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Aims. One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. Background. With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). Design. A cross-sectional retrospective review of health records. Methods. Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper-based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0·001), size (p = 0·004), risk assessment (p = 0·002), nursing history (p = 0·040), nursing diagnoses (p < 0·001), nursing goals (p < 0·001) and nursing outcomes (p = 0·016) in 2006 than in 2002. One third of the recordings used preformulated templates. Conclusions. Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow-up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. Relevance to clinical practice. Education related to the use of the electronic health record and evidence-based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user-friendly. [ABSTRACT FROM AUTHOR]

Aims. This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. Background. Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses’ and physicians’ perceptions about good quality of care do not always agree with patients’ perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment. Method. A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection. Results. Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care. Conclusions. The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient. Relevance to clinical practice. Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients’ perceptions of quality of care at emergency departments. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments. BACKGROUND: Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue. METHOD: A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden. RESULTS: The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings. CONCLUSION: In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended. RELEVANCE TO CLINICAL PRACTICE: The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task. [ABSTRACT FROM AUTHOR]

wadensten b. (2005) International Journal of Older People Nursing in association with Journal of Clinical Nursing 14, 8b, 84–89 The content of morning time conversations between nursing home staff and residents The aim of this paper was to investigate what nursing home staff and residents converse about when they first meet each other in the morning and to investigate who starts the conversation. It is a pilot project about communication in a nursing home in Sweden and a basis for a practice development programme. Studies in Sweden have shown that nurse assistants working in care of the older people felt they had too little training in how to communicate. Communicative behaviour influences patients, but little is known about the content of morning time communication in nursing homes. Non-participant observation of 18 staff was carried out using an observation schema. Content analysis was performed. The findings were that it was the staff who initiated conversation and chose the content of conversation. The most common topic in morning time conversation was residents’ health and sickness. Staff in nursing homes, both nurses and nurse assistants need to reflect on their interaction with residents and be conscious of their important role because they create the climate on the ward through conversation. Further studies are needed in order to explore residents’ opinions of what the content of a good communication could be and also to find out how nurses and other staff members’ communication with residents could be improved. Staff need more training and knowledge about how to communicate with older people. [ABSTRACT FROM AUTHOR]

• This paper explores nurses’ reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme. • Ten registered nurses, all in clinical practice, participated in a research-orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants’ wards. • Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research. • Organizational and leadership issues, nurses’ interest in research, nurses’ reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important. • This study confirms that research utilization and the change to research-based nursing practice are complex issues which require both organizational and educational efforts. [ABSTRACT FROM AUTHOR]

The role of community staff in placing a relative in a care home is a relatively unexplored area of practice. Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement. This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision. However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects. Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home. [ABSTRACT FROM AUTHOR]

The article presents a commentary on an article about the experiences of Swedish women and men after a myocardial infarction (MI). It is stated that myocardial infarction poses a serious threat to individual and it often disrupts the normal functioning of every aspect of the patients daily life. In addition, the process of adjustment to MI is complex, while previous studies consistently report that patients initially attempt to try strategies to return to a state of equilibrium.

The article comments on "Management of gestational diabetes from the patient's perspective—a comparison of Swedish and Middle-Eastern born women," a paper by K. Hjelm, K. Bard, P. Nyberg and J. Apelqvist that appeared in the 2007 issue. The problem situations that come together in the work of Hjelm and her colleagues are cited. The researchers' finding that the women were largely satisfied with their experience of care to the point of being grateful is discussed.

Aim. To identify the core components of cultural competence from a Swedish perspective. Background. The cultural diversity of Swedish society raises challenges for nursing practice. Nurses need to be culturally competent, i.e. demonstrate the effective application of knowledge, skills and attitudes to practice safely and effectively in a multicultural society. Existing frameworks of cultural competence reflect the socio-cultural, historical and political context they were developed in. To date, there has been no research examining cultural competence within a Swedish context. Design. A Delphi survey. Methods. A purposeful sample of 24 experts (eight nurses, eight researchers and eight lecturers) knowledgeable in multicultural issues was recruited. Interviews were undertaken to identify the knowledge, skills and attitudes that formed the components of cultural competence. Content analysis yielded statements which were developed into a questionnaire. Respondents scored questionnaire items in terms of perceived importance. Statements which reached consensus were removed from questionnaires used in subsequent rounds. Three rounds of questionnaires were distributed during 2006. Results. A total of 118 out of 137 components reached a consensus level of 75%. The components were categorised into five areas, cultural sensitivity, cultural understanding, cultural encounters, understanding of health, ill-health and healthcare and social and cultural contexts with 17 associated subcategories. Conclusions. There are some similarities between the issues raised in the current study and existing frameworks of cultural competence from the USA and the UK. However, Swedish experts placed less emphasis on ethnohistory and on developing skills to challenge discrimination and racism. Relevance to clinical practice. This study identified the core components of cultural competence important to nurses practising within a multicultural society such as Sweden. Acquisition of the knowledge, skills and attitudes identified should enable nurses to meet the needs of patients from different cultural backgrounds. The components of cultural competence can form the basis of nursing curricula. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of the current study was to present the outcome of clinical nurse performed foot examinations in a group of Tanzanian diabetic patients and make comparisons with matched Swedish patients. Background. Nurses working with diabetic patients in any country need to be familiar with foot problems in diabetic patients to educate patients about foot care. Design. A comparative study examining diabetic patients in Tanzania and Sweden with a quantitative approach. Method. One hundred and forty-five diabetic patients in each country were examined. They were matched in gender and age. All patients responded verbally to questions about individual foot-care and underwent clinical foot examination concerning existing foot lesions, sensitivity testing using Semmes-Weinstein monofilament (5·07) and, vibratory perception using a tuning fork (128 Hz). Results. The Tanzanians had more reported foot problems than the Swedes. The latter reported problems due to poorly fitting footwear whilst the Tanzanians reported pain issues of the feet irrespective of footwear. In the Tanzanian group 37 patients presented with peripheral neuropathy (PN), 13 with peripheral vascular disease (PVD) and six had both PN and PVD. In the Swedish group of patients four had PN, three PVD, but none had both PN and PVD. Only 20 Tanzanians reported carrying out self-inspections of their feet, while 103 Swedes reported doing so. Conclusions. Nurse performed foot examinations showed that the Tanzanian diabetic patients in this study had poorer foot status than the Swedish study sample. Relevance to clinical practice. Knowledge about foot problems in diabetic patients worldwide will hopefully improve education about self foot-care and therefore decrease incidence of foot lesions and other foot problems in this cohort. [ABSTRACT FROM AUTHOR]

Aim. The aim of the present study was to investigate nurses’ opinions about using standardised care plans in electronic health record and quality standards for clinical practice. Background. Following introduction of an electronic health record, use of standardised care plans and quality standards has increased among nurses at two hospitals in Sweden. Understanding nurses’ opinions is important to continued development in this area. There are few previous studies on nurses’ opinions about standardised care plans. Design. Survey. Method. The study was quantitative, descriptive and based on a questionnaire. The questionnaire included items on nurses’ knowledge of and opinions about standardised care plans and quality standards. Results. The majority of the nurses were of the opinion that standardised care plans increase their ability to provide the same high-quality basic care for all patients. They also thought that a common standardised care plan across several professions would improve conditions for provision of high-quality care. The majority of the nurses also felt that the quality standards are a prerequisite of maintaining standardised care plans of high quality. There was no consensus on whether standardised care plans increase the risk of failing to notice patients’ individual problems. Most agreed that standardised care plans decrease documentation time as well as redundant documentation. The study showed that training is needed to teach nurses how to use standardised care plans in care provision. Conclusions. The nurses in the study had positive attitudes towards use of standardised care plans and felt that they could facilitate nursing practice. Relevance to clinical practice. Use of standardised care plans can improve nursing documentation and facilitate work for nurses. Moreover, it can support nurses in their use of evidence-based nursing methods. The present study shows that nurses have positive attitudes, which could facilitate continued use of standardised care plans. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to investigate the meanings of the concept of patient participation in nursing care from a nurse perspective. Background. Participation is essential and increases patients' motivation and satisfaction with received care. Studies of patient participation in nursing care are not congruent regarding definition, elements and processes. This lack of clarity is amplified by several terms used; patient/client/consumer involvement or collaboration, partnership and influence. Despite the fact that several nursing theories have emphasized the importance of patient participation, an empirically grounded theory has yet to be published. Methods. Seven focus group interviews were held with nurses providing inpatient physical care at five hospitals in West Sweden. The focus groups consisted of Registered Swedish nurses (n = 31) who described the meaning and implementation of patient participation in nursing care. A Grounded Theory approach has been applied to tape-recorded data. Constant comparative analysis was used and saturation was achieved. Results. Mutuality in negotiation emerged as the core category for explaining nurses? perspectives on patient participation in nursing care. It is characterized by four interrelated sub-core categories: interpersonal procedure, therapeutic approach, focus on resources and opportunities for influence. Mutuality in negotiation constitutes the dynamic nurse--patient interaction process. Conclusions. The study clarifies that patient participation can be explained as an interactional process identified as mutuality in negotiation based on four components. Relevance to clinical practice. The results are important and can be used in nursing practice and education. Application in a clinical context means nursing care organized to include all the components presented. The results can also be used in quality assurance to improve and evaluate patient participation. [ABSTRACT FROM AUTHOR]

Aim. The aim is to describe experiences of daily life of women and men during the first four to six months after a myocardial infarction. The focus is on problems, managing problems and support from their network. Background. A cardiac event is traumatic and may influence well-being during a significant period of time. Few qualitative studies have investigated experiences of both women and men after a myocardial infarction and remarkably little research has been conducted on men's experiences. Design. The study design was descriptive, retrospective and qualitative. Methods. Semi-structured interviews were conducted with 20 women and 19 men from January 2000 to November 2001. Data were analysed using qualitative content analysis. Results. Three themes were generated from the analysis: 'Threatening ordinary life', 'Struggling for control' and 'The ambiguous network'. Physical symptoms and emotional distress were the most commonly described problems during the first months after a myocardial infarction. The informants manage the problems by negotiating with themselves, relying on their own capabilities, changing attitudes and behaviours and taking their own decisions and actions. The network was generally supportive but rather often the informants also experienced communication problems when they interacted with their network. Conclusions. Women and men strive for balance between problems and resources in daily life after a myocardial infarction. How well they succeeded depends on how secure they feel how well they communicate their needs to their network and how sensitive their network is to their spoken and unspoken needs. Relevance to clinical practice. The findings provide an insight into what kind of problems women and men may experience after myocardial infarction and how caregivers can aid them to increase security in their daily life. Some risk characteristics that may have increased their problems in daily life are suggested, for women and men respectively. [ABSTRACT FROM AUTHOR]

Aims and objectives. To identify factors which may influence attitudes to spiritual care, test the relevance of these identified influencing factors in a Swedish nursing context, and replicate a part of a previous study by Strang et al. ( Journal of Clinical Nursing 2002; 11:48-57) dealing with attitudes to spiritual care in a holistic perspective. A questionnaire was handed out to all nursing staff at a Swedish oncology clinic ( n = 93) excluding the radiation therapy ward. Data were obtained from 68 nurses or nursing auxiliaries. Design and methods. (i) Literature review of international research reports concerning spiritual care in a nursing context. (ii) Construction of a questionnaire comprising 17 questions with given alternatives based on the previous literature study. (iii) Operationalization of the concept 'attitudes to spiritual care' into some more easily measurable questions through identification in earlier research reports of conceivable indicators of attitudes to spiritual care. (iv) Construction of a suggestion for a definition of the concept 'spiritual care' from the results of Strang et al. (2002) to be used in the questionnaire. (v) Statistical analysis of the data from the questionnaire and a comparison with previous studies. Results and conclusions. The replicating part of the study are mainly in accordance with Strang et al. (2002) and lead to the conclusions that holistic care (i) is desirable, (ii) should include spiritual needs of the patients and (iii) is not yet realized in Swedish health care. The identified influencing factors are relevant in a Swedish nursing context. The factors influencing the largest number of indicators of attitudes to spiritual care are 'non-organized religiousness' and 'degree of comfort while providing spiritual care'. Other influencing factors are: 'belief in God', 'belief in life after death', 'organized religiousness', 'profession', and 'the perceived degree of education in spiritual care'. Relevance to clinical practice. Knowledge of attitudes towards spiritual care among nursing staff and factors influencing these attitudes will improve the possibilities of meeting the spiritual needs of patients. [ABSTRACT FROM AUTHOR]

Summary • Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. • The aim of this study was thus to analyse older people's basic needs in the emergency care environment. • The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. • Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. • Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. • Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process. [ABSTRACT FROM AUTHOR]

* Despite a universal policy of community care, the number of frail older people entering care homes is likely to increase in the future.* There have been relatively few studies exploring the experience of spouses who have placed a partner in care.* Due to a lack of preparation, the placement process is often ad hoc, with little attention being given to spouses' emotional reactions or their efforts to maintain their relationship with their partner.* The relationship between care home staff and families is often superficial and strained.* There is a need for more proactive efforts to facilitate a partnership between care home staff and families. [ABSTRACT FROM AUTHOR]

* The implantable cardioverter-defibrillator (ICD) is today widely used for the treatment of sudden cardiac near-death episodes as a result of malignant ventricular dysrhythmia. * After examining the literature, only four descriptive studies, all carried out in the USA, with a qualitative analysis based on ICD-patients' own perspectives on their life situation have been found. * The aim of this study was to describe how patients living with an ICD-device in south-western Sweden conceive their life situation. * As the focus was on patients' conceptions seen from a holistic perspective, an analysis inspired by phenomenography was employed on a strategic sample of 15 ICD-patients. * Six categories emerged: a feeling of safety, a feeling of gratitude, a feeling of being, having a network, having a belief in the future, and gaining awareness. * Although the findings cannot be generalized because of the descriptive research design, they illuminate the beneficial as well as intrusive effects of such a device, and emphasize the need for support groups for patients and families as well as further education for personnel in hospital and primary health care. [ABSTRACT FROM AUTHOR]

Six clients with a diagnosis of schizophrenia were interviewed about their experiences of their lives in a home-like setting, their key care provider and the care received. Their narratives of lived experiences in care were interpreted as living a process of health in the midst of severe mental illness, involving: 'becoming more', 'being disabled', 'comforting/confirming relationship', 'discomforting/unconfirming relationship' and 'caring about the caring relationship'. Fatigue and lack of strength influenced the lives of most clients considerably, and the stories were about problems and conflicts. Nevertheless, the clients seemed really to struggle to make communal life work, and there were experiences of increased competence and better self-confidence in most of the stories. On the whole care was described as good, and the process of health seemed to be supported by experiences of comfort and being confirmed in the client-care provider relationship. [ABSTRACT FROM AUTHOR]

Deficient routines in use, care, handling and documentation of peripheral intravenous vein cannulae (PIV) have previously been reported, and complications have been noted in 50-75% of the patients. The aim of the study was to examine whether specially trained nurses change their actions to decrease complications when using cannulae. The study included 36 nurses assigned to experimental and control groups. The experimental group followed an education programme explaining how to use and take care of a PIV. Copyright (c) 1999 by W.B. Saunders Company [ABSTRACT FROM AUTHOR]

This article focuses on the results of a single case study which illuminates an understanding of phases in nursing care for a patient in a psychiatric setting in Sweden. The focus of this study is a 50-year-old man who showed progressive deterioration from increased motor activity to oral, sexual, destructive and aggressive actions. Data collection using five methods occurred during a 21-month period. Results of the content analysis processes identified four distinct but non-discrete phases of the patient's complex condition. Medical and nursing care was categorized in three approaches: optimistic, strategic and resigned. The results raise the question of whether there is action that is without any meaning as an expression of the patient's wishes, thoughts and feelings. It seems clear that the patient in this study felt really angry and in despair. However, during moments of lucidity, he also indicated that he felt this was not an authentic expression of his 'real' self. His experience was that of a splintered world. [ABSTRACT FROM AUTHOR]

The article discusses the use of Delphi technique in identifying research priorities in various fields of nursing and health research including HIV/AIDS, occupational health, occupational medicine, health sector library and information services, oncology, paediatric haematology, immunology and infectious diseases, and emergency care.

The article presents a response to an article by McKenna and Keeney about a study of research priorities in nursing among Swedish nurses.

The author comments on the study conducted by Karin Josefsson, Lars Sonde and Tarje-Brita Robins Wahlin concerning the violence of older people in Sweden as perceived by the registered nurses. He argues with the findings and according to him at one level, nurses do need to address such problems personally. He added that all they need is to offer support to each other and recognize their own stress and reactions to difficult behaviour.

A response to a commentary about the quality of life for Swedish children with asthma is presented. The authors stress the problem associated in comparing the quality of life investigations between countries. They agree to the suggestion that the inclusion of more children will improve their study. They emphasize the importance of physical activity in asthmatic children.

Describes some experiences expressed by artificially ventilated patients in an intensive care unit (ICU) in Sweden. Expression of feelings of fear of pain and examination; Efforts to involve as many nurses as possible in the study; Influence of the results of the interviews on the quality-improvement process in the ICU; Influence of sedation routines on the occurrence of nightmares and strange dreams in patients.