Lisbeth Kristiansen

Struggle with a gap between intensive care units and general wards.

Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process—the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses’ “struggling with a gap.” The “gap” was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients’ ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

Swedish assistant nurses' experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances. An interview study

Job satisfaction is complex and is an important component in facilitating high quality nursing care. Behavioural and psychological symptoms of dementia (BPSD) can be clustered into one of five syndromes: psychosis, aggression, psychomotor agitation, depression and apathy, and comprise signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia. BPSD can cause tremendous distress both for the patients and for their caregivers and they have been seen as the most stressful aspect of care giving. Two registered nurses, 16 assistant nurses and two nursing assistants in Sweden talked about their job satisfaction when caring for residents suffering from dementia and BPSD. Thematic content analysis was conducted. The nurses’ narrations indicate exposure, insufficiency, not being valued and doubt, as well as respect and importance and devotion towards the residents. One core theme was formulated: “Job satisfaction as a process moving between breaking down and occasionally building up the working person”. A positive relationship with colleagues was the primary reason for nurses continuing to work at the group dwellings. The organization and resident behaviours were seen as very negative. Some nurses described insecurity in terms of how long they could continue to take rudeness, being spat at, being scratched or physically hit by residents, without “hitting back”. In order to increase the well-being of the nurses, the pressure on them needs to be relieved. The development of leadership, education, supervision and reflection might be one possible way of reducing the prevalence of BPSD-related violence, enhancing job satisfaction and handling moral stress.

Decreased Risk for Violence in Patients Admitted to Forensic Care, Measured With the HCR-20

AIM The aim of this study was to explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the clinical (C) and risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data. METHODS The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment. RESULTS The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce. CONCLUSION The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patients risk for violence in order to work with the patients specific risk factors to reduce the risk.

Exploring the influence of Internet‐based caregiver support on experiences of isolation for older spouse caregivers in rural areas: a qualitative interview study

BACKGROUND Many older spouse caregivers are tied to the home by their caring duties and feel isolated. The values of supporting older caregivers are well known. In rural areas with long distances and decline in essential services, attending caregiver support groups can be difficult. Using Internet-based services can provide an opportunity for rural caregivers to participate in caregiver support, regardless of geographical distances and without the need for physical presence. AIMS AND OBJECTIVES This study aimed to explore how Internet-based caregiver support may influence the experience of isolation among older spouse caregivers in rural areas. DESIGN An intervention study where 63 older rural caregivers received an Internet-based caregiver support service. METHOD A qualitative interview study based on 31 interviews with open-ended questions, analysed using latent content analysis. FINDINGS Two themes represent the findings from the study: Expanding the concept of place and Developing networks. Even though participants still spent their days in the house, they experienced that daily life was being spent in a variety of places, both physically, virtually and emotionally. The Internet-based support service provided them with a tool to reconnect with family and develop new friends. CONCLUSIONS Internet-based caregiver support may reduce the experience of isolation for spouse caregivers in rural areas. Nurses played a crucial part in the development, by encouraging, educating and inspiring caregivers and supporting their independence. IMPLICATIONS FOR PRACTICE Internet-based services ought to be an option for caregiver support in rural areas as it may reduce feelings of isolation for older spouse caregivers.

To reduce technology prior discharge from intensive care –important but difficult? : A grounded theory

Aim:  The aim of this study was to provide a deeper understanding of the experience of intensive care staff regarding the reduction in the use of medical technology prior to patients’ transfer from the ICU. Background:  The goal of ICU transitional care, provided for intensive care patients before, during and after the transfer from the ICU to another care unit, is to ensure minimal disruption and optimal continuity of care for the patient. To smooth this transition, there is a need to prepare for a less technological environment and therefore also a need for a gradual reduction in the use of monitoring equipment. Method:  Group interviews and individual interviews, together with participant observations, were conducted with ICU staff in two hospitals in Sweden. The data were analysed using classic grounded theory. Results:  The main concern was the ICU staff’s ambiguity regarding whether and how to reduce the use of medical technology devices. Insecurity about weaning patients from medical equipment combined with a lack of standardized routines made it difficult for staff to reduce the technical support. The core category describes how the ambiguity was solved primarily by ‘prioritizing control’. However, this often caused the ICU staff to use advanced technology while the patients were in the ICU until the ward staff arrived, even if this should have been handled otherwise. Why and how the ICU staff used the strategy of ‘prioritizing control’ is further explained in the categories ‘being affected by cultural/contextual aspects’, ‘searching for guidance and a shared understanding’ and ‘weighing advantages with more v s less technology’. Conclusion:  It is important to consider ICU staff ambiguity concerning the reduction in technology and to establish strategies for a safe and structured transitional phase with step-down procedures in which technology and monitoring is gradually reduced prior to transfer from ICU.

Correlations between Clinical Judgement and Learning Style Preferences of Nursing Students in the Simulation Room

Background: Health care educators account for variables affecting patient safety and are responsible for developing the highly complex process of education planning. Clinical judgement is a multidimensional process, which may be affected by learning styles. The aim was to explore three specific hypotheses to test correlations between nursing students’ team achievements in clinical judgement and emotional, sociological and physiological learning style preferences. Methods: A descriptive cross-sectional study was conducted with Swedish university nursing students in 2012-2013. Convenience sampling was used with 60 teams with 173 nursing students in the final semester of a three-year Bachelor of Science in nursing programme. Data collection included questionnaires of personal characteristics, learning style preferences, determined by the Dunn and Dunn Productivity Environmental Preference Survey, and videotaped complex nursing simulation scenarios. Comparison with Lasater Clinical Judgement Rubric and Non-parametric analyses were performed. Results: Three significant correlations were found between the team achievements and the students’ learning style preferences: significant negative correlation with ‘Structure’ and ‘Kinesthetic’ at the individual level, and positive correlation with the ‘Tactile’ variable. No significant correlations with students’ ‘Motivation’, ‘Persistence’, ‘Wish to learn alone’ and ‘Wish for an authoritative person present’ were seen. Discussion and Conclusion: There were multiple complex interactions between the tested learning style preferences and the team achievements of clinical judgement in the simulation room, which provides important information for the becoming nurses. Several factors may have influenced the results that should be acknowledged when designing further research. We suggest conducting mixed methods to determine further relationships between team achievements, learning style preferences, cognitive learning outcomes and group processes.

Transitions in the Swedish school system and the impact on student’s positive self-reported-health

BackgroundTo explore three school based transitions and their impact on positive self- reported- health (SRH), pre-school to elementary school (6–10 y), elementary school to junior high school (10-13y), and junior high school to upper secondary school/high school (13-16y), in a long-term longitudinal population based study.MethodsThe study followed three cohorts through one school transition each.A longitudinal study with data from 6693 Health Dialogue questionnaires were used. Data were collected in the middle of Sweden during 2007–2012 with school children age 6–16 years old.ResultsSeveral significant factors were identified with an impact for a positive self-reported-health among children age 6-16y; not feeling sad or depressed, afraid or worried, positive school environment (schoolyard and restrooms), not bullied, good sleep, daily physical activity and ability to concentrate. There was no single factor identified, the factors differed according to gender and age.ConclusionThe study have identified several gender and age specific factors for successful school transitions relevant for a positive SRH. This is valuable information for school staff, parents and school children and provides a possibility to provide support and assistance when needed.

Svensk översättning, kvalitativ relevansvärdering och kvantitativ reliabilitetstestning av Lasater Clinical Judgment Rubric Swedish translation, qualitative relevance evaluation and quantitative reliability test of Lasater Clinical Judgment Rubric

Newly graduated nurses show lacking skills and competences regarding the ability to make appropriate clinical assessment of acute, complex care situations. There is also a lack of translated, qualitative relevance-evaluated and reliability-tested rubrics in the Swedish language. The purpose of this method article was to translate, and conduct a relevance evaluation and reliability test of the identified Lasater Clinical Judgment Rubric (LCJR). In this article, the Swedish translation LCJR (S) is presented. The results showed that the LCJR (S) was both qualitatively relevant and quantitatively reliable. We claim that there are several advantages to systematic use LCJR (S) for assessment of nursing students’ clinical judgement in laboratory simulation environments with acute patient situations.

Health among 6-year-old children in a Swedish county: based on the Health Dialogue

Aim To explore the experiences of self-reported health (SRH) of 6-year-old boys and girls. Background The goals for the Swedish School Health Services (SHS) are to identify health problems, take measures to prevent illness, and promote health. One approach used to achieve this is the use of the Health Dialogue (HD) questionnaire. The HD is offered at three occasions during compulsory school and once in high school; it follows the childs development and growth from 6 to 16 years old. Methods The HD is a structured questionnaire consisting of 15 questions related to health, each phrased in a positive manner. The HD represents a cross-sectional image of the childs SRH according to the child and parents. The SRH in this study is based on the results from the 5259 HD questionnaires conducted during 2006–2009 with 6-year-old children and parents. OR were analyzed for the HD. Results Experiencing comfortableness in preschool, good sleep, absence of severe headaches, being physical active/play every day, and not being a victim for bullying shows to be important preschool indicators for boys and girls. Discussion The most important health variable tagging in the preschool childrens positive SRH was comfortableness in preschool. Both boys and girls need to feel comfortable in preschool to report a positive SRH in school. The girls seem to be more dependent on comfortableness, being physical active, and not being bullied while the boys need to have lunch in school every day and not to show symptoms like severe headaches. Conclusion The most important health variable tagging the preschool childrens SRH is comfortableness in school. The HD can increase the knowledge of 6-year-old childrens SRH and also be a tool to gain further insight into childrens health by highlighting patterns in childrens SRH.

Skolsköterskans rolltransformering till den nya hälsofrämjande positionen: The transformation of the school nurse’s role towards the new health-promoting position

Aim The aim of this study was to describe the role transformation of school nurses towards primary health promotion, and secondary preventive and health treatment work. Background According to the Swedish educational act, the school nurse profession has changed towards being mainly health promotion and secondary preventive and health treatment work. Method The study consisted of a qualitative study design with content analysis inspired by Elo and Kyngäs. Sixteen individual interviews were conducted with school nurses from across one county. Findings The role transformation towards a more health promotion was described by school nurses’ statements. The process of the transformation differed among the school nurses. Three categories illuminated their work; professional approach, student-centred and collaboration. Conclusion The role transformation process required enhanced relation and communicational skills. Structured collegial supervision might support the process.