribed verbatim and the texts were analysed using manifest and latent content analysis. RESULTS The nurses gave descriptions covering numerous experiences, interpreted and categorised in the following eight subcategories: uncertainty and chaos; need for induction; need for a supportive environment; need for recognition; awareness of responsibility; need for positive experiences; becoming experienced; and managing challenges. These subcategories gave reason for the three categories: experience of being new; gaining nurse experience; and gaining competence. The nurses described a tough start as a nurse, but they most of all gave descriptions interpreted as an experience of growth and development, which constituted the theme in this study. CONCLUSIONS Recently graduated nurses have a positive attitude to the challenges of being a new nurse. Although the initial period as a nurse was tough, the nurses appreciated their experiences because they learnt from them. RELEVANCE TO CLINICAL PRACTICE Recently graduated nurses should be spared from being the only nurse on duty. Employers both in hospital and home care should facilitate induction programmes for new graduate nurses.

Health-related quality of life in food hypersensitive schoolchildren and their families: parents' perceptions

BackgroundAbout 20% of schoolchildren and adolescents in Sweden suffer from perceived food hypersensitivity (e.g. allergy or intolerance). Our knowledge of how child food hypersensitivity affects parents HRQL and what aspects of the hypersensitivity condition relate to HRQL deterioration in the family is limited. Thus the aim of this study was to investigate the parent-reported HRQL in families with a schoolchild considered to be food hypersensitive. The allergy-associated parameters we operated with were number of offending food items, adverse food reactions, additional hypersensitivity, allergic diseases and additional family members with food hypersensitivity. These parameters, along with age and gender were assessed in relation to child, parent and family HRQL.MethodsIn May 2004, a postal questionnaire was distributed to parents of 220 schoolchildren with parent-reported food hypersensitivity (response rate 74%). Two questionnaires were used: CHQ-PF28 and a study-specific questionnaire including questions on allergy-associated parameters. In order to find factors that predict impact on HRQL, stepwise multiple linear regression analyses were carried out.ResultsAn important predictor of low HRQL was allergic disease (i.e. asthma, eczema, rhino conjunctivitis) in addition to food hypersensitivity. The higher the number of allergic diseases, the lower the physical HRQL for the child, the lower the parental HRQL and the more disruption in family activities. Male gender predicted lower physical HRQL than female gender. If the child had sibling(s) with food hypersensitivity this predicted lower psychosocial HRQL for the child and lower parental HRQL. Food-induced gastro-intestinal symptoms predicted lower parental HRQL while food-induced breathing difficulties predicted higher psychosocial HRQL for the child and enhanced HRQL with regards to the familys ability to get along.ConclusionThe variance in the childs physical HRQL was to a considerable extent explained by the presence of allergic disease. However, food hypersensitivity by itself was associated with deterioration of childs psychosocial HRQL, regardless of additional allergic disease. The results suggest that it is rather the risk of food reactions and measures to avoid them that are associated with lower HRQL than the clinical reactivity induced by food intake. Therefore, food hypersensitivity must be considered to have a strong psychosocial impact.

Psychosocial Adjustment and General State of Health In Patients With Ileal Conduit Urinary Diversion

The psychosocial adjustment and general state of health were investigated in 66 patients (40 males, 26 females) who had been subjected to an ileal conduit urinary diversion on account of bladder cancer (44 patients) or incontinence or bladder dysfunction (22 patients). Seventy per cent of the patients reported unchanged, overall, social activity (OSA) after the operation. Twenty per cent reported less and 10% more activity. Bladder-cancer patients were more likely to curtail their social activities compared with the patients with incontinence or bladder dysfunction. Appliance-related problems were mentioned by half of the patients who reported decreased OSA. One-third of the patients considered accidental leakage or fear of such leakage as the most negative aspect of surgery. Factors related to an altered body image were the most common negative aspect reported by females. Despite psychosocial problems, the majority of the patients (80%) considered their health to be good. Males, individuals working full-time and patients with unchanged OSA scored higher on a Health Index, i.e. considered themselves healthier than the rest of the patients.

Critical thinking dispositions among newly graduated nurses

wangensteen s., johansson i.s., björkström m.e. & nordström g. (2010) Critical thinking dispositions among newly graduated nurses. Journal of Advanced Nursing66(10), 2170–2181. Aim The aim of the study was to describe critical thinking dispositions among newly graduated nurses in Norway, and to study whether background data had any impact on critical thinking dispositions. Background Competence in critical thinking is one of the expectations of nursing education. Critical thinkers are described as well-informed, inquisitive, open-minded and orderly in complex matters. Critical thinking competence has thus been designated as an outcome for judging the quality of nursing education programmes and for the development of clinical judgement. The ability to think critically is also described as reducing the research–practice gap and fostering evidence-based nursing. Methods A cross-sectional descriptive study was performed. The data were collected between October 2006 and April 2007 using the California Critical Thinking Disposition Inventory. The response rate was 33% (n= 618). Pearson’s chi-square tests were used to analyse the data. Results Nearly 80% of the respondents reported a positive disposition towards critical thinking. The highest mean score was on the Inquisitiveness subscale and the lowest on the Truth-seeking subscale. A statistically significant higher proportion of nurses with high critical thinking scores were found among those older than 30 years, those with university education prior to nursing education, and those working in community health care. Conclusion Nurse leaders and nurse teachers should encourage and nurture critical thinking among newly graduated nurses and nursing students. The low Truth-seeking scores found may be a result of traditional teaching strategies in nursing education and might indicate a need for more student-active learning models.

Food hypersensitivity and quality of life

Purpose of review The present article presents an accessible review of research results on food hypersensitivity and quality of life (QoL), including 15 original articles on the subject. Recent findings Research on food hypersensitivity and QoL covers children and their parents, adolescents and adults. Several domains of QoL are affected, such as family and social activities, emotional issues and family economy. Food-hypersensitive children are to a large extent limited in their autonomous social activities. Food-allergic adolescents have a higher number of weeks absent from school compared with a control group, and a relatively high percentage of food-allergic young adults do not participate in the labour market. Comorbidity has to be taken into consideration when assessing QoL in food-hypersensitive individuals. Research on gender differences in food hypersensitivity and QoL are scarce. Summary Although development in this research field has only just begun, it is obvious that food hypersensitivity has a significant impact on individuals’ and families’ QoL. An important advance is the disease-specific QoL measure instruments that have been created. There is still, however, a need for a more in-depth knowledge as a basis for further development of QoL instruments, and as a basis for societal interventions and family/individual support.

Moral Sensitivity: some differences between nurses and physicians

We report the results of an investigation of nurses’ and physicians’ sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories ‘meaning’ and ‘autonomy’ and to a lesser degree with the categories ‘benevolence’ and ‘conflict’. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females.

Effects of flotation-restricted environmental stimulation technique on stress-related muscle pain: what makes the difference in therapy--attention-placebo or the relaxation response?

INTRODUCTION The purpose of the present study was to examine the potential effects of attention-placebo on flotation tank therapy. Flotation-restricted environmental stimulation technique is a method whereby an individual lies in a floating tank and all stimuli are reduced to a minimum. METHODS Thirty-two patients were diagnosed as having stress-related muscular pain. In addition, 16 of the participants had received the diagnosis of burnout depression. The patients were treated with flotation-restricted environmental stimulation technique for six weeks. One-half of the patients were also given special attention for 12 weeks (high attention), while the remainder received attention for only six weeks (normal attention). RESULTS The participants exhibited lowered blood pressure, reduced pain, anxiety, depression, stress and negative affectivity, as well as increased optimism, energy and positive affectivity. The results were largely unaffected by the degree of attention-placebo or diagnosis. CONCLUSION It was concluded that flotation therapy is an effective, noninvasive method for treating stress-related pain, and that the method is not more affected by placebo than by other methods currently used in pain treatment. The treatment of both burnout depression and pain related to muscle tension constitutes a major challenge for the patient as well as the care provider, an area in which great gains can be made if the treatment is effective. Flotation therapy may constitute an integral part of such treatment.

Research use in the care of older people: a survey among healthcare staff

Background.  Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community-based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design.  The overall aim of this cross-sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method.  Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results.  Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions.  Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice.  There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence-based practice that involves the EN/NA group.

Classification of peristomal skin changes in patients with urostomy

Peristomal skin lesions in patients with ileal conduit urinary diversion have been reported in frequencies ranging from none to occurrence in 100% of patients. In previous studies skin lesions often are referred to in unspecific terms, which has made it impossible to compare results with those of other studies. Thus a classification of peristomal skin (CPS) has been developed on the basis of macroscopic peristomal findings. It defines what can be accepted as ordinary findings, as well as two different types of skin lesions, erythematous-erosive and pseudoverrucous. Each of these is divided into two subgroups. Such a classification is a prerequisite for a meaningful comparison of the type, incidence, and severity of skin lesions in different groups; it also may allow a more reliable clinical evaluation of new ostomy appliances and skin care products. In addition, CPS may also facilitate communication among professionals who are responsible for the care of ostomy patients.

HEALTH-RELATED QUALITY OF LIFE IN WOMEN WITH BREAST CANCER UNDERGOING AUTOLOGOUS STEM-CELL TRANSPLANTATION

The functional capacity and the health-related quality of life were investigated in nine women (ages 23-58 years) undergoing high-dose chemotherapy with autologous stem-cell transplantation (ASCT). Data were obtained by using two questionnaires: the Sickness Impact Profile (SIP) and the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). The patients answered the questionnaires on three occasions: on admission to the transplant unit, at discharge from the unit, and 7-15 weeks after ASCT. It was found that the women were affected by the treatment in various dimensions of daily life. The transplantation primarily affected their self-rated physical health and functions. Their physical-health status was poorest at the time of discharge. The womens emotional status was found to be poor during the whole study period. The results of the present study indicate that professional nursing is essential for breast cancer patients undergoing ASCT.