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Background: Psychological distress can cause burnout, which affects mental and physical well‐being. It is important to identify factors associated with psychological distress and physical discomfort and how nurses deal with these problems. Aim: The aim was to investigate distress, burnout and coping among community nurses (CN) and hospital nurses (HN). Approach and Methods: In this cross‐sectional study, 409 nurses completed three questionnaires: Perceived Stress Scale (PSS), Copenhagen Burnout Inventory (CBI) and Ways of Coping (WOC). Findings: Participants younger than 40 demonstrated significantly more distress and burnout than those older than 40 years. Participants who had moderate and high distress on the PSS were significantly more at risk for experiencing personal, work‐related and patient‐related burnout. A significant positive correlation was found between distress and behavioural escape‐avoidance, cognitive escape‐avoidance and distancing. Significant positive correlations were also seen between all the subscales of the CBI and behavioural escape‐avoidance, cognitive escape‐avoidance and distancing. Positive significant correlation was also obtained between staff resources and distress and personal‐related and work‐related burnout. Negative correlation was demonstrated between staff resources and patient‐related burnout. Participants with longer work experience were less likely to report moderate or high distress, and those who scored higher on personal burnout and behavioural escape‐avoidance were more likely to have moderate or high distress. Conclusion: The results of this study call for increased attention to the younger generation in the nursing profession. The results also validate the need to investigate further the correlation between distress, burnout and coping and how these issues might influence each other among nurses working in the community and hospitals. Findings should be taken with precaution, they do not describe in detail what underlying factors contribute to distress and discomfort found in this study, they do, however, indicate certain coping strategies nurses use to deal with distress and burnout. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To (i) determine the prevalence of delirium and identify delirium subtypes in surgical and non‐surgical patients aged ≥65 years, (ii) determine whether certain precipitating factors affect the prevalence of delirium and (iii) review patients' medical records for description of delirium symptoms and the presence of International Classification of Diseases (ICD‐10) coding for delirium in discharge summaries. Methodological Design and Justifications: Despite being a robust predictor of morbidity and mortality in older adults, delirium might be inadequately recognised and under‐reported in patients' medical records and discharge summaries. A point prevalence study (24‐h) of patients ≥65 years from surgical and non‐surgical wards was therefore conducted in a tertiary university hospital. Ethical Issues and Approval: The study was approved by the Data Protection Officer at the university hospital (2018/3454). Research Methods, Instruments and/or Interventions: Patients were assessed for delirium with 4AT and delirium subtypes with the Delirium Motor Subtype Scale. Information about room transfers, need and use of sensory aids and medical equipment was collected onsite. Patients' medical records were reviewed for description of delirium symptoms and of ICD‐10 codes. Results: Overall, 123 patients were screened (52% female). Delirium was identified in 27% of them. Prevalence was associated with advanced age (≥85 years). The uncharacterised delirium subtype was most common (36%), followed by hypoactive (30%), hyperactive (24%) and mixed (9%). There were significant associations between positive screening tests and the need and use of sensory aids. Delirium symptoms were described in 58% of the patients who tested positive for delirium and the ICD‐10 code for delirium was registered in 12% of these patients' discharge summaries. Conclusions: The high prevalence of delirium and limited use of discharge codes highlight the need to improve the identification of delirium in hospital settings and at discharge. Increased awareness and detection of delirium in hospital settings are vital to improve patient care. [ABSTRACT FROM AUTHOR]

Introduction: It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. Aim: To explore the process of preparing discharge for patients with COPD in a hospital setting. Method: Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. Results: We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co‐creating, hesitating and socialising. The co‐creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. Conclusion: This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co‐creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes. [ABSTRACT FROM AUTHOR]

Background and Aim: Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use. Methods: A survey was distributed to first‐line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically. Results: 73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program. Conclusion: This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence. [ABSTRACT FROM AUTHOR]

Background: Individualising the provided care is mandatory in nursing and is essential in clinical practice. Therefore, there is a need to develop accurate instruments to evaluate the quality of care. Moreover, there is no validated instrument to assess nurses' views of individualised care in Spanish‐speaking countries. Aim: To assess the construct validity and internal consistency of the Spanish version of the Individualised Care Scale‐Nurse. Methods: A cross‐sectional study including 108 nursing professionals (40.84 ± 9.51 years old, 86.1% female) was used to validate the Spanish Individualised Care Scale‐Nurse version. A forward‐back translation method with an expert panel and a cross‐sectional study was used for transcultural adaptation and psychometric validation purposes. Psychometric properties of feasibility, reliability and validity were assessed. Construct validity was examined through a confirmatory factor analysis and fit indices of the overall model were computed. Internal consistency was explored through McDonald's omega and Cronbach's alpha coefficients among other correlation measures. Results: The back‐translation concluded both Spanish and English Individualised Care Scale‐Nurse versions to be equivalent. The original structure of the Individualised Care Scale‐Nurse was verified in the Spanish version through the confirmatory factor analysis (factor loadings >0.3; acceptable fit indices: SRMR ≈ 0.08, CFI ≈ 0.9, RMSEA ≈ 0.09 after posteriori modifications). McDonald's omega exceeded 0.7 for both subscales and complete scales revealing an adequate internal consistency. Conclusions: The Spanish version of the Individualised Care Scale‐Nurse has exhibited good properties of homogeneity and construct validity for its use in practice and research in health care systems. [ABSTRACT FROM AUTHOR]

Background: Care left undone is a worldwide problem for both the quality of health care and the safety of patients. In surgical nursing, care left undone is a critical issue arising from the intensive pace of work, invasive procedures and the pressure for efficiency. Previous knowledge about care left undone in surgical contexts is missing. Objective: To describe care left undone and its relationship to nursing and organisational characteristics in the surgical wards of regional and central hospitals in Estonia. Methods: A cross‐sectional study with an online questionnaire took place from June to October of 2018. The target population (N = 570) consisted of nurses working in the surgical wards of two regional and three central hospitals at the time of the study. The data were analysed using descriptive statistics and Fisher's exact test. The open‐ended questions were analysed with deductive content analysis. Results: Nursing care in the surgical wards was reported as having been left undone sometimes or often by 88% of the nurses. Most often, the documentation and evaluation of care plans (33%) were reported as undone and most rarely, disinfection measures were left undone (5%). Nurses with a shorter employment history left care undone more frequently, and when the number of patients per nurse increased, the amount of care left undone increased as well. More than half of the participants (59%) considered work organisation to be the cause of care left undone. Conclusions: Work organisation and staffing in surgical wards require more attention at the management level, as nursing care left undone occurred to a significant degree in the investigated wards, and more than half of the nurses considered work organisation to be the reason for care left undone. [ABSTRACT FROM AUTHOR]

Background: The Trust in Nurses Scale (TNS) was developed and psychometrically assessed so that patients' trust could be accurately and reliably measured. The TNS has been translated, assessed and administered to patients in Europe, Asia and North America. Aim: This descriptive, cross‐sectional, correlational study aimed to assess the psychometric characteristics of the Italian version of the Trust in Nurses Scale. Methods: An Italian version of the TNS was developed. We used a forward–backward translation methodology to establish semantic and conceptual equivalence within the Italian context. The scale was then administered to a convenience sample of 200 hospitalised patients in medical, surgical or oncology units. Internal consistency and construct validity were assessed performing Cronbach's alpha and confirmatory factor analysis (CFA). Both a 4‐item and a 5‐item TNS were assessed. Results: The 4‐item TNS demonstrated better construct validity than the 5‐item version. Similarly, the internal consistency reliability was better with 4 items than 5 (0.83 and 0.79, respectively). Conclusion: The Italian version of the scale has acceptable reliability and validity and may be used to assess this aspect of the nurse–patient relationship. Being tested in different settings, it may be used with all patients admitted to hospital. Trust in nurses is critically important to patient outcomes; however, it is rarely measured quantitatively on a wide scale. The use of the Italian validated scale could be useful to increase evidences on this important topic, as it represents a core component of nursing care. [ABSTRACT FROM AUTHOR]

Background: Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work. Aim: The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses. Method: A descriptive qualitative study using four semi‐structured group interviews (20 nurses) and inductive descriptive content analysis. Results: Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care. Conclusions: End‐of‐life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future. [ABSTRACT FROM AUTHOR]

Aims and objectives: Translating and psychometrically assessing the Individualised Care Scale (ICS) for patients and nurses for the Flemish and Dutch healthcare context. Background: Individualised care interventions have positive effects on health outcomes. However, there are no valid and reliable instruments for evaluating individualised care for the Flemish and Dutch healthcare context. Design: Psychometric validation study. Setting and participants: In Flemish hospitals, data were collected between February and June 2016, and in Dutch hospitals, data were collected between December 2014 and May 2015. Nurses with direct patient contact and a working experience of minimum 6 months on the wards could participate. Patient inclusion criteria were being an adult, being mentally competent, having an expected hospital stay of minimum 1 day, and being able to speak and read the Dutch language. In total, 845 patients and 569 nurses were included. Methods: The ICS was translated into Dutch using a forward–backward translation process. Minimal linguistic adaptations to the Dutch ICS were made to use the scale as a Flemish equivalent. Omega, Cronbach's Alpha, mean inter‐item correlations and standardised subscale correlations established the reliability and confirmatory factor analysis the construct validity of the ICS. Results: Internal consistency using Omega (Cronbach's Alpha) ranged from 0.83 to 0.96 (0.82–0.95) for the ICS‐Nurse and from 0.88 to 0.96 (0.87–0.96) for the ICS‐Patient. Fit indices of the confirmatory factor analysis indicated a good model fit, except for the root mean square error of approximation, which indicated only moderate model fit. Conclusion: The Dutch version of the ICS showed acceptable psychometric performance, supporting its use for the Dutch and Flemish healthcare context. Relevance to clinical practice: Knowledge of nurses' and patients' perceptions on individualised care will aid to target areas in the Dutch and Flemish healthcare context in which work needs to be undertaken to provide individualised nursing care. [ABSTRACT FROM AUTHOR]

Introduction: Self‐rated health (SRH) is a recognised tool for predicting morbidity and mortality. Aim: The aim of the study was to investigate and compare SRH in a group of mothers of hospitalised children and mothers of healthy children and to indicate the variables associated with poor SRH in both groups. Methods: We conducted questionnaire‐based cross‐sectional research in a group of 184 women. Half of the respondents (n = 92) were the mothers of children hospitalised for a severe illnesses (Group H). The control group (n = 92) comprised mothers of healthy children (Group C). Self‐Rated Health (SRH), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale‐Revised (IES‐R) and Interpersonal Support Evaluation List (ISEL‐40 v. GP) were used. In order to facilitate critical appraisal and interpretation of results, STROBE recommendations were used. Results: The prevalence of poor SRH was greater in mothers of children hospitalised for a severe illness than in those of healthy children (35 and 19%, respectively). In both groups, the risk of poor SRH was statistically significantly higher in those mothers who for the past 7 days reported at least moderate pain and in mothers who manifested anxiety symptoms. In both groups, the prevalence of poor SRH was statistically significantly lower if the respondents' children were in good health. The risk of poor SRH was associated with poor financial status in group H and with depression and at least moderate pain for the past 7 days in group C. Relevance to clinical practice: In order to provide mothers of severely ill children with high‐quality health care including preventive measures, it is recommended that their health is assessed by healthcare professionals. [ABSTRACT FROM AUTHOR]

Background and purpose of study: Transition from the intensive care unit to the hospital ward can be considered as a vulnerable period for patients as nursing care changes hands. How the transition is experienced by the ICU patient and the family is influenced by how it is organised, communicated and executed. The transition may positively or negatively affect patient recovery. Aim: To explore the experiences of intensive care unit patients and their relatives during the transition to hospital ward in order to find ways of supporting them during the transition process. Methods: Eligible participants were asked for participation from April to September 2016 from a mixed medical and surgical intensive care unit (Level II) at a university hospital. We conducted six semi‐structured interviews with former intensive care unit patients and four dyad interviews with patients and spouses. Data were analysed according to the methodology Interpretive Description with the aim to discover associations, relationships and patterns within the phenomenon. Results: Our analysis revealed the following three themes: (1) Taking up the mantel (2) Adjusting to 'being one in the crowd' and (3) Integrated spouses became visitors. It was a change from an environment with high dependence to increasing independence and a shift from attention to loneliness. Focus moved from the bodily functions to basic activities of living. Spouses experienced that their position was reduced from integrated relatives in the intensive care unit to visitors of the hospital ward. Conclusions: This article shows that it is important to mentally prepare patients and their family for transfer and a gradual withdrawal of intense nursing observation and monitoring. Discharge planning should begin early and involve spouses to a higher extent as they have a major role in the recovery process far beyond hospitalisation. [ABSTRACT FROM AUTHOR]

Nursing shift‐to‐shift handovers are important as they impact the care quality indicators such as safety, patient satisfaction and continuity. However, nurses' handovers have also been criticised and described as unstructured and ineffective. To improve the handovers and involve patients and their loved ones in the process, a person‐centred handover (PCH) model performed at bedside has been developed and tested at Karolinska University Hospital, Sweden. This study reports on the nursing staffs' compliance to a checklist used for the newly introduced PCH model. A total of 43 PCH sessions were observed at two acute care wards, using a structured observation protocol. None of the observed handover sessions included all the 13 PCH checklist subcomponents. The checklist was used in 18 (44%) of the observed handover sessions. A statistically significant higher number of subcomponents were observed when the nurses used the PCH checklist (6.4 vs. 4.5 subcomponents, p < 0.05). The mean time spent on each PCH was 6 minutes. In 56% of the sessions, the patients were observed to actively participate in the handover. Overall, the nursing staffs' compliance to the PCH checklist needs to be improved. The observations suggest that training on communication‐oriented tasks would be beneficial to establish a person‐centred handover process. [ABSTRACT FROM AUTHOR]

Background: Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction. Aim: The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care. Design and methods: A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer‐as‐participant observation data and semi‐structured interviews were undertaken. Following separate inductive content analysis, data were triangulated. Results: Thirty‐two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality. Conclusion: The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision‐making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence‐based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting. [ABSTRACT FROM AUTHOR]

Background Patient satisfaction with nursing care (NC) is an important predictor of overall satisfaction with the hospital experience. However, the concept of patient satisfaction has been criticised both at the theoretical and at the methodological levels, and more attention on patient dissatisfaction has been called for with the aim of identifying strategies to improve the quality of care. Aims To describe dissatisfaction with NC as perceived by acute medical patients and identify predictors. Design and methods A secondary analysis of longitudinal data involving 12 Italian medical units was performed. A consecutive sample of 1016 patients ≥65 years (2012-2013) was included, and their satisfaction with NC was assessed, administering the Italian version of the Patient Satisfaction Scale ( PSS) at the day of discharge. The scale was based on 11 items evaluated on a four-point Likert scale (score ranging from 11 - very dissatisfied to 44 - very satisfied). Patients were defined as 'satisfied with NC' when the score was ≥33, whereas they were considered as 'dissatisfied with NC' when the score was <33. A logistic regression analysis was performed to identify the predictors of patient dissatisfaction with NC. Results There were 788 (77.6%) patients satisfied (≥33 at the PSS) and 228 (22.4%) dissatisfied with NC (<33). The risk of dissatisfaction was likely to be higher in female patients ( RR 1.883, 95% CI 1.359-2.609), in those who developed pressure sores during the in-hospital stay ( RR 1.555, 95% CI 1.021-2.368), who received NC with high skill mix ( RR 1.072, 95% CI 1.034-1.111) and those who were admitted to a large hospital ( RR 1.001, 95% CI 1.001-1.002). In contrast, increased age ( RR 0.987, 95% CI 0.975-0.998), increased amount of care offered by Registered Nurses ( RR 0.984, 95% CI 0.974-0.994), a higher proportion of baccalaureate nurses on staff ( RR 0.975, 95% CI 0.958-0.993) and being admitted to a teaching hospital ( RR 0.497, 95% CI 0.130-0.910) all decreased the likelihood of being dissatisfied with NC. Conclusions Dissatisfaction with NC was affected by individual, NC and hospital variables, such as the amount of staff resources, nurses education and skill mix. The findings emerged may inform clinicians, managers and policymakers regarding strategies that should be designed and implemented to prevent patient dissatisfaction. [ABSTRACT FROM AUTHOR]

Background Caring relationships are important for developing a caring culture. It is important that care provider's relationships with patients, co-workers and managers are caring relationships. However, in the Slovene language, there is a lack of psychometrically sound instruments to measure these caring relationships. Aim To explore the psychometric properties of the Slovenian version of the Caring Factor Survey (CFS) for care providers, the care given by co-workers and managers as judged by the providers, by evaluating its content validity, face validity and internal consistency. Methods In the process of our instrument, we used translation and back translation and validation based on experts' agreement. Content validity was quantified by the content validity index (CVI) and a modified Cohen's kappa index. Face validity was evaluated by ten nurses who reviewed the instruments. In the process of psychometric testing based on survey data, we used a cross-sectional research design with a convenience sample of 91 caregivers working in internal or surgical wards in two health care institutions. Cronbach's alpha and corrected item-total correlations were used to test internal consistency. Results All items in all three versions of the CFS had a CVI score higher than 0.78 and excellent modified Cohen's kappa index, showing excellent content validity. The average content validity indices were 0.990, 0.975 and 0.963. The face validity was good with no major remarks given. Cronbach's alpha was 0.941, 0.962 and 0.970. The item-total correlations reached a criterion of 0.2 < r < 0.3 for all items. Conclusion All three versions of the CFS showed an acceptable content validity, face validity and internal consistency; however, due to some methodological shortcomings, results should be interpreted with caution. Further psychometric testing is needed. [ABSTRACT FROM AUTHOR]

Background Informal caregiving offered by family members has been widely studied in the community setting, but little attention to date has been dedicated to that offered at the hospital level. Aims To describe the proportion of patients admitted to acute medical units receiving care from informal caregivers as decided by the family and to identify the factors affecting the numbers of care shifts performed by informal caregivers. Design and methods A longitudinal study was performed involving 12 acute medical units located in 12 northern Italian hospitals. Results All patients (N = 1464) admitted to medical units were included, and 77.1% of them received at least one shift of informal care during their in-hospital stay, especially during the mornings and afternoons. At the patient level, those at higher risk of prolonged hospitalisation and difficult discharge at admission, and those reporting higher occurrence of adverse events, such as pressure sores, confusion events and use of physical restraints during hospitalisation, were more likely receiving informal care. At the nursing care level, a higher amount of missed nursing care was associated with an increased number of care shifts offered by informal caregivers during patient hospitalisation, whereas the amount of care offered by staff was a protective factor. Conclusions Families play a care role in the care of older patients admitted to acute medical units. They contribute substantially to the care of patients, especially during morning and afternoon shifts. [ABSTRACT FROM AUTHOR]

Aim Investigation of a possible relation between body temperature measurements by the current generation of tympanic ear and rectal thermometers. Background In Denmark, a national guideline recommends the rectal measurement. Subsequently, the rectal thermometers and tympanic ear devices are the most frequently used and first choice in Danish hospital wards. Cognitive changes constitute challenges with cooperating in rectal temperature assessments. With regard to diagnosing, ethics, safety and the patients' dignity, the tympanic ear thermometer might comprise a desirable alternative to rectal noninvasive measurement of body temperature during in-hospital-based neurorehabilitation. Design A prospective, descriptive cohort study. Consecutive inclusion of 27 patients. Linear regression models were used to analyse 284 simultaneous temperature measurements. Ethics Ethical approval for this study was granted by the Danish Data Protection Agency, and the study was completed in accordance with the Helsinki Declaration 2008. Results About 284 simultaneous rectal and ear temperature measurements on 27 patients were analysed. The patient-wise variability of measured temperatures was significantly higher for the ear measurements. Patient-wise linear regressions for the 25 patients with at least three pairs of simultaneous ear and rectal temperature measurements showed large interpatient variability of the association. Conclusion A linear relationship between the rectal body temperature assessment and the temperature assessment employing the tympanic thermometer is weak. Both measuring methods reflect variance in temperature, but ear measurements showed larger variation. [ABSTRACT FROM AUTHOR]

Rationale Individualised care is considered a key attribute of the quality in clinical care. Despite the environment in which the care is delivered and the care providers can influence in this concept, perceptions of individuality in the care settings for older people are rarely studied. Aim To identify nurses' characteristics and organisational factors associated with nurses' views about the provision of individualised care in care settings for older people. Study Design A cross-sectional multisite survey design. Methods A multisite survey of nursing staff (N = 1513, n = 874, response rate 58%) working in 62 different units for older people in southwest Finland was carried out using self-administered questionnaires (The Individualised Care Scale-Nurse-B and a questionnaire gathering socio-demographic and organisational variables). Data were analysed using descriptive statistics, Spearman's correlation coefficients, paired-sample t-tests and one-way analyses of variance. Results Participants' perceptions about the level of individualised care provided to older people were generally positive (Mean 3.92, SD 0.56). In this regard, taking into account the patients' clinical situation (Mean 4.31, SD 0.53) and the support of older patients' decisional control (Mean 3.80, SD 0.71) obtained the highest scores. Regarding nurses' socio-demographic variables, a positive correlation between age and type of organisation with the assessments of individualised care provision was found. Conclusions The findings of this study show that nurses' age and the type of organisation where the care is delivered have an impact on the perceptions of individualised care of nurses working in institutions for older people. The participants' assessments about individualised care delivery have practical utility as it may help managers better understand and develop areas that obtained the lowest scores. This information may lead to the reduction of barriers (structures and processes) that hinder individualised care delivery and facilitate programs aimed at developing professional environments that improve the delivery of older people's care. [ABSTRACT FROM AUTHOR]

Background Poor oral health has been associated with systemic diseases, morbidity and mortality. Many patients in hospital environments are physically compromised and rely upon awareness and assistance from health professionals for the maintenance or improvement of their oral health. This study aimed to identify whether common individual and environment factors associated with hospitalisation impacted on oral hygiene. Methods Data were collected during point prevalence audits of patients in the acute and rehabilitation environments on three separate occasions. Data included demographic information, plaque score, presence of dental hygiene products, independence level and whether nurse assistance was documented in the health record. Results Data were collected for 199 patients. A higher plaque score was associated with not having a toothbrush (p = 0.002), being male (p = 0.007), being acutely unwell (p = 0.025) and requiring nursing assistance for oral hygiene (p = 0.002). There was fair agreement between the documentation of requiring assistance for oral care and the patient independently able to perform oral hygiene ( ICC = 0.22). Conclusion Oral hygiene was impacted by factors arising from hospitalisation, for those without a toothbrush and male patients of acute wards. Establishment of practices that increase awareness and promote good oral health should be prioritised. [ABSTRACT FROM AUTHOR]

Introduction Observing real situations in clinical practice can provide undetected information regarding problems in the medication process. Aims The aims of this study were to describe the frequency, types, and severity of medication errors in medical and surgical inpatients as well as to study the relationship between medication errors and associating factors. Methods A cross-sectional study using direct observations and medication record reviews was conducted to assess how 32 registered nurses administered 1058 medications to 122 inpatients in four medical and surgical wards at a university hospital in Finland between April and May 2012. Observations were recorded using a structured observation form and patients' medication record reviews (n = 122) before and after the observations were conducted. A multiprofessional team analysed and classified all of the detected errors and assessed their severity. A logistic regression was used to analyse the factors (work environment, team, person-specific, patient-specific or medication-related) associated with medication errors. Results At least one error was found in 22.2% (235/1058) of administered medications , 63.4% of which were medication administration errors and 18.3% of which were documentation errors. Of the medication administration errors, 59.1% involved an incorrect administration technique. 3.4% of errors caused harm to patients. Statistically significant factors that increased the risk of medication errors included every other weekday, except Sunday; morning shifts; increased rushes; nurses asking for help; and increased number of medications that patients used. Factors that decreased the risk of errors included administering medications through an oral route, double-checking the drugs, and additional people in the medication room at the same time. Conclusion Medication errors in inpatient care are frequent, and improvements to increase safety are vital. More attention to medication administration techniques, administration instructions and attitudes toward safety are needed to prevent problems. [ABSTRACT FROM AUTHOR]

Background There are two types of bed baths: the traditional basin used with soap and water, and the disposable bath, which is prepacked in single-use units and heated before use. Objective To compare the traditional basin bed bath to a disposable bed bath, there are four factors that need to be considered: (1) duration and quality of the bath, (2) cost, (3) nurse satisfaction and (4) patient satisfaction. Methods Fifty-eight patients received bed baths on two consecutive days - a traditional bed bath on 1 day and a disposable bed bath on the other. The patients were bathed by the same nurse on both days. The baths were observed in relation to duration, use of supplies and quality. Nurses and patients were interviewed about their preferences. Results Both types of baths scored very highly in the area of quality. There was no difference in the cost of supplies. Significantly less time was used with the disposable baths (p < 0.001). In terms of total expenditure, the disposable bath cost 11.84 DKK and the basin method cost 11.87 DKK, resulting in an insignificant difference (p > 0.05). Taking the nurses salaries into account, it was much cheaper to bathe patients using the disposable bath. Most patients preferred the disposable bath, while others preferred the basin method or were equally satisfied with both types of baths. There was no significant difference in these results (p > 0.22). There were 46 cases during the trial where nurses preferred the disposable bath method. The washbasin method was preferred in six cases. And there was one case where the nurse was equally satisfied with both types of baths. The nurses rated the disposable bath significantly higher than the basin method. In most cases, patients and nurses preferred the same type of bath (70%). Conclusion This study presents a comparison of the new method of bed bathing to the traditional basin method, in relation to cost, duration, quality and nurse and patient preference. In the case of disposable baths, the costs are lower as significantly less time is used. The nurses were very clear in their preference for disposable baths, and this was also the case for the majority of patients. There was consistency between the nurses and the patients in terms of their preference of bath type. When patients need assistance with personal hygiene, the nurse should inform the patient about the two methods and involve the patient in the decision. [ABSTRACT FROM AUTHOR]

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross-sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence-based guidelines in their practice. [ABSTRACT FROM AUTHOR]

Aims To describe and compare the perceived social provision for a group reporting never feeling lonely with that of a group reporting feeling lonely and to explore the meaning of loneliness. Subjects Participants (N = 101) were recruited from geriatric wards. Inclusion criteria were as follows: aged 65 years or more, the absence of dementia, one or more chronic physical disorders and plans to be discharged from the hospital to their home. The mean age was 81.3 years (range: 65-96 years), 68% were women, and 66% lived alone. Measures Assessments of social provisions and loneliness were collected by a subjective report using the Social Provision Scale ( SPS), and the Montgomery-Aasberg Depression Rating Scale ( MADRS) was used to assess depression. The participants were also asked whether they felt lonely and were then asked to describe the meaning of loneliness if they had indicated feeling lonely. Narratives were then condensed by the participants into short sentences. Results Seventy-five per cent of the participants reported feeling lonely, of these 54% were living alone, and 18% identified with depression. Three subscales of SPS scores were significantly lower in the lonely group: attachment (p < 0.001), a sense of reliable alliance (p = 0.001) and the obtaining of guidance (p = 0.01). The overall view of the experience of loneliness was dominated by emptiness and negative emotions. The following themes were identified: Emotions were dominated by sadness, anxiety and restlessness, anger and guilt. Relationships were dominated by being left alone, being confined and feeling useless. Existential dimensions were characterised by emptiness, endless boredom, isolation and the potential for change. Conclusion The study shows that loneliness is prevalent among older people suffering from chronic physical illness and confirms the complexity of the concept. A mixed-methods design contributed to nuanced and detailed information about the meaning of loneliness. [ABSTRACT FROM AUTHOR]

Background: The concept of nursing power has not been extensively reported in the nursing literature. Power is an extremely abstract concept, making it difficult to define and study. However, when defined as the capacity to achieve goals, power becomes a significant resource in nursing. Aims: The aim of this study was to describe how nursing professionals perceive the level of nursing group power in public healthcare organizations. Additionally, the connections between the background variables and nursing group power were analysed. Methods: The participants in the study consisted of 289 Finnish nurses working in the specialist healthcare sector in Finland. The Sieloff-King Assessment of Group Outcome Attainment within Organizations© (SKAGOAO) instrument was utilized to assess the level of nursing group power within the selected organizations. Findings: According to the present study, nursing professionals rated the outcome attainment (mean, 1.93), as well as goals/outcome competency (mean, 2.24), as very good. The position of nursing (mean, 2.55) as part of the healthcare service system was considered fairly respected. The role of nursing (mean, 2.54) was also considered to be at a good level. As regards to the actualization of power or outcome attainment capacity, respondents gave the lowest ratings to controlling the effects of environmental forces (mean, 2.75), resources (mean, 3.48), communication competency (mean, 3.00) and group supervisor's outcome attainment competency (mean, 2.87). Age, education, type of employment and work experience had an impact on how nursing group power was perceived. Conclusions: The results of the present study indicated that the nurses perceived the lowest levels of group power in relation to the subscales of controlling the effects of environmental forces, resources, communication competency and group supervisor's outcome attainment competency. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 184-194 Patients' lived experiences of a reduced intake of food and drinks during illness: a literature review Aim: This study aims to identify patients' lived experiences of having a reduced intake of food and drink during illness, through a literature review. Methods: Scientific studies were selected through a systematic search of CINAHL, PubMed, SweMed, British Nursing Index, Psycinfo and EMBASE. A deductive thematic analysis was performed on the studies included. The analysis provided three main themes: (i) serving of food and drink - patient experiences. (ii) Modifications related to illness - patient experiences. (iii) Nutritional care provided by healthcare professionals nutritional care - patient experiences. Findings: Generally speaking, the findings showed high satisfaction with the food served at hospitals. However, patients' individual tastes and preferences as to when and where to eat were found to affect their intake of food and drink. Physical changes because of illness were stated as the main reason for the patients' lived experiences of a reduced intake of food and drink. These experiences seemed to be related to negative feelings, such as anxiety and shame during meals. Furthermore, the literature review revealed a lack of professional assistance during meals and insufficient guidance on how to handle specific nutritional problems. Conclusions: Patients expect committed nursing care in regard to nutritional advice during illness and assistance in meal-related situations. Nurses need to refocus on fundamental caring. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 84-91 Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record Aim: To describe the accuracy, completeness and comprehensiveness of information on pressure ulcers documented in patient records. Design and setting: A cross-sectional descriptive study performed in 29 wards at a university hospital in Iceland. The study included skin assessment of patients and retrospective audits of records of patients identified with pressure ulcers. Participants: A sample of 219 patients was inspected for signs of pressure ulcers on 1 day in 2008. Records of patients identified with pressure ulcers were audited (n = 45) retrospectively. Results: The prevalence of pressure ulcers was 21%. Information in patient records lacked accuracy, completeness and comprehensiveness. Only 60% of the identified pressure ulcers were documented in the patient records. The lack of accuracy was most prevalent for stage I pressure ulcers. Conclusions: The purpose of documentation to record, communicate and support the flow of information in the patient record was not met. The patient records lacked accuracy, completeness and comprehensiveness, which can jeopardise patient safety, continuity and quality of care. The information on pressure ulcers in patient records was found not to be a reliable source for the evaluation of quality in health care. To improve accuracy, completeness and comprehensiveness of data in the patient record, a systematic risk assessment for pressure ulcers and assessment and treatment of existing pressure ulcers based on evidence-based guidelines need to be implemented and recorded in clinical practice. Health information technology, including the electronic health record with decision support, has shown promising results to facilitate and improve documentation of pressure ulcers. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 123-130 The unexpected force of acute stroke leading to patients' sudden death as described by nurses Stroke occurs suddenly and unexpectedly and its consequences can mean the difference between life and death. Research into stroke is extensive but largely focused on patients who survive. The aim of the study was to describe how nurses experience the patient's death and dying, when patients are afflicted by acute stroke and whose lives cannot be saved. The study had a descriptive design with a hermeneutical approach. Interviews were carried out with ten nurses in stroke units at three hospitals. Data were interpreted using hermeneutic textual interpretation based on Gadamer's philosophy. The study shows that sudden death, when unexpected forces intervene in the lives of patients afflicted by acute stroke, was described by the main theme sudden death - the unexpected force and the following three sub-themes: death comes unexpectedly and without warning to the patient; the relatives are at the mercy of the unexpected and the nurses find themselves in demanding situations. The new understanding emphasizes that the unexpected and demanding situations the nurses are put in can be understood as ethical dilemmas and value conflicts because they are not free to give their time to preserving the dying patient's dignity and are not able to give the good care they wish to. A more flexible organization could support the nurses in making use of the creative forces in the unexpected event which an acute stroke that leads to death constitutes. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 545-552 Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards Aims: To investigate attitudes, beliefs and self-reported competence with regard to pain management in nurses and physicians on surgical wards. Interprofessional differences between physicians and nurses were also examined. Methods: A total of 795 physicians and nurses from different surgical departments in Norway were invited to complete a questionnaire measuring attitudes, beliefs and self-reported competence about postoperative pain. Findings: In total, 128 physicians and 407 nurses completed the questionnaire (response rate 68%). Of these, 77% of physicians and 57% of nurses reported more than 4 years' work experience with postoperative pain. Most of the physicians (95%) and nurses (86%) reported that patients 'often' or 'very often' achieved satisfactory pain relief. Overall, 69% of the sample evaluated themselves as being highly competent or competent in treating nociceptive pain, while only 16% reported they were highly competent or competent in treating neuropathic pain. There were no statistically significant differences between the professions regarding their self-reported competence in pain management, and nurses and physicians only differed on three out of 18 conditions regarding their appraisal of conditions related to postoperative pain management after controlling for years of experience. Only 20% of respondents were satisfied with the annual updates for staff about pain relief for patients with postoperative pain. Conclusions: Even though the majority of physicians and nurses described themselves as competent in management of nociceptive pain, and thought that patients often or very often achieved satisfactory pain relief, the respondents reported dissatisfaction with the annual updates in pain management and poor competence in treatment of neuropathic pain. [ABSTRACT FROM AUTHOR]