Lise Hounsgaard

Forensic psychiatric nursing: a literature review and thematic analysis of staff–patient interaction

In Denmark the increasing number of forensic mental health patients has led to prioritized services, including the area of nursing; however, this field is subject to sparse research. The aim of this study was to review existing research literature and in doing so investigate what characterizes forensic mental health staff interaction with forensic mental health inpatients and furthermore to investigate what significance these staff characteristics have for the inpatients. The literature review spans the period September 1997 to January 2009 and was based on a systematic keyword combination search in the following databases: CINAHL, CSB, PsycINFO, Scopus, Pubmed, MEDLINE and Sociological Abstracts. The articles were categorized using a literature matrix and analysed using content analysis. Seventeen quantitative and qualitative research studies were analysed. The results show that the interaction between forensic staff and forensic inpatients is characterized by two overriding themes: parentalistic & behaviour-changing care and relational & personal quality-dependent care. Only a few of the findings represent a clear account of how the interactional characteristics impact on the forensic inpatient. The conclusion is that no clear account of the patient impact issue can be reached at this point and that further investigation needs to take place.

The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation

Summary We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation. Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at two hospitals were recruited at hospital discharge. They were randomly assigned to intervention or control. The telemedicine equipment consisted of a briefcase with built-in computer including a web camera, microphone and measurement equipment. The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge. A total of 266 patients (mean age 72 years) were allocated to either intervention (n = 132) or control (n = 134). There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks: mean 1.4 (SD 2.1) in the intervention group and 1.6 (SD 2.4) in the control group. In a secondary analysis, there was no significant difference between the two groups in mortality, time to readmission, mean number of total hospital readmissions, mean number of readmissions with AECOPD, mean number of total hospital readmission days or mean number of readmission days with AECOPD calculated at 4, 8, 12 and 26 weeks. Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality.

Reconstructing Normality: Characteristics of Staff Interactions with Forensic Mental Health Inpatients

Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic mental health nursing staff interaction with forensic mental health inpatients and to explore how staff give meaning to these interactions. The project included 32 forensic mental health staff members, with over 307 hours of participant observations, 48 informal interviews, and seven semistructured interviews. The findings show that staff interaction is typified by the use of trust and relationship-enabling care, which is characterized by the establishment and maintenance of an informal, trusting relationship through a repeated reconstruction of normality. The intention is to establish a trusting relationship to form behaviour and perceptual-corrective care, which is characterized by staffs endeavours to change, halt, or support the patients behaviour or perception in relation to staffs perception of normality. The intention is to support and teach the patient normal behaviour by correcting their behaviour, and at the same time, maintaining control and security by staying abreast of potential conflicts.

Cognitive adaptation training combined with assertive community treatment: - A randomised longitudinal trial

BACKGROUND Cognitive adaptation training (CAT) targets the adaptive behaviour of patients with schizophrenia and has shown promising results regarding the social aspects of psychosocial treatment. As yet, no reports have appeared on the use of CAT in combination with assertive community treatment (ACT). Our purpose was to evaluate the effect of CAT in comparison with ACT, focusing on social functions (primary outcome), symptoms, relapse, re-hospitalisation, and quality of life of outpatients with schizophrenia. METHODS The trial was a parallel, randomised, multicentre trial conducted in three centres treating patients with a first episode of schizophrenia disorder. A total of 62 outpatients diagnosed as having schizophrenia were randomly assigned to CAT+ACT or ACT alone. The CAT was conducted in the patients home and included instruction in prompting for specific actions. The treatment lasted for 6months, and the patients were assessed at baseline and at 6- and 9-month follow-ups. RESULTS The results of mixed-effects regression models indicated no significant differences between intervention group and control group at 6 and 9months in any outcome [Global Assessment of Functioning at 6months (p=0.32) and the Health of the Nation Outcome Scales social subscale at 6months (p=0.30)]. CONCLUSION The results from this trial differ from previous CAT trials because use of CAT showed no significant effects. However, the low number of participants may have been responsible for these results. Thus, additional studies are needed to determine whether the use of some elements of CAT can help to make ACT more economically effective.

Hoping for the best, preparing for the worst: the lived experiences of women undergoing ovarian cancer surgery.

SEIBAEK L., PETERSEN L.K., BLAAKAER J. & HOUNSGAARD L. (2012) European Journal of Cancer Care21, 360–371 Hoping for the best, preparing for the worst: the lived experiences of women undergoing ovarian cancer surgery In this study, the lived experiences of women undergoing ovarian cancer surgery were explored, aiming to provide a patient perspective on being newly diagnosed and starting treatment for ovarian cancer. The study period ran from the first visit in the outpatient clinic, till 8 weeks later, when the women had either begun chemotherapy or completed their recovery. Ten women participated in two qualitative research interviews each, before and after surgery. By applying a phenomenological-hermeneutic text interpretation methodology, the findings were systematically identified, put into meaning-structures, interpreted and discussed. This process constituted the theme: ‘Hoping for the best, preparing for the worst’. Final diagnostics and treatment start were extensive life events, where life itself was threatened, although hope and will were present. The women intuitively prepared themselves for the diagnosis and treatment. However, the ability to prepare was influenced by personal lifestyle, social conditions, coping strategies, and experiences of hope. The ability to prepare could be strengthened by providing adjusted information, psychosocial support and physical optimisation during the perioperative period. By offering targeted family counselling and taking good care of the womens general health and well-being, hope could be sustained and early cancer rehabilitation initiated.

Expectations of Becoming a Nurse and Experiences on Being a Nurse

Aim: To obtain knowledge of nearly graduated nursing students expectations to becoming a nurse and experiences of being a new nursing graduate Background: The transition from student to new nursing graduate is experienced to be conflict-ridden and may result in newly registered nurses changing jobs (staff turnover) after a short period of time. Disharmony between expectations and the experience of being a nurse may complicate the transition. Method: Field work with participant observation and interviews with nine participants as nursing students and as new graduated nurses with analysis of data based on a phenomenological hermeneutic interpretation theory. Results: The nearly graduated nursing students were preoccupied with considerations about future employment as a registered nurse. The joy of finishing the education was mixed with apprehension about having to take on independency. If they as nursing students had had independent work, and if the interaction with colleagues was characterized by dialogue, andling the independency as new nursing graduate was easier.

The nature of nursing practice in rural and remote areas of Greenland

Background The Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing. Aim To investigate current nursing practice in Greenland and to identify whether it meets the requirements of healthcare reform. Design This ethnographic study utilised documentary analysis, participant observation and qualitative interviewing carried out in remote areas of Greenland during 2011–2012. Eight registered nurses, four women and four men, aged between 35 and 55, participated in this study. Four were working at healthcare centres in towns and four were working at nursing stations in villages. The nurses were educated in Greenland or a Nordic country and had been practicing nursing for at least 2 years in an Arctic region. They were observed for 1–5 days, and subsequently interviewed. Interviews included in-depth questioning, based on emerging outcomes from observation. Interviews were recorded and transcribed; they were analysed within a phenomenological–hermeneutic approach. Results Nurses in rural and remote areas navigate their health promotion and preventive work with conflict between health strategies and everyday realities, where unpredictable tasks often lead to prioritisation of urgent, acute work. There is interaction between personal and professional skills. Everyday life is characterised by opportunities and challenges in the grey areas, namely nursing, medical and social work. Conclusion The nature of nursing practice in rural and remote Greenland is characterised by a high degree of variability and complexity, with a requirement for a wide range of knowledge and skills. Nurses need to be better prepared with regard to acute medical care, preventive care, social work, humanistic approaches and information technology to implement the ideology of health strategies.

Implementation of coherent, evidence-based pathways in Danish rehabilitation practice

Abstract Aim: Studies have shown that evidence-based practice improves outcomes, both for patients and for staff organisational systems. However, the incorporation of evidence-based guidelines in a health care practice requires a specific, targeted approach on all organisational levels. Purpose: To gain a deeper understanding of how to facilitate the implementation of coherent and evidence-based guidelines in Danish rehabilitation contexts. Method: The study was based on a phenomenological hermeneutic approach and on theories within knowledge translation. Fifteen municipalities and four hospitals volunteered to participate. Facilitators were appointed locally. Data concerning factors facilitating the implementation were generated in three focus group interviews. Results: Evidence-based rehabilitation was implemented with local adaptation for each participating setting, resulting in context-dependent variations. Conclusion: The PARIHS framework is based on concepts that capture factors of impact on clinical decision-making and interventions which enhance changes of daily practice in the participating rehabilitation settings. The rehabilitation pathways reinforced the foundation and ownership of the daily practice and created an impetus for raising the quality of clinical practice. The facilitators constituted important actors in anchoring the implementation. Moreover, it was important for the local implementation to be an integrated element of a common workforce agenda. Implications for Rehabilitation Evidence-based rehabilitation pathways updated the professional knowledge and reinforced the therapists’ ownership of the daily practice. Appointed facilitators are key stakeholders and important elements in anchoring an implementation. Local implementation processes being part of a cross-sectoral enhancement support successful implementation.

Symptoms and health-related quality of life in patients with advanced cancer - A population-based study in Greenland

PURPOSE The aims were to describe symptoms and health-related quality of life (HRQoL) in Greenlandic patients with advanced cancer and to assess the applicability and internal consistency of the Greenlandic version of the EORTC-QLQ-C30 core version 3.0. METHODS A Greenlandic version of the EORTC QLQ-C30 v.3.0 was developed. The translation process included independent forward translation, reconciliation and independent back translation by native Greenlandic-speaking translators who were fluent in English. After pilot testing, a population-based cross-sectional study of patients with advanced cancer receiving palliative treatment was conducted. Internal consistency was examined by calculating Cronbachs alpha coefficients for five function scales and three symptom scales. RESULTS Of the 58 patients who participated in the study, 47% had reduced social functioning, 36% had reduced physical and role functioning and 19% had reduced emotional and cognitive functioning. Furthermore, 48% reported fatigue, and 33% reported financial problems. The Greenlandic version of the EORTC had good applicability in the assessment of symptoms and quality of life. Acceptable Cronbachs alpha coefficients (above 0.70) were observed for the physical, role and social functioning scales, the fatigue scale and the global health status scale. CONCLUSIONS Patients with undergoing palliative treatment in Greenland for advanced cancer reported high levels of social and financial problems and reduced physical functioning. This indicates a potential for improving palliative care service and increasing the focus on symptom management. The Greenlandic version of the EORTC-QLQ-C30 represents an applicable and reliable tool to describe symptoms and health-related quality of life among Greenlandic patients with advanced cancer.

Evaluating the Impact of Audits and Feedback as Methods for Implementation of Evidence in Stroke Rehabilitation

Introduction: This paper evaluates audits and feedback as methods to increase implementation of evidence in stroke rehabilitation. Method: The study used an action research approach and theories of knowledge translation. A sample of 22 occupational therapists participated from two Danish hospitals that admitted stroke patients. Data collection methods included audits of occupational therapy medical records, documentations of daily practice, and collaborative discussions. Active feedback and discussions of the findings took place, at a group level in four local clinical audits. Data analysis of daily self-reported recordings and audits was descriptive. Audit data were analysed using descriptive statistics. A phenomenological hermeneutical interpretive methodology was used for analysing qualitative data. Findings: Audits and feedback were based on clear standards and contextual developing action plans. Daily practice in both settings adapted to the clinical guidelines. Implementations of the standardized assessment tools seemed to be the most successful. Conclusion: The effects of audit and feedback profited from the active participation of the therapists, as well as local gatekeepers having formal responsibilities for implementing change. The process was strengthened by providing the audits and feedback more than once. The effect of audits and feedback was positively influenced by being in line with current conceptual frameworks, local policies, and values.