Lena Oxelmark

Developing an assessment tool for intended learning outcomes in clinical practice for nursing students

This report describes the development of a new criterion based reference tool to assess nursing knowledge and competence in clinical practice. Nursing education has changed from educating a profession, based on tested experience, to being based on a scientific approach and research based knowledge. Assessment should be capable of measuring whether intended learning outcomes have been reached or not, and if the aims of a course have been fulfilled in order to ensure safe and competent nursing care. The intended learning outcomes from a first year course syllabus were integrated and formed into a three-graded criterion-referenced assessment tool, Assessment of Clinical Education, (AClEd). The AClEd is to be seen as a template, and may be tailor-made in accordance to the objectives, level and criteria of a specific course. The tool showed validity in assessing nursing skills not only the nursing students ability to perform a task but also, most importantly, the quality of nursing care.

Experiences of complementary and alternative medicine in patients with inflammatory bowel disease – a qualitative study

BackgroundThe use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients’ well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD.MethodsFifteen patients with IBD, eight with Crohn’s disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed.ResultsThe analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment.ConclusionsThe finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients’ CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.

The Food hypersensitivity famiLy ImPact (FLIP) questionnaire - development and first results

Elimination of the offending food(s) is the usual treatment when a child suffers from food hypersensitivity. This treatment can impair everyday life in families with affected children. Instruments to assess these impairments generated from families attending primary care and in comparison to families with children without food hypersensitivity are scarce. The aim of this study is to develop and test a method to assess food hypersensitivitys impact on everyday life on affected families.

Anxiety, functional health status, and coping ability in patients with ulcerative colitis who are undergoing colonoscopic surveillance

Background:Patients with long-standing extensive ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). High-risk UC patients are nowadays enrolled in surveillance programs to decrease CRC incidence and mortality, although little is known about patients’ concerns and anxiety when subjected to colonoscopic surveillance. The aims of this study were to evaluate functional health status, general state of health, anxiety, and coping ability in patients with UC taking part in such a program in a university hospital setting. Methods:Forty-one patients with long-standing, extensive/total UC in remission (median disease duration, 21.0 years) undergoing surveillance comprised the study group. Twenty patients with extensive disease but with shorter disease duration (median, 8.0 years) and 19 patients with only distal involvement UC acted as controls. Four different self-administered questionnaires (SAQs) were used. The SAQ assessments were made twice in the study group and once in the controls. Results:No statistically significant differences were found in any of the SAQ assessments. The median scores obtained were well within the ranges seen in normal healthy subjects. Conclusions:Colonoscopic surveillance in long-standing UC does not seem to generate increased anxiety or impairment of functional or general health status among participating patients. Rather, UC patients in clinical remission seem to cope just as well as healthy individuals irrespective of the CRC risk or surveillance procedures.

Use of complementary and alternative medicine in Swedish patients with inflammatory bowel disease: a controlled study.

Background There is an increasing interest in complementary and alternative medicine (CAM) in patients with chronic diseases, including those with inflammatory bowel disease (IBD). Patients may turn to CAM when conventional therapies are inadequate or associated with side effects for symptomatic relief or to regain control over their disease. The objectives were to explore CAM use and perceived effects in IBD patients in comparison with a control group. Methods A cross-sectional, multicenter, controlled study was carried out. IBD patients were invited from 12 IBD clinics in Sweden. Controls were selected randomly from a residence registry. A study-specific questionnaire was used for data collection. Results Overall, 48.3% of patients with IBD had used some kind of CAM during the past year compared with 53.5% in controls (P=0.025, adjusted for age, sex, geographic residence, and diet). The most frequently used CAM among IBD patients was massage (21.3%), versus controls (31.4%) (adjusted P=0.0003). The second most used CAM was natural products, 18.7% in IBD patients versus 22.3% of the controls (unadjusted P=0.018). In all, 83.1% of the patients experienced positive effects from CAM and 14.4% experienced negative effects. Conclusion Overall, 48.3% of Swedish IBD patients used some kind of CAM and controls used CAM significantly more. Natural products were used by one-fifth of the patients and even more by controls. This is notable from a patient safety perspective considering the possible risks of interactions with conventional medication. In all, 40% of the patients reported adverse events from conventional medicine. Patients experienced predominantly positive effects from CAM, and so did controls.

Monitoring the impact of cow's milk allergy on children and their families with the FLIP questionnaire--a six-month follow-up study.

Many children with cows milk allergy (CMA) develop tolerance, but, challenges in daily life may remain. Using the Food hypersensitivity famiLy ImPact questionnaire (FLIP), we sought to monitor changes in the impact of CMA over time.

Assessment in clinical education: A comparison between a generic instrument and a course-specific criterion-based instrument

Assessment of students’ clinical performance and reasoning raises critical questions of whether learning outcomes have been reached and whether the aims of a course/education programme have been fulfilled. The aim of this study was to compare two assessment instruments in clinical education. A cross-sectional, comparative design was used. Nursing students and supervisors from five universities and university colleges in Sweden were included in the study. A sample of 435 students was used. Data were collected with study-specific questionnaires targeted for the two groups, nursing students and supervisors, and were analysed using cross-tabulation, chi-square with WinSTAT. Students perceived supervisors using the instrument Assessment of Clinical Education (AClEd) to be more aware of what to assess and they experienced more support from the ‘AClEd supervisors’ as compared to the supervisors using the second instrument, the Assessment form for Clinical education (AssCe). Furthermore, the AClEd assessment was perceived to be fairer compared to the AssCe assessment. The criterion-referenced assessment instrument AClEd was perceived, by both nursing students and supervisors, to give a clearer view of the learning outcome and the possibility of a fair and comprehensive assessment.