Herdís Sveinsdóttir

Prospective assessment of menstrual and premenstrual experiences of Icelandic women

In the only Icelandic study on premenstrual symptoms, a retrospective one conducted in 1991, investigators found 30% of the sample to have severe premenstrual changes. In light of critique that retrospective data primarily reflect socioculturally held beliefs about menstruation, the present study was undertaken in order to assess prospectively Icelandic womens premenstrual and menstrual symptoms and experiences. A total of 211 menstrual cycles were recorded by 83 women using a daily health diary. A symptom pattern was defined for each woman. A small majority of the women (51.8%) displayed a low symptom pattern. Two women (2.4%) demonstrated a premenstrual syndrome pattern, and 5 women (6.0%) exhibited a premenstrual magnification pattern. The remaining women displayed mixed symptom patterns indicating wide variability in womens experiences. These findings differ from the Icelandic retrospective study and from a USA study using prospective data. Therefore, it is concluded that menstrual socialization influences symptoms expectation and reporting.

Menstrual cycle symptom variation in a community sample of women using and not using oral contraceptives.

Background. The prevalence of significant symptom change (symptom cyclicity) prospectively rated over multiple menstrual cycles has not been established in a non‐clinical population.

Quality Pain Management in the Hospital Setting from the Patient's Perspective

Pain management is a crucial issue for patients, and patients’ perception of care is an important quality outcome criterion for health care institutions. Pain remains a common problem in hospitals, with subsequent deleterious effects on well‐being.

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses’ attitudes as measured by the Families Importance in Nursing Care–Nurses’ Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses’ attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration.

Predictors of psychological distress in patients at home following cardiac surgery: an explorative panel study.

Background: Knowledge is lacking on what predicts psychological distress in cardiac surgery patients. Aim: To describe the post-operative symptoms of anxiety and depression in cardiac surgery patients; to detect associations between those symptoms and patient’s experiences of illness and hospitalisation and also their family and social situations; and identify experiences and situations that predict symptoms of anxiety and depression at home when measured at least four weeks after hospital discharge. Method: In this prospective explorative panel study all eligible cardiac surgery patients over a six month period in 2007 were invited to participate. Data was collected at the hospital and at home. Two questionnaires were developed and included the Hospital Anxiety and Depression Scale (HADS), questions on family and social issues, patient’s experience of illness, hospitalisation and family and social situations. Results: Of the 66 participants few had symptoms of anxiety and depression at hospital or at home. Significant associations were found between symptoms of anxiety and depression measured at home and the same symptoms at hospital; pain and general post-operative symptoms; satisfaction with discharge education; self-assessed post-operative recovery and quality of sleep at home. Post-operative anxiety was predicted by depression at the hospital, not feeling rested upon awakening and presence of pain at home. Post-operative depression was predicted by depression at the hospital and not feeling rested upon awakening. Conclusion: Signs of patients’ anxiety and depression should be assessed before surgery and appropriate intervention planned accordingly in order to support patients at risk of post-operative psychological distress.

Quality pain management practices in a university hospital.

Despite available guidelines and efforts to improve pain management, pain remains prevalent in hospitals. The aim of this study was to explore whether pain management practices in a university hospital were in line with guidelines on acute, geriatric, and cancer pain. This was a descriptive, correlational, and point-prevalence study conducted at a university hospital with 282 adults, who were hospitalized for 24 hours and were alert and able to participate. Patient self-report data were collected with the American Pain Society questionnaire and pain management data were collected from medical records. Adequacy of treatment was measured with the Pain Management Index, calculated for prescribed and administered treatments. The mean age of participants was 68.9 years (SD = 17; range 18-100); 49% were women; and 72% were on medical services. Pain assessment was documented for 57% of patients, of those, 27% had pain severity documented with a standardized scale. Most patients (85%) were prescribed analgesics and multimodal therapy was prescribed for 60%. Prescribed treatment was adequate for 78% of patients, whereas 64% were administered adequate treatment. The odds of receiving adequate treatment were higher (odds ratio, 3.44; 95% confidence interval, 1.38-8.60) when pain severity was documented. Nonpharmacologic methods were used by 34% of patients. Although the majority of patients had an analgesic prescription, many did not receive adequate treatment. The use of pain severity scales was associated with the provision of more adequate pain treatment. To provide quality pain management, pain assessment needs to be improved and available treatments used to meet patient needs.

The predictive role of support in the birth experience: A longitudinal cohort study

BACKGROUND Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. OBJECTIVE The aim of this study was to describe womens birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. METHOD A longitudinal cohort study was conducted with a convenience sample of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11-16 weeks of pregnancy (T1, n=1111), at five to six months (T2, n=765), and at 18-24 months after birth (T3, n=657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. RESULTS The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. CONCLUSIONS Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on womens perception of birth experience.

Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study

BACKGROUND Pregnant women expect childbirth to be painful. However, little is known about their expectations of the intensity of pain in childbirth (EIPC) and their attitudes to pain management. METHOD The design was a cross-sectional survey, with self-reported questionnaires used to collect data from low-risk pregnant women (N = 1111) early in pregnancy at 26 of the largest primary health care centres in Iceland. This consecutive national sample was stratified by residency. RESULTS The mean score for the EIPC was 5.58 (SD = 1.38) measured on a 7 point scale. The strongest predictors of a high EIPC score were: negative attitude to the impending childbirth (OR = 2.39), low manifestation of a sense of security (OR = 1.80), and a positive attitude to pain management with medication (OR = 1.63). Women living outside the capital area were less likely to have a high EIPC (OR = 0.68). Most women (77%) had a positive attitude towards pain management without medication and 35% had a positive attitude to pain management with medication. CONCLUSIONS The study detected multiple predictors of womens EIPC and attitude to pain management. Early and throughout pregnancy, midwives and health care professionals need to address these predictors in order to assist women to prepare themselves for the pain of labour.

Autonomy in place of birth: a concept analysis.

This article examines one of the relevant concepts in the current debate on home birth—autonomy in place of birth—and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.

Determinants of Knowledge and Attitudes Regarding Pain among Nurses in a University Hospital: A Cross-sectional Study

ABSTRACT The aim of this cross‐sectional study was to evaluate the primary determinants of knowledge and attitudes regarding pain among nurses in a hospital setting. All registered nurses employed at participating units at a university hospital were invited to participate. Information on work experience, education, and hospital unit was evaluated using a questionnaire. The Knowledge and Attitude Survey Regarding Pain instrument was used to assess knowledge on pain management. The difference in knowledge between nurses with different levels of education was assessed with analysis of variance. The discriminatory ability of each question was determined with item response theory, and the association between correct answers to individual items and the total score were calculated using linear regression. Participants were 235 nurses, 51% of the 459 invited. The overall pain knowledge score was 26.1 (standard deviation 5.3, range 8–38) out of a total of 40 possible. Those with an advanced degree in nursing scored on average 2.9 points higher than those who did not have an advance degree (95% confidence interval: 0.9–4.7). Responses to clinical vignette questions showed more difference between nurses with different levels of knowledge of pain management than the other questions. Participants with the correct response to the best discriminatory item had 5.35 (95% confidence interval 4.08–6.61) points higher total score than those with an incorrect answer. Higher education is associated with better knowledge on pain management. To assess pain knowledge, the ability to interpret and solve a clinical vignette leads to better results than answering direct questions.