Lisbeth Fagerström

Older adults' motivating factors and barriers to exercise to prevent falls

Abstract The aim of this study was to describe motivating factors and barriers for older adults to adhere to group exercise in the local community aiming to prevent falls, and thereby gain knowledge about how health professionals can stimulate adherence. The motivation equation was used as a theoretical framework. Data were collected from individual semi-structured interviews (n = 10). The interviews were taped, transcribed, and thereafter analysed by using a descriptive content analysis consisting of four steps. The results showed that motivating factors to adhere to recommended exercise were perceived prospects of staying independent, maintaining current health status, and improving physical balance and the ability to walk. Barriers were reduced health status, lack of motivation, unpleasant experience during previous exercise group sessions, and environmental factors. All participants wanted information from health professionals on the benefit of exercise. Many considered individual variations in functional skills within each group as a disadvantage. The knowledge gained from this study suggests a greater involvement from all health professionals in motivating older adults to attend exercise groups. The results also suggest that physical therapists should be more aware of the importance of comparative levels of physical function when including participants in exercise groups.

Experiences of the new role of advanced practice nurses in Swedish primary health care—A qualitative study

Experiences of the new role of advanced practice nurses in Swedish primary health care-A qualitative study The aim of this study was to investigate and describe the experiences of the first advanced practice nurses (APNs), a new profession for Swedish health care, and of their supervising general practitioners (GPs), regarding the new role and scope of practice of APNs in primary health care. Individual interviews were conducted with the four first APNs and one focus group interview was conducted with five supervising physicians. The material was transcribed verbatim and analysed using latent content analysis. The respondents expressed confidence and trust in the new role of APNs. Some opposition to this new role from the GPs and other colleagues was observed, but was nonetheless overcome. The experiences of the APN role indicate that the new role is clearly demarcated from the role of physicians. The APNs were considered an extra resource for both the GPs and other nurses, which contributed to an increased availability of care for patients. The APN role requires an explicit definition and demarcation in relation to responsibility and roles among colleagues. Further development of the APN role presupposes the right to prescribe medication and order treatments, as well as an evaluation of patient, organizational and inter-professional perspectives on the matter.

Urinary tract infection in very old women is associated with delirium.

BACKGROUND The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and ≥95-year-old women is associated with delirium. METHODS In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered. RESULTS Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimers disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9). CONCLUSIONS A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.

Prevalence and factors associated with urinary tract infections (UTIs) in very old women

The aim of this study was to describe the prevalence of urinary tract infection (UTI) and associated factors among very old women. In a cross-sectional, population-based study in Sweden and Finland, 532 women were asked to participate and 395 (74.2%) were possible to evaluate for UTI. Data were collected from structured interviews and assessments made during home visits, from medical charts, caregivers and relatives. UTI diagnosis documented in medical records during the preceding 1 and 5 years was registered. About one-third (117/395, 29.6%) were diagnosed as having suffered from at least one UTI in the preceding year and 60% in the preceding 5 years. In a multivariate logistic regression model, UTI in the preceding year, was associated with vertebral fractures (odds ratio (OR) = 3.2; 95% confidence interval (95% CI) = 1.4-7.1), incontinence (OR = 2.8; 95% CI = 1.8-4.5), inflammatory rheumatic disease (OR = 2.8; 95% CI = 1.4-5.7) and multi-infarct dementia (OR = 2.4; 95% CI = 1.3-4.5). UTI is a major public health problem in very old women and were independently associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might indicate that UTI is not a harmless disease.

Leading change: a three‐dimensional model of nurse leaders’ main tasks and roles during a change process

AIM This paper is a report of a qualitative study which explored how nurse leaders described and understood their main tasks and roles during a change process. BACKGROUND During a database search for literature, no actual research that highlighted the main tasks and roles of nurse leaders during a change process was found. Earlier research has indicated the need for different leadership styles and the importance of strategies and values. METHOD In-depth interviews with 17 nurse leaders took place in 2004. A phenomenological-hermeneutical approach was used for data analysis. RESULTS The findings resulted in a model of leading change in health care that focuses on good patient care and consists of three dimensions: leading relationships, leading processes and leading a culture. In addition to leading relationships and processes, nurse leaders, as role models, greatly impact caring culture and its inherent ethical behaviour, especially about the responsibility for achieving good patient care. Nurse leaders are also instrumental in leading ward culture. CONCLUSION Nurse leaders need guidance and knowledge of what is expected of them during a structural change process. They play different roles by directing, guiding, motivating, supporting and communicating without losing their cultural ethos of caring and use various leadership styles to bring about actual change, which, in turn, requires learning so that the thought patterns, values and attitudes of personnel can be changed.

Psychometric properties of the Swedish version of the Purpose in Life scale

The aim of this study was to test the theoretical assumptions beyond the Purpose in Life (PIL) scale, and to elucidate the underlying structure of the Swedish version of the PIL. The PIL, originally created by Crumbaugh and Maholick, is a 20-item scale of the Lickert type with possible scores ranges from 20 to 140, the higher score, the stronger PIL. The analysis was based on 449 participants, 62% of whom were women, from five different samples, ranging from 19 to 103 years old. An exploratory factor analysis restricted to three factors was performed. The factors were labelled meaning in existence, freedom to create meaning in daily life, and will to find meaning in future challenges. These factors reflected the three dimensions described by Frankl. Cronbachs alpha coefficient for the total scale was 0.83 and varied between 0.54 and 0.83 in the three factors. We concluded that the Swedish version of the PIL scale seems to have construct validity and reliability. Our results give support to the fact that the PIL scale captures and confirms the theoretical assumptions of Frankls existential theory. We consider the PIL scale to be both feasible and appropriate for use in nursing research.

The first evaluation of the advanced practice nurse role in Finland - the perspective of nurse leaders.

fagerstrom l. & glasberg a.-l. (2011) Journal of Nursing Management19, 925–932 The first evaluation of the advanced practice nurse role in Finland – the perspective of nurse leaders Aims  The aim of this study is to explore and describe nurse leaders’ (NLs) experiences of the role of advanced practice nurses (APNs). Background  The first group of advanced practice nurses (17) in Finland graduated in 2006 and were thereafter employed by seven different organizations in more or less clearly defined advanced practice nurses roles. Methods  Seven nurse leaders at the relevant organizations were interviewed a year after the introduction of the advanced practice nurses role. Content analysis was used to analyze the data. Results  All of the nurse leaders emphasized the importance of the advanced practice nurses role in their organization. The advanced practice nurses’ scope of practice comprised a more autonomous and independent role than registered nurses. Advanced practice nurses are an important resource in the care of patients with chronic diseases and acute health problems. An important aspect regarding support for the advanced practice nurses role is the provision of information to all health-care personnel and patients about the role and clearly defined areas of responsibility. Conclusions  Advanced practice nurses are an important resource in the development of evidence-based nursing and improve the availability of health-care services for patients. Implications for nursing management  Nurse leaders are responsible for creating sustainable structures and the prerequisites needed for advanced practice nursing through the formation of supportive organizational systems.

An integrative research review of preventive home visits among older people--is an individual health resource perspective a vision or a reality?

This study has two aims: (i) to explore and evaluate the health-promoting effect of preventive home visit (PHV) by analysing the activities conducted during the PHV and the reported results, and (ii) to critically analyse if PHV is characterized by an individualized health resource perspective. The material was compiled through a systematic literature search in the databases Ebsco, CINAHL, Medline, Science Direct and CSA from the period 1984 to 2004. The result of the systematic database search was a total number of 49 scientific research articles, of which 18 are included in this study. The analysing method was a four-step integrating research review. The review describes the following content concerning (i) activities during home visits: screening, observation and evaluation, guidance, support, referral to care and other services, follow-up and individual aim; (ii) positive effects: reduced mortality, improved ability to function, improved life quality, improved subjective health, fewer admittances for care, older peoples experiences of home visits and increased knowledge on health and (iii) unclear/negative effects: admittance to care, no effect on mortality, unaffected ability to function, unaffected general health and uninfluenced life quality. PHVs had been implemented based on an individual perspective in a total of 13 studies out of 18. The focus on sickness was surprisingly clear, and in 10 studies out of 18 a health resource perspective was lacking. The effects of PHVs have been questioned. Despite this, current research results imply that this method has a positive affect on older peoples health and well-being. This form of care must still be developed to include extensive screenings and interventions, as well as a health resource perspective where the starting point during every home visit is the older persons individual needs and wishes.

Do urinary tract infections affect morale among very old women

BackgroundUrinary tract infection (UTI) is among the most common bacterial infections in women of all ages but the incidence increases with older age. Despite the fact that UTI is a common problem it is still poorly investigated regarding its connection with experienced health and morale. The aim of this study was to explore the impact of a diagnosed, symptomatic urinary tract infection (UTI) with or without ongoing treatment on morale or subjective wellbeing among very old women.MethodsIn a cross-sectional, population-based study, 504 women aged 85 years and older (range 84-104) were evaluated for ongoing UTI. Of these, 319 (63.3%), were able to answer the questions on the Philadelphia Geriatric Center Morale Scale (PGCMS) which was used to assess morale or subjective wellbeing.ResultsIn the present study sample of 319 women, 46 (14.4%) were diagnosed as having had a UTI with or without ongoing treatment when they were assessed. Women with UTI with or without ongoing treatment had significantly lower PGCMS scores (10.4 vs 11.9, p = 0.003) than those without UTI, indicating a significant impact on morale or subjective wellbeing among very old women. Depression (p < 0.001), UTI (p = 0.014) and constipation (p = 0.018) were the medical diagnoses significantly and independently associated with low morale in a multivariate regression model.ConclusionsAs UTI seems to be independently associated with low morale or poor subjective wellbeing, there needs to be more focus on prevention, diagnosis and treatment of UTI in old women.

“To Be stuck in It—I Can’t Just Leave” A Qualitative Study of Relatives’ Experiences of Dementia Suffers Living at Home and Need for Support

The large number of individuals affected by dementia entails major challenges for home health care (HHC) and dementia-affected families. The aim of the study was to explore and describe relatives’ experiences of people with dementia living at home and to reveal the relatives’ needs for support. Focus group interviews (10 people) were used for data collection. The analysis was qualitative content analysis. The results show that relatives are unable to escape the situation and that the dignity of the person with dementia is threatened. Relatives experience a sense of powerlessness due to fragmented services. The continuity of HHC services constitutes a major challenge. Personnel should focus more on ethical considerations and on dialogue between formal and informal caregivers.