Marie-Louise Hall-Lord

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

BackgroundThe role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.MethodsIn this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.ResultsFive main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 107 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).ConclusionMany healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.

Burden and health in relatives of persons with severe mental illness: a Norwegian cross-sectional study.

This study describes and investigates burden to and health of relatives of persons with severe mental illness in relation to background variables, everyday life with the mentally ill person, and sense of coherence. A cross-sectional design was used. The respondents were 226 relatives from the Norwegian National Association for Families of Mentally Ill Persons. In addition to background variables and variables about everyday life with the mentally ill person, the questionnaire was comprised of the Burden Assessment Schedule (BAS), Short Form Health Survey (SF-36), and Sense of Coherence Instrument (SOC). This study shows that the relatives were burdened and also reported poor health. Greater burden was experienced by women and by relatives who did not have anyone with whom to share the caregiving of the mentally ill person. For relatives who were single, divorced, or widowed, burden was greater and health was poorer; likewise for relatives who reported financial problems and frequent phone calls with the mentally ill person. Burden and poor health were associated with low SOC. The findings suggest a need for the health services to include and support these relatives in order for them to sustain health.

Left alone with straining but inescapable responsibilities: relatives' experiences with mental health services.

Relatives of persons with severe mental illness experience burden and straining changes in their lives that put their health at risk. Consequently, they need support from health professionals. The aim of this study was to describe experiences from encounters with mental health services as seen from the point of view of relatives of persons with severe mental illness. A qualitative, explorative study was performed, based on two open-ended questions in a cross-sectional study of relatives’ health, burden, and sense of coherence (n = 216). A manifest qualitative content analysis was used to describe the relatives’ experiences. The findings show that some relatives had experienced positive encounters with health personnel, but the majority of experiences reported were negative. The encounters can be summarized into one main category: “Left Alone with Straining but Inescapable Responsibilities.” Two categories emerged: “Striving for Involvement for the Sake of the Mentally Ill Person,” and “Wanting Inclusion for the Sake of Oneself.” There is a gap between relatives’ needs for support in order to handle their own situation in relation to their mentally ill next of kin, and what they actually receive from the mental health services. The findings suggest that health professionals should collaborate with and support these relatives.

Nurses’ dilemmas concerning support of relatives in mental health care

Relatives of persons with severe mental illness face a straining life situation and need support. Exclusion of relatives in mental health care has long been reported. The aim of this study was to describe conceptions of nurses in mental health care about supporting relatives of persons with severe mental illness. Focus group interviews with nurses from all levels of mental health care in Norway were performed. A phenomenographic approach was used. The nurses found that their responsibility first and foremost was the patient, especially to develop an alliance with him or her. Additional premises for supporting relatives were the context framing the nursing care, aspects of the actors, and relational concerns between them. Competing or contradictory demands were found within these premises. Two paths were identified concerning the nurses’ support of relatives: seeing the relative in the shadow of the patient or as an individual person.

Contending and Adapting Every Day: Norwegian Parents’ Lived Experience of Having a Child With ADHD

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders, and little attention has been paid to the parents and their experiences. The aim of this study was to gain a deeper understanding of the Norwegian parents’ lived experiences of having a child with an ADHD diagnosis. A descriptive design using phenomenological approach was chosen as the research method. Individual qualitative interviews with nine parents, who were members of the ADHD Association, were conducted. The interviews were analyzed according to Colaizzi’s method. The essential structure of the parents’ experiences was Contending and Adapting Every Day—Windsurfing in unpredictable waters which was embedded in the interrelated main themes: Maintaining the Self and Parenthood, and Interacting With the Surrounding World. Being the parent of a child with ADHD is a demanding situation. Nurses need to address the needs of these parents and focus on the family unit.

A descriptive study of Swedish women with symptoms of breast inflammation during lactation and their perceptions of the quality of care given at a breastfeeding clinic.

BackgroundWomens perceptions of quality of care during episodes of breast inflammation have been scantily explored. It was the objective of the present study to describe a cohort of breastfeeding women with inflammatory symptoms of the breast during lactation regarding demographical variables, illness history and symptoms at first contact with a breastfeeding clinic and to explore their physical health status, psychological well-being and perceptions of quality of care received, at a six-week postal follow-up.MethodsThis is a descriptive study set at a midwife-led breastfeeding clinic in Sweden, which included a cohort of women with 210 episodes of breast inflammation. The women had taken part in a RCT of acupuncture and care interventions and were recruited between 2002 and 2004. Of the total cohort, 176 (84 %) responded to a postal questionnaire, six weeks after recovery.ResultsOf the 154 women for whom body temperature was recorded at the first visit, 80 (52%) had fever ranging from 38.1°C to 40.7°C. There was no significant difference between those with favourable outcomes (5 or less contact days) and those with less favourable outcomes (6 or more contact days) for having fever or no fever at first contact. Thirty-six percent of women had damaged nipples. Significantly more women with a less favourable outcome (6 or more contact days) had damaged nipples. Most women recovered well from the episode of breast inflammation and 96% considered their physical health and 97% their psychological well-being, to be good, six weeks after the episode. Those whose illness lasted 6 days or more showed less confidence in the midwives and in the care given to them. Twenty-one (12%) women contacted health care services because of recurring symptoms and eight of the 176 responders (4.5%) were prescribed antibiotics for these recurring symptoms. A further 46 women (26% of the responders) reported recurring symptoms that they managed without recourse to health care services.ConclusionInitial fever may not be indicative of outcomes for women with inflammatory breast symptoms and treatment by antibiotic therapy may be necessary less often than has been supposed. Women who are also suffering from damaged nipples may need special attention. Those with protracted symptoms were less satisfied with care and showed less confidence in caregivers. International research collaboration might help us find the optimal level of antibiotic therapy for this group of women. This is an important consideration for the global community.

Exploring intensive care nurses' team performance in a simulation-based emergency situation, − expert raters' assessments versus self-assessments: an explorative study

BackgroundEffective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual’s technical skills and too little on the teams’ performance of non-technical skills. The aim of the study was to explore intensive care nurses’ team performance in a simulation-based emergency situation by using expert raters’ assessments and nurses’ self-assessments in relation to different intensive care specialties.MethodsThe study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams’ performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann–Whitney U tests, Spearman’s rho and Intraclass Correlation Coefficient Type III.ResultsThe expert raters assessed the teams’ performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters’ assessments and the registered nurses’ self-assessments.ConclusionsTeams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters’ assessments and registered nurses’ self-assessments are useful in raising awareness of team performance with regard to patient safety.

Oral health-related quality of life in older Swedish people with pain problems.

OBJECTIVES The aim of the present paper was to explore the oral health-related quality of life in old Swedish people with pain problems, with special reference to demography, socio-economic factors, health, and general health-related quality of life. METHOD Individuals ≥ 80 years (n = 186) who earlier reported pain problems answered two multi-item instruments on oral health-related quality of life (Oral Health Impact Profile, OHIP-14) and general health-related quality of life (Short Form Health Survey, SF-12), respectively. Socio-demographic and health questions were also inquired. RESULTS Both the oral and general health-related quality of life were rated very low. Two thirds (67.2%) reported at least one of the aspects in the OHIP-14 fairly often, very often or all the time. The mean additive score of the OHIP-14 was 14.6 (SD 10.5). The mean value of the physical component scale (PCS) of SF-12 was 25.9 (SD 6.2) and of the mental component scale (MCS) 44.1 (SD 11.5). The OHIP-14 was consistently and significantly correlated with self-rated general and oral health, chewing ability and MCS. The associations between self-rated general and oral health in relation to the OHIP-14 were independent of possible confounders: OR 3.63 (95% CI 1.58-8.32) and OR 2.68 (95% CI 1.44-4.99), respectively. CONCLUSION Old people with pain problems experienced very low oral and general health-related quality of life. Personnel caring for the oldest with pain problems should be aware that oral health problems can contribute to a low quality of life and that oral care should be included in the general care.

The psycho-social dimension of pain and health-related quality of life in the oldest old.

BACKGROUND Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health-related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce. AIMS   The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho-social) and health-related quality of life as well as to compare sex and age groups in people aged 80 years and over. METHODS In this cross-sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho-social dimension of pain was measured using the Multidimensional Pain Inventory-Swedish language version (MPI-S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health-related quality of life was measured using the Short Form Health Survey-12 (SF-12). RESULTS Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI-S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80-85 years had higher pain severity than those aged≥86. Participants with a lower health-related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life. CONCLUSIONS Older people with prolonged pain suffered from a low health-related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older peoples physical, mental and social health.

Nursing theory based changes of work organisation in an ICU: effects on quality of care

The study evaluated the effects of an organisational change programme on quality of care in a Swedish intensive care unit (ICU). The programme included: structural components e.g. converting assistant nurse positions to nurse positions; behavioural components e.g. improvements of report routines; and attitudinal components e.g. explication of what quality of care could mean in the ICU. Planning and implementation of the programme took about 1 year. Quality of care was studied on 40 patients 3 months before the intervention and on 40 patients 18 months after. An observation and question scheme was used for data collection. using Hendersons (1960) nursing model of patients needs as point of departure. Statistically significant improvements of quality of care were noted on several observations at the postintervention assessment. Most of the improvements were noted on activities aimed at assisting the patient with basic physical needs such as breathing, nutrition, elimination, movement, sleep and rest, and avoiding dangers. No effects were noted on activities aimed at assisting the patient with psychological and spiritual needs. Discussing the results, the multimodal character of the intervention programme was believed to be a significant factor.