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Background and Aims: Several factors exist regarding the risk for, healing and prevention of pressure ulcers (PUs). A mobile PU team with an individualized holistic approach adapted to the home or outpatient clinic setting could be beneficial for the prevention, and management of PUs. Aims: To describe the mobile PU team's interventions among individuals who had deep PUs and were living at home. Another aim was to describe the patients' perceptions of the quality of the care and having a deep PU. Methods: A quantitative study with a cross-sectional design. At an outpatient clinic, a mobile PU team was established to perform and follow up PU prevention interventions and advanced wound care treatment at home and at the outpatient clinic. All adult patients with existing deep category four PUs remitted to the outpatient clinic were asked to participate, and 16 out of 24 individuals consented. Instruments used for data collection were "Quality from the Patient's Perspective," "Wound-Quality of Life," "Modified Norton Scale," and a study developed protocol for the mobile team's PU interventions. Results: The patients chose home visits 20 times and outpatient clinic visits 89 times. In total, 8-13 interventions per participant were performed by the mobile team. The results show that having PUs affected the participants' perceptions of care and general well-being. The PUs did not heal completely but they did improve, six patients underwent flap surgery. Conclusion: When organizing care regarding patient safety for patients with deep PUs, it is important to consider the patient's perspective and well-being and to involve patients in their care plans. Home care is perhaps not the only way of caring; other aspects, in addition to telemedicine, could be an option.
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PURPOSE: The aim of this study is to describe how Swedish women, planned for vaginal birth, perceive the quality of intrapartal care that they receive and the subjective importance they ascribe to their care. DESIGN/METHODOLOGY/APPROACH: The study was nested within a Swedish national survey of intrapartal care. The women whose care was investigated were invited to participate in the current study by the midwife who attended the birth. A total of 1,173 women agreed to answer a questionnaire about "quality of general care" and "quality of specific intrapartal care" at two months postpartum. The questions were posed in two ways, the perceived reality (PR) of care given and the subjective importance (SI) the women ascribed to this care. FINDINGS: A total of 739 women (63 percent) returned their questionnaires. Scores for PR and SI for "quality of general care" were in the main high (PR range 2.98-3.81; SI range 2.85-3.85, out of a possible 4) and also for "quality of specific intrapartal care" (PR range 3.15-3.86; SI range 3.23-3.86, out of a possible 4). A total of 12 items showed statistically significantly higher scores for SI than for PR. Of the women, 81 percent agreed fully or mostly that the birth of their child was a positive experience. ORIGINALITY/VALUE: The way in which women answer questions about intrapartal care reflects the way in which the questions are posed. This study therefore has asked not only how care was perceived but also what importance individual women ascribed to different areas of their care. The questionnaire used in this study allows identification of areas where "what is, could be better".
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Parto/psicología , Satisfacción del Paciente , Percepción , Atención Perinatal/organización & administración , Adulto , Competencia Clínica , Estudios Transversales , Ambiente , Femenino , Humanos , Partería , Manejo del Dolor , Educación del Paciente como Asunto/organización & administración , Calidad de la Atención de Salud , SueciaRESUMEN
PURPOSE: The purpose of this paper is to test the psychometric properties and dimensionality of a new instrument, quality in psychiatric care (QPC), and to describe and compare quality of care among in-patients as measured by this instrument. DESIGN/METHODOLOGY/APPROACH: The instrument quality in psychiatric care measures patients' experiences regarding quality of care. The instrument is based on a definition of quality of care from the patients' perspective. A sample of 265 in-patients at eight general psychiatric wards in Sweden was assessed. FINDINGS: Exploratory factor analysis revealed that the original five-dimensional 69-item QPC was better with six dimensions and reduced to 30 items, hereinafter denoted quality in psychiatric care-in-patients (QPC-IP) with retained internal consistency. The patients' ratings of quality of care were generally high; the highest rating was for quality of encounter and the lowest for participation. RESEARCH LIMITATIONS/IMPLICATIONS: Analysis of the dropouts was not possible because of incomplete registrations at the wards. PRACTICAL IMPLICATIONS: QPC-IP is a simple, inexpensive and quick way to evaluate quality of care and thus contributes to health care improvement in the field of psychiatry. ORIGINALITY/VALUE: The new 30 items instrument, QPC-IP includes important aspects of patients' perceptions of quality of care. The QPC-IP is psychometrically adequate and thus recommended for evaluating patients' experiences of the quality of psychiatric care.
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Pacientes Internos , Servicios de Salud Mental/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto , Continuidad de la Atención al Paciente/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , PsicometríaRESUMEN
AIM: The aims of this study were to elucidate women's perception of intrapartal care and women's perceptions of normal birth. METHODS: A questionnaire developed from the WHO's recommendations for care in normal birth was answered by 138 (response rate 66.0% Swedish women. The women were asked to evaluate items in two ways: their perceived reality of care received and the subjective importance of each item. RESULTS: Most women reported receiving care in the category (A) practices that are good and should be encouraged. However, women to a minor degree reported assessment for physical health, enquiring about support needs and pain assessment on admission. Many women received electronic foetal monitoring, repeated vaginal examinations, oxytocin augmentation and suturing after birth which fall under the category (B) practices that are harmful, (C) insufficient evidence exists and (D) practices frequently used inappropriately. The women who reported 'Yes' for perceived reality also reported high subjective importance for those items regardless of category A-D. Eighty-four per cent of the women perceived that they had a normal delivery. CONCLUSION: The result suggests that women have great trust that the care midwives give them is the best care. Midwives, therefore, have an ethical responsibility to keep themselves informed about the best evidence-based care and to implement critical reviewing of their practice as part of continuing professional development. The women's perceptions of a normal birth allows for a wide range of interventions. RELEVANCE FOR CLINICAL PRACTICE: The result emphasises the importance of midwives' knowledge of evidence-based care and how to implement this into practice. Further research should include elucidation of the meaning of normal childbirth to childbearing women.
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Guías como Asunto , Atención Prenatal , Mujeres/psicología , Organización Mundial de la Salud , Femenino , Humanos , Encuestas y Cuestionarios , SueciaRESUMEN
The aim of this study was to explore the pattern of the Swedish version of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI), in respect of age and gender, in a sample of old people with locomotor disability from a population aged 60 years and older in Sweden and compare it with other studies in the same area for the purpose of further validation. The participants (n = 199) were selected from a population (n = 3469), age >or=60 years, in two counties in Sweden and were visited in their own homes. The measure was carried out with two instruments, the Swedish version of PGCMAI, used as an interview, and the Standardized Practical Equipment test consisting of practical tasks. We found that these two instruments distinguished the functional pattern among old men and women where women had deteriorated most with age. This is in agreement with other studies.
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Personas con Discapacidad , Evaluación Geriátrica , Actividad Motora , Actividades Cotidianas , Anciano , Femenino , Humanos , Masculino , SueciaRESUMEN
AIMS: To study, within municipal care and county council care, (1) chief nurses' and registered nurses' perceptions of patient nutritional status assessment and nutritional assessment/screening tools, (2) registered nurses' perceptions of documentation in relation to nutrition and advantages and disadvantages with a documentation model. BACKGROUND: Chief nurses and registered nurses have a responsibility to identify malnourished patients and those at risk of malnutrition. DESIGN AND METHODS: In this descriptive study, 15 chief nurses in municipal care and 27 chief nurses in county council care were interviewed by telephone via a semi-structured interview guide. One hundred and thirty-one registered nurses (response rate 72%) from 14 municipalities and 28 hospital wards responded to the questionnaire, all in one county. RESULTS: According to the majority of chief nurses and registered nurses, only certain patients were assessed, on admission and/or during the stay. Nutritional assessment/screening tools and nutritional guidelines were seldom used. Most of the registered nurses documented nausea/vomiting, ability to eat and drink, diarrhoea and difficulties in chewing and swallowing, while energy intake and body mass index were rarely documented. However, the majority documented their judgement about the patient's nutritional condition. The registered nurses perceived the VIPS model (Swedish nursing documentation model) as a guideline as well as a model obstructing the information exchange. Differences were found between nurses (chief nurses/registered nurses) in municipal care and county council care, but not between registered nurses and their chief nurses. CONCLUSIONS: All patients are not nutritionally assessed and important nutritional parameters are not documented. Nutritionally compromised patients may remain unidentified and not properly cared for. RELEVANCE TO CLINICAL PRACTICE: Assessment and documentation of the patients' nutritional status should be routinely performed in a more structured way in both municipal care and county council care. There is a need for increased nutritional nursing knowledge.
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Actitud del Personal de Salud , Documentación/normas , Enfermeras Administradoras/psicología , Evaluación en Enfermería/normas , Personal de Enfermería/psicología , Estado Nutricional , Adulto , Distribución de Chi-Cuadrado , Adhesión a Directriz/normas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Desnutrición/diagnóstico , Desnutrición/epidemiología , Tamizaje Masivo , Persona de Mediana Edad , Modelos de Enfermería , Rol de la Enfermera , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Registros de Enfermería/normas , Personal de Enfermería/educación , Personal de Enfermería/organización & administración , Evaluación Nutricional , Guías de Práctica Clínica como Asunto , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Suecia/epidemiologíaRESUMEN
BACKGROUND: The 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. METHODS: In 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. RESULTS: Five 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 >/= 10(7) cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003). CONCLUSION: Many 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.
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The next of kin play a decisive role in the care provided for patients. This and their unique experience of psychiatric care make it important to include them when defining quality of care. The aim of the present study was to describe how next of kin perceive the concept of quality of care in the case of psychiatric care. Twelve next of kin were included in a qualitative interview study and a phenomenographic approach was used for the analysis of the interviews. The next of kin described quality of care mainly from their own perspective but also to a large extent from the patient's perspective as well. Five descriptive categories resulted: dignity, security, participation, recovery, and health-promoting surroundings. Good relations and communication between staff, patients, and next of kin emerged as the central factors regarding the quality of psychiatric care. The next of kin asked for information about psychiatric illnesses and wanted to cooperate in the care. They avoid telling others about their family member's psychiatric illness because of a feeling of shame and guilt. Staff education regarding such feelings and stigmatization could be useful in furthering the understanding of the next of kin's distress and developing interventions to alleviate it. Clinical practice can be improved by guidelines and instruments developed on the basis of this study.
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Familia , Servicios de Salud Mental/normas , Calidad de la Atención de Salud , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: The principal aim of this paper is to develop an instrument to measure quality of care in the psychiatric setting from an in-patient perspective and to describe quality of care by means of this instrument. A further aim is to investigate the influence of background variables and expectations on the experience of care. DESIGN/METHODOLOGY/APPROACH: The instrument "Quality in psychiatric care" consists of two parts: one for measuring the patient's expectations regarding quality of care, the other for measuring his or her experiences regarding it. The instrument was derived from an earlier interview study of patients' perceptions of the quality of psychiatric care. A sample of 116 patients from eight in-patient wards in Sweden participated in the present study. FINDINGS: Results indicate a generally high quality of care. Experienced quality of care was significantly lower, however, than expectations in all the dimensions of the instrument: total dimension, dignity, security, participation, recovery and environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health experienced this too, but also significantly higher participation. RESEARCH LIMITATIONS/IMPLICATIONS: This new instrument needs to be further tested before the psychometric properties can be established. ORIGINALITY/VALUE: The value of the research is that instruments for measuring the quality of in-patient psychiatric care from the patient's perspective and with a theoretical foundation are less common.
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Satisfacción del Paciente , Psiquiatría , Calidad de la Atención de Salud , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , SueciaRESUMEN
We examined whether the Swedish adaptation of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) developed by Lawton meets criteria for reliability and validity in an elderly Swedish population with locomotor disability. Data were collected, using the mid-length version of the instrument, from 199 elderly people with locomotor disability in two Swedish counties. Reliability was determined by Cronbach's alpha and construct validity was tested by means of exploratory factor analysis. Comparison was made with the Standardized Practical Equipment (SPE) test. Factor analysis identified eight factors, which were comparable to the original eight domains. There was a logical correlation between the PGCMAI and the SPE test. Further psychometric testing is recommended on other groups of elderly people.
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Evaluación de la Discapacidad , Evaluación Geriátrica , Limitación de la Movilidad , Anciano , Análisis Factorial , Humanos , Funciones de Verosimilitud , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , SueciaRESUMEN
BACKGROUND: Women's 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. METHODS: This 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. RESULTS: Of the 154 women for whom body temperature was recorded at the first visit, 80 (52%) had fever ranging from 38.1 degrees C to 40.7 degrees 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. CONCLUSION: Initial 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.
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OBJECTIVES: to further compare acupuncture treatment and care interventions for the relief of inflammatory symptoms of the breast during lactation and to investigate the relationship between bacteria in the breast milk and clinical signs and symptoms. DESIGN: randomised, non-blinded, controlled trial of acupuncture and care interventions. SETTING: a midwife-led breast feeding clinic in Sweden. PARTICIPANTS: 205 mothers with 210 cases of inflammatory symptoms of the breast during lactation agreed to participate. The mothers were randomly assigned to one of three treatment groups, two of which included acupuncture among the care interventions and one without acupuncture. All groups were given essential care. Protocols, which included scales for erythema, breast tension and pain, were maintained for each day of contact with the breast feeding clinic. A Severity Index (SI) for each mother and each day was created by adding together the scores on the erythema, breast tension and pain scales. The range of the SI was 0 (least severe) to 19 (most severe). FINDINGS: no significant difference was found in numbers of mothers in the treatment groups, with the lowest possible score for severity of symptoms on contact days 3, 4 or 5. No statistically significant differences were found between the treatment groups for number of contact days needed until the mother felt well enough to discontinue contact with the breast feeding clinic or for number of mothers prescribed antibiotics. Significant differences were found in the mean SI scores on contact days 3 and 4 between the non-acupuncture group and the two acupuncture groups. Mothers with less favourable outcomes (6 contact days, n=61) were, at first contact with the midwife, more often given advice on correction of the baby's attachment to the breast. An obstetrician was called to examine 20% of the mothers, and antibiotic treatment was prescribed for 15% of the study population. The presence of Group B streptococci in the breast milk was related to less favourable outcomes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: if acupuncture treatment is acceptable to the mother, this, together with care interventions such as correction of breast feeding position and babies' attachment to the breast, might be a more expedient and less invasive choice of treatment than the use of oxytocin nasal spray. Midwives, nurses or medical practitioners with specialist competence in breast feeding should be the primary care providers for mothers with inflammatory symptoms of the breast during lactation. The use of antibiotics for inflammatory symptoms of the breast should be closely monitored in order to help the global community reduce resistance development among bacterial pathogens.
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Terapia por Acupuntura/métodos , Lactancia Materna , Lactancia , Mastitis/terapia , Partería/métodos , Manejo del Dolor , Adulto , Femenino , Humanos , Recién Nacido , Madres/psicología , Relaciones Enfermero-Paciente , Dolor/prevención & control , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Suecia , Resultado del TratamientoRESUMEN
OBJECTIVES: to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births. DESIGN: an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period. SETTING: a conventional maternity unit in Western Sweden. FINDINGS: an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage. CONCLUSION AND IMPLICATIONS FOR PRACTICE: a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.
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Parto Obstétrico/enfermería , Partería/métodos , Evaluación en Enfermería/métodos , Auditoría de Enfermería , Evaluación de Resultado en la Atención de Salud , Atención Perinatal/métodos , Adulto , Centros de Asistencia al Embarazo y al Parto/organización & administración , Áreas de Influencia de Salud , Parto Obstétrico/normas , Femenino , Monitoreo Fetal/métodos , Humanos , Recién Nacido , Partería/normas , Rol de la Enfermera , Relaciones Enfermero-Paciente , Evaluación en Enfermería/normas , Investigación en Evaluación de Enfermería , Complicaciones del Trabajo de Parto/enfermería , Embarazo , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud , Suecia , Organización Mundial de la SaludRESUMEN
PURPOSE: The aim of the paper is to compare the computer administration method (touch-screen) with the original paper-and-pen approach when measuring patients' perceptions of care quality. DESIGN/METHODOLOGY/APPROACH: The study group consisted of 199 patients who responded to touch-screen and 219 who responded to paper-and-pen questionnaires, receiving care between January and March 2003 at two out-patient clinics in one county in Sweden. The response rate was 75 per cent. A modified version of the quality from the patient's perspective questionnaire was used. FINDINGS: Two main findings emerged: first, both methods yielded almost identical results in quality of care ratings, and second, the touch-screen method was perceived to be easier to use and to take less time to complete. ORIGINALITY/VALUE: The paper shows that both methods are acceptable, but the touch-screen method appears to be preferred by patients.
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Satisfacción del Paciente , Calidad de la Atención de Salud , Encuestas y Cuestionarios , Interfaz Usuario-Computador , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , SueciaRESUMEN
Previous studies examining the influence of patient and nurse characteristics on assessments of pain and distress are not consistent in their results. Few studies have focused on the influence of nurses' personality factors on the assessment of pain and distress. The aims of this study were to compare registered nurses' and student nurses' assessments of patients' pain and distress and to identify if the assessment relate to specific patient and nurse characteristics. Seventy-one registered nurses and 184 student nurses assessed pain and distress in three hypothetical cases and responded to personality factors scales. The assessments of pain and distress regarding the patients showed significant differences. The respondents were divided into two groups, respectively, for each patient according to whether the patient's experiences of pain and distress were assessed as more or less intense. Both the groups of registered nurses and student nurses showed significantly differences on personality factors. The groups of student nurses also differed on nursing experience. Patients' age, and type and stage of illness, personality factors, and nursing experience influenced the respondents' assessments. These findings can be used to help educators in nursing to develop strategies to improve skills and knowledge in the assessment at pain and distress.
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Actitud del Personal de Salud , Evaluación en Enfermería/normas , Personal de Enfermería/psicología , Dolor/diagnóstico , Estrés Psicológico/diagnóstico , Estudiantes de Enfermería/psicología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Competencia Clínica/normas , Bachillerato en Enfermería , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Evaluación en Enfermería/métodos , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Dimensión del Dolor/métodos , Dimensión del Dolor/enfermería , Dimensión del Dolor/normas , Personalidad , Índice de Severidad de la Enfermedad , Estrés Psicológico/etiología , Encuestas y Cuestionarios , SueciaRESUMEN
AIM: The aim was to describe how patients perceived the concept of quality of care in psychiatric care. BACKGROUND: It is important to include patients' experiences in defining quality of care and in the development of instruments measuring quality of psychiatric care, as patients have unique information. But only a limited number of studies have directly involved patients. DESIGN: It was a qualitative interview study with 20 adult in and outpatients from psychiatric care. METHOD: A phenomenographic approach was used for the analysis of the interviews. RESULTS: The results showed that quality of care was perceived as a positive concept, namely as 'good' quality of care. The normative component was striking. Five descriptive categories emerged: The patient's dignity is respected; The patient's sense of security with regard to care; The patient's participation in the care; The patient's recovery; and The patient's care environment. Two conceptions emerged that had not emerged explicitly in earlier studies of quality of care: Being helped to reduce the shame and Being looked upon as like anyone else. CONCLUSIONS: The findings emphasize the importance of the interpersonal relationship between patients and staff. There is a need for further exploration of central aspects of quality in psychiatric care. RELEVANCE TO CLINICAL PRACTICE: It is important that the knowledge about how patients perceived the quality of care in psychiatric care is included in the planning and evaluation of care. The guidelines should designate quality of care from the patient perspective as the goal of interventions.
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Trastornos Mentales/terapia , Relaciones Enfermero-Paciente , Satisfacción del Paciente , Servicio de Psiquiatría en Hospital/normas , Enfermería Psiquiátrica/normas , Calidad de la Atención de Salud , Adulto , Actitud del Personal de Salud , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Investigación Cualitativa , Percepción SocialRESUMEN
The aims of this descriptive study were to examine (1) nurses' perceptions of responsibility, knowledge and documentation focusing on enteral nutrition and (2) nursing practice regarding enteral feeding in the intensive care unit. Forty-four nurses in three intensive care units responded to a questionnaire (response rate 70%) and 40 bedside observations were performed. The nurses' primary source of knowledge was consultation with colleagues. Regarding responsibility, knowledge and documentation, the focus was more on planning, implementation and prevention than on the assessing phase of the nursing process. Gastric residual volumes were almost never checked, and none of the tubes were labelled. Seven out of 40 bedside observations revealed a backrest elevation of 30 degrees or more. Mean backrest elevation was 20.7 degrees. Comparisons between nurses in the three hospitals revealed significant differences. This study indicates that enteral nutritional nursing care within intensive care has its strength in planning, implementation and prevention of complications. Regarding nutritional assessment, the registered nurses (RNs) scored low. There are gaps between recommended nursing care and nursing practice regarding enteral nutrition. Knowledge and awareness of responsibilities in combination with a systematic documentation could increase the optimal nutritional care of the intensive care patient.
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Actitud del Personal de Salud , Nutrición Enteral/enfermería , Proceso de Enfermería , Personal de Enfermería en Hospital , Adulto , Documentación , Humanos , Unidades de Cuidados Intensivos , Persona de Mediana Edad , Rol de la Enfermera , Registros de Enfermería , Evaluación Nutricional , Encuestas y Cuestionarios , SueciaRESUMEN
OBJECTIVE: to gain an understanding of the experiences of women who have had an episode of inflammatory symptoms of the breast during lactation. DESIGN: a grounded theory approach, inspired by Glaser and Strauss, was used in an interview study. SETTING: the study was carried out at a midwife-led breast-feeding clinic in Sweden. PARTICIPANTS: the strategic sample consisted of 14 mothers, all of whom had had an episode of breast inflammation between 10 and 22 weeks before the interview. Nine were primiparous. Ages ranged between 24 and 38 years. FINDINGS: the analysis resulted in the emergence of one core category and five conceptual categories. The core category was 'the will to breast feed', and the five conceptual categories were 'perspectives on breast feeding', 'personal strategies', 'enduring and adjustment', 'support' and 'causal frameworks'. The core category was reflected in all the other categories and was dependent on them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: an episode of breast inflammation is a possible threat to the maintenance of breast feeding, but the will to breast feed may make it possible for mothers to withstand physical and emotional difficulties caused by the illness. Breast-feeding mothers may have chosen a goal for the length of time they wish to breast feed, and the attainment of this goal is prestige-filled. Midwives, throughout the chain of care, could improve the amount and type of information given about the demands and possible complications of breast feeding. The availability of immediate clinical expertise for these mothers is an important factor, and health-care planners should be aware of this.
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Lactancia Materna/psicología , Inflamación/psicología , Conducta Materna/psicología , Relaciones Madre-Hijo , Madres/psicología , Adulto , Lactancia Materna/efectos adversos , Femenino , Humanos , Recién Nacido , Inflamación/etiología , Partería , Rol de la Enfermera , Relaciones Enfermero-Paciente , Investigación Metodológica en Enfermería , Atención Posnatal/métodos , Encuestas y Cuestionarios , SueciaRESUMEN
OBJECTIVES: To describe documented intrapartal care in relation to the World Health Organization (WHO) recommendations for care in normal birth, and to compare intrapartal care for pregnant women at low and high risk in a conventional maternity unit. DESIGN: Retrospective examination of 212 consecutive childbirth records using an audit instrument developed from WHO's recommendations. SETTING: A conventional maternity unit in Western Sweden. FINDINGS: Practices that are demonstrably useful and should be encouraged were mostly documented, except for physical assessments, such as pulse and temperature and emotional aspects. Vaginal examinations were carried out more often than recommended, and fetal heart rates were seldom monitored intermittently. Practices classified as harmful, practices with insufficient evidence and practices frequently used inappropriately, were used to a large extent. There were high rates of interventions regardless of the women's risk level. The interventions were carried out without a rational documented indication. According to the documentation, only two-thirds of the women were in active labour on admission to the labour ward. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The recommendations from WHO were only partly adhered to. The instrument is considered useful for systematic audit of documented intrapartal care, and may help to identify areas in need of improvement. Improvements suggested by this study were as follows: inclusion of emotional aspects in the documentation, differentiation in cardiotocographic (CTG) surveillance for women at low and high risk, documentation of explicit indications for interventions and guidelines for admission to the maternity unit.
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Centros de Asistencia al Embarazo y al Parto/organización & administración , Parto Obstétrico/enfermería , Partería/métodos , Evaluación en Enfermería/métodos , Auditoría de Enfermería , Atención Perinatal/métodos , Parto Obstétrico/normas , Femenino , Monitoreo Fetal/métodos , Humanos , Recién Nacido , Partería/normas , Rol de la Enfermera , Evaluación en Enfermería/normas , Investigación en Evaluación de Enfermería , Embarazo , Estudios Retrospectivos , Suecia , Organización Mundial de la SaludRESUMEN
The aim was to describe quality of care from a patient perspective among adolescents receiving orthodontic treatment and to assess the relationship between quality of care and outcome-related aspects. The research design was cross-sectional. The sample consisted of 151 young people (mean age 17.1 years, SD: 2.2; 53% girls and 47% boys) receiving orthodontic treatment in the Stockholm region in Sweden (response rate 75%). Data were collected using the Quality from the Patient's Perspective questionnaire. The highest quality of care perceptions were noted on items dealing with receiving the best possible orthodontic treatment and being treated with respect. Less favourable perceptions of the quality of care were found regarding the opportunity to participate in the decisions related to the orthodontic treatment. In order to improve the quality of care a more active involvement of these patients in the decision-making process is suggested. The item 'I received the best possible orthodontic treatment' noted the highest subjective importance rating. The youngest participants reported the most favourable scores and the oldest the least. The majority (74%) reported that they were 'completely satisfied' with the result of the orthodontic treatment. However, 52% claimed that they had not followed all of the advice obtained during the treatment period, and 29% indicated some or more hesitation about attending the same dentist for future treatment.