Search

Aims. Decision-making is an important prerequisite for empowerment. The aim of this study was to explore teenagers' perceptions of factors affecting decision-making competence in diabetes management. Background. A previous study that assessed an empowerment programme for teenagers with diabetes showed no effects on metabolic control or empowerment outcomes, which is not in accordance with results from studies on adult diabetes patients. The definition of empowerment highlights the patient's own responsibility for decision-making. Earlier studies have shown that many teenagers' may not be mature in decision-making competence until late adolescence. To explore the significance of decision-making competence on the effectiveness of empowerment education we wanted to explore teenagers' own view on factors affecting this competence. Design. An explorative, qualitative interview study was conducted with 31 teenagers with type 1 diabetes, aged 12--17 years. Methods. The teenagers were interviewed two weeks after completing an empowerment education programme. The interviews were analysed using qualitative content analysis. Results. Five categories stood out as important for decision-making competence: cognitive maturity, personal qualities, experience, social network and parent involvement. Based on the content in the interviews and the five categories, we made an interpretation and formulated an overall theme: 'Teenagers deserve respect and support for their short-comings during the maturity process'. Conclusion. Our conclusion is that teenagers deserve respect for their immature decision-making competence. Decision-making competence was described as cognitive abilities, personal qualifications and experience. To compensate for the deficiencies the teenagers deserve constructive support from their social network and the essential support is expected to come from their parents. Relevance to clinical practice. These findings can be useful for diabetes team members in supporting teenagers with diabetes and their parents both in individual meetings and when planning and delivering group education. [ABSTRACT FROM AUTHOR]

Objective. To describe how patient education is arranged in Swedish primary healthcare (PHC) and to assess whether the type of patient education and individual goal setting have an impact on diabetic patients' possibilities of reaching national treatment targets. Design. A Swedish national survey. Setting. Swedish PHC. Subjects. Data from 485 primary healthcare centres (PHCCs) and 91 637 diabetic patients reported by the PHCCs to the National Diabetes Register in 2006. Main outcome measures. Description of how patient education is arranged, HbA1c, body mass index, cholesterol, blood pressure, and physical activity. Results. Of the PHCCs that reported how they performed the individual counselling, 50% reported checklist-driven counselling and 8% individualized counselling based on patients' needs. A total of 105 PHCCs reported that they arranged group education. Of these, 67% used pre-planned programmes and 9% individualized the programme to the patients' needs. The majority of PHCCs (96%) reported that they set individual goals (HbA1c, blood pressure, lipids, and lifestyle). A minority of the PHCCs (27%) reported that the patients were involved in the final decision concerning their goals. Individual goal-setting facilitated patients' possibilities of reaching treatment targets. Goal-setting, list size of PHCCs, and personnel resources explained a variance of 2.1-5.7%. Neither individual counselling (checklist-driven or individualized to patients' needs) nor group education had an impact on patients' possibilities of reaching the targets. Conclusion. The current study indicates that improvement is needed in patient education in PHC to facilitate diabetic patients' possibilities of reaching national treatment targets. [ABSTRACT FROM AUTHOR]

BACKGROUND: Encounters in emergency departments have been described from different perspective and with different research approaches. On reviewing the literature, along with medical skills, interpersonal skills such as the ability to create a relationship with the patient was considered significant. Patients exposed to high-energy violence arrive at the emergency department in a vulnerable condition. Apart from their physical condition, they might be in shock and frightened by the experiences of the injury. The team at the emergency department is responsible for a complex situation and has to quickly establish rapport, gather information, assess the physical condition, and design a treatment plan. AIM: The aim of this study was to explore trauma patients' conceptions of the encounter with the trauma team. DESIGN AND METHOD: A qualitative inductive design was used and data were collected by semi-structured interviews. The interviews were transcribed verbatim and analysed according to contextual analysis. PARTICIPANTS: Twenty-three trauma patients with minor injuries, 17 from a university hospital and six from a county hospital with minor injuries, were included in the study. FINDINGS: The main findings were three main categories, labelled modes of being with the patients: the instrumental, the attentive and the uncommitted mode. All encounters contained the instrumental mode and mostly there were a combination of instrumental mode and attentive mode. The patients were satisfied with these modes, which created emotions of confidence, comfort and satisfaction. The uncommitted mode occurred in some encounters together and generated emotions of abandonment, dissatisfaction. CONCLUSION: The main conclusion is that a high-quality encounter in trauma care is likely to be received from caregivers who can shift their mode of being with the patient between the instrumental and the attentive mode as the patient/situation demands. That is, flexibility between the physical and psycho-social care. [ABSTRACT FROM AUTHOR]

Background: Individuals with blindness caused by diabetes face problems in their daily life that are related to both conditions. Hopefully some of these problems can be solved and simplified through a suitable educational programme. Aims: The aim of this study was to evaluate whether the educational programme 'I'm the boss' is suitable for blind individuals with diabetes, and to discover whether and how the programme inspired the participants in developing self-management skills. Methods: An ophthalmologic centre and two medical centres in a well-defined geographic area were screened for blind individuals with diabetes, resulting in the participation of nine individuals in the educational programme. The programme consisted of six three-hour-long weekly sessions based on empowerment and problem-based learning. Empowerment was measured using the Swedish version of the diabetes empowerment scale (Swe-DES-23). After completion of the programme, the participants were interviewed (focus group and individual interviews). The interviews were analysed using qualitative content analysis. Findings: The evaluation of the educational programme showed that almost half the participants improved their diabetes empowerment in the subscales ‘self-awareness’ and ‘ability to manage stress’. The qualitative data corresponded well with the quantitative data in terms of increasing participants' self-efficacy and knowledge. The learning process was experienced as flexible and the content as stimulating and creative. Conclusion: It is concluded that the programme seems suitable for blind individuals with diabetes, and in collaboration with others allows space for innovation and self-realisation. Copyright © 2006 FEND. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study that compares opinions of final year nursing students, rating their own competence, with the opinions of experienced nurses on the competence of newly-graduated nurses. Background. The transition of nursing preparation into higher education is regarded as positive, although it has led to differences in opinion about the competence of newly-graduated nurses and their readiness to enter the nursing profession. There are studies showing that newly-graduated nurses perceive themselves as holistically focused, professional practitioners, while other nurses are concerned that newly-graduated nurses do not have necessary skills. Methods. A convenience sample of 106 nursing students in the final week of their course and 136 nurses who had experience of supervising nursing students completed a questionnaire. The data were collected in 2002. Results. Own competence, in the form of ability to perform nursing care, was rated by nursing students to be good or strongly developed in most of the investigated areas of nursing care. Experienced nurses also estimated newly-graduated nurses' competence to be good or strongly developed, although to a lesser extent. Nurses qualified within the previous 5 years rated newly-graduated nurses' competence to be higher in comparison with those with less recent education. Conclusions. Further studies are needed to broaden our understanding of why some areas of nursing care, such as ethical awareness, were rated very highly, while others, like informing and teaching of co-workers and planning and prioritizing interventions had the lowest rating. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that about 6% of the school nurses had provided information on TC and 9% on TSE; however, the majority was open to presenting such information. The major reason reported for not providing this guidance was insufficient knowledge about the subject. The nurses who had given information were knowledgeable about both TC and TSE and more often informed young men about TC and TSE, whereas those who had only received information about TC were not as likely to provide information about TC or TSE. The results of this study highlight the need to educate school nurses about TC and TSE so they can include this information in their health teaching to adolescent males. [ABSTRACT FROM AUTHOR]

BACKGROUND: Delirium is an important form of psychopathology in older people and is associated with increased morbidity and functional decline. In the prodromal phase of delirium early symptoms occur, before all criteria have been met. AIM: The aim of this study was to delineate behavioural changes before and during the prodromal phase of delirium. That was considered to include the time from the first behavioural change up to the point when all DSM-IV criteria for delirium were met. DESIGN: Prospective and descriptive observation study. METHODS: One hundred and three hip surgery patients (hip fracture and hip replacement) aged > or = 80 years participated in this study. On admission none of them was delirious or had severe cognitive decline, but 32 patients met the DSM-IV criteria for delirium during the hospital stay. Frequent observations were performed up to delirium onset or 48 hours postoperatively. The observations included 37 items on the patient's state of mind, cognition, activity and behaviour. The first observation on admission was used as a reference and behavioural changes were defined as deviations from this first observation. RESULTS: Twenty-one patients out of the 32 who met the DSM-IV criteria (62%, D group) demonstrated behavioural changes before delirium onset, as did 34 (48%, R group) out of the remaining 71 patients. The D group had different and more numerous behavioural changes than the R group. Anxiety was common in both groups. Disorientation and urgent calls for attention were the most frequent changes in the D group. The D group presented a pattern of behavioural changes and early symptoms of the approaching delirium. Six hours immediately before the onset of delirium, the behavioural changes were more numerous and evident. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: It is necessary to pay attention to each behavioural change in the patients and to be aware of the prodromal phase of delirium in order to prevent its onset and to maintain the patient's well-being. [ABSTRACT FROM AUTHOR]

Patient education programmes have shown only small to modest effects on diabetes self-care and metabolic control. Despite that, almost all diabetes teams agree that patient education is an extremely important part of the treatment of diabetes. It is, therefore, important to identify components of successful patient education as a basis for creating and testing an evidence-based education programme. In a review of controlled studies evaluating patient education such components were identified and these were then used in building up the new programme. This programme, called ‘I'm the Boss’, is based on the notion that the patient is an active care participant, setting his own self-care goals, and is the one responsible for his own life. The content of the programme did not, therefore, focus on diabetes as such, but on life with diabetes. Six themes were explored during six three-hour weekly sessions. The educational method used was problem-based learning. This method is founded in cognitive theory and views the learner as active in seeking knowledge and able to solve the self-care problems identified. The aim of this study was to explore the feasibility of the programme which was tested in four small groups (five to eight participants) of diabetic patients together with two facilitators. After completing the programme, the patients participated in focus group interviews to evaluate the programme. They identified both positive and negative factors. After each session the two facilitators reflected upon the group dynamics. In particular, problems with allowing patients to be the experts should be highlighted. This programme has been modified according to the evaluation and it is now being tested in a randomised, controlled, multicentre study. Copyright © 2004 FEND. [ABSTRACT FROM AUTHOR]

BACKGROUND: Caring is a core characteristic of nursing. Nurses' caring behaviour has been explored in several studies. When caring for trauma patients, the most important caring behaviour must be the procedures associated with lifesaving. However, it is important not to forget the patient's psychological needs. AIM: The aim of this study was to highlight encounters between injured patients and nurses in the trauma team and to explore whether the theory of caring and uncaring encounters in nursing and health care is applicable in emergency care. DATA COLLECTION AND ANALYSIS: Data were collected by videotaping caring episodes between slightly injured patients and nurses in the trauma team. Five episodes involving 10 nurses were studied. The analysis was carried out in four steps. First the videotapes were studied several times and then transcribed into narratives, which were reduced into courses of events. These were subsequently classified according to aspects of caring and uncaring. RESULTS: The nurses' verbal and non-verbal communication was poor, and they adopted a wait-and-see policy. A new uncaring aspect, instrumental behaviour, emerged from this poor communication. One of the caring aspects, being dedicated and having courage to be appropriately involved, could not be identified. Most encounters included several aspects of caring and uncaring, but the uncaring aspects predominated. The dominance of uncaring aspects indicates a lack of affective caring behaviour. CONCLUSION: The result showed that the theory is partly applicable in emergency care. A new aspect, instrumental behaviour emerged. The nurses' behaviour in the five episodes was labelled as uncaring. Authentic nurse-patient encounters are essential in nursing. RELEVANCE TO CLINICAL PRACTICE: The importance of meeting patients' psychological needs and nurses' affective caring behaviour should be emphasized in trauma care, trauma courses and nursing education. It is necessary to measure the caring behaviour of trauma nurses. [ABSTRACT FROM AUTHOR]

NEED: Delirium is a serious psychiatric disorder, and elderly patients who undergo hip surgery are at higher risk for delirium development. PURPOSE: The purpose was to compare change in cognitive function and health-related quality of life 6 months after hip surgery in patients who experienced postoperative delirium with those who did not. SAMPLE: A total of 115 patients 75 years or older were included. MEASURES: Screening for delirium was done using the Diagnostic and Statistical Manual, 4th ed criteria. Cognitive function was measured with the Mini Mental State Examination and health-related quality of life with the SF-36. RESULTS: Of the 115 patients, 32 became delirious during hospital stay (D group), whereas the remaining patients did not (NonD group). Both D and NonD groups scored lower on the Mini Mental State Examination at follow-up than during hospital stay, but the deterioration was significantly greater in the D group. At follow-up, health-related quality of life was improved in patients who were destined for hip replacement surgery but unchanged or impaired for those with hip fracture. Delirium onset in connection with hip fracture lowered the health-related quality of life even more. At follow-up, low cognitive function correlated with lower scoring in physical function. Greater knowledge about delirious patients' vulnerable positions related to lower cognition and life quality can improve rehabilitation and support for these patients. [ABSTRACT FROM AUTHOR]

Aim. To examine the relationship between sustained work with quality improvement (QI) and factors related to research utilization in a group of nurses. Design. The study was designed as a comparative survey that included 220 nurses from various health care organizations in Sweden. These nurses had participated in uniformly designed 4-day basic training courses to manage a method for QI. Method. A validated questionnaire covering different aspects of research utilization was employed. The response rate was 70% (154 of 220). Nurses in managerial positions at the departmental level were excluded. Therefore, the final sample consisted of 119 respondents. Four years after the training courses, 39% were still involved in audit-related activities, while 61% reported that they had discontinued the QI work (missing = 1). Results. Most nurses (80-90%) had a positive attitude to research. Those who had continued the QI work over a 4-year period reported more activity in searching research literature compared with those who had discontinued the QI work (P = 0.005). The QI-sustainable nurses also reported more frequent participation in research-related activities, particularly in implementing specific research findings in practice (P = 0.001). Some contextual differences were reported: the QI-sustainable nurses were more likely to obtain support from their chief executive (P = 0.001), consultation from a skilled researcher (P = 0.005) and statistical support (P = 0.001). Within the broader health care organization, the existence of a research committee and a research and development strategy, as well as access to research assistant staff, had a tendency to be more common for nurses who had continued the QI work. Conclusion. Sustainability in QI work was significantly related to supportive leadership, facilitative human resources, increased activity in seeking new research and enhanced implementation of research findings in clinical practice. It appears that these factors constitute a necessary prerequisite for professional development and the establishment of evidence-based practice. [ABSTRACT FROM AUTHOR]

Unlabelled: When parents are informed that their newborn child has Down syndrome (DS), they often respond with a traumatic crisis reaction. The aims of this study were to assess the clinical goals regarding the first information and support provided to parents of newborn children with DS at the Swedish paediatric departments, and to analyse the parents' experiences of how they were first informed and treated. Data were collected during 1992-1993 from all of the 51 departments of paediatrics in Sweden. Information on the parents' experiences, collected retrospectively in 1996, was based on recollection by 165 parents of 86 children with DS born between 1989 and 1993 at 10 of the paediatric departments considered representative for Sweden. Seventy-five percent of the families were informed about the diagnosis within 24 h post partum. Some parents felt they were informed too late, and a few parents that they were told too soon. Half of the parents were satisfied with the timing. About 70% of the parents considered the information insufficient and 60% felt that they had been unsupported. Seventy percent would have liked more frequent information. Parental criticisms concerning the way in which the information was provided were that they received too much negative information about DS and that both the communication skills and the basic knowledge of DS on the part of the professionals could have been better.Conclusion: The Swedish paediatric departments fall short of their reported strong clinical goals regarding the initial information in Sweden, and improvements in this area are desirable. [ABSTRACT FROM AUTHOR]

AIMS OF THE STUDY: To investigate self-reported health in adult Tanzanian and Swedish diabetic patients in relation to the general population in the two countries and to investigate whether diabetic patients with poor glycaemic control also rated their self-reported health to be impaired. DESIGN/METHODS: The study design was cross-sectional and comparative. One hundred and fifty Tanzanian patients were age- and gender-matched with Swedish diabetic patients. Self-reported health was measured using the generic SF-36 health questionnaire, measuring eight different health domains. Glycaemic control was measured by testing glycosylated haemoglobin (HbA1c). RESULTS: The main results were that Tanzanian diabetic patients had poorer health in comparison with general Tanzanian population living in the same geographical area. In contrast, diabetic patients in Sweden did not markedly differ from the Swedish general population. Furthermore, Tanzanian patients had poorer glycaemic control. In both countries poor glycaemic control did not associate with impaired self-reported health, with one exception. Tanzanian patients with unsatisfactory or poor glycaemic control had significantly poorer reported health in the mental health domain. CONCLUSIONS: The results indicated that patients' health should be assessed using a specific health measure in addition to general medical measures. [ABSTRACT FROM AUTHOR]

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and self-perceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gender-matched non-diabetic controls. Oral health variables were also related to glycemic control (HbA1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%. Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff. [ABSTRACT FROM AUTHOR]

* The purposes of this longitudinal study were to examine Swedish student nurses' perceptions of independence and to explore to what extent the students had had opportunities to practise different tasks during clinical practice.* Data were collected on weekly self-assessment forms during the first and final clinical courses of a 3-year nursing programme for 60 and the remaining 48 students, respectively.* The majority of the students rated themselves as being independent of supervision to a great extent both at the beginning and throughout the clinical courses. Some students reported no or few opportunities to practise certain tasks during both courses.* Factors that may have influenced the students' perception of independence are discussed, such as preparation before the clinical courses and the importance students gave to certain tasks.* Clinical practice should be carefully planned and individualized to facilitate students' opportunities to practise different tasks. [ABSTRACT FROM AUTHOR]

In a retrospective study of 277 survivors of testicular cancer aged 18 to 83, the authors investigated health-related quality of life. A packet including a questionnaire about health-related quality of life, specific questions concerning testicular cancer, and a symptom checklist was sent to 367 men with nonseminomatous and seminomatous tumors who had completed treatment 3 to 13 years before the study; 277 of the men (75.5%) completed the questionnaires. The results were compared with an age-matched group of 122 men in the general population. Overall, the health-related quality of life experienced by the survivors was as good as, or even better than, that of the men in the general population. Men treated with chemotherapy, either as a single therapy or in combination with other treatments, scored less favorably regarding quality of life. Perceived attractiveness, being fertile, having children, and living with a partner were the most important aspects of good health-related quality of life. [ABSTRACT FROM AUTHOR]

Background: There is general agreement that acute confusional state (ACS) is common among elderly patients admitted to hospital, although exact figures are difficult to obtain. The objective of the current study was to investigate the onset of ACS during hospital stay and to isolate possible predisposing, facilitating and precipitating factors associated with the onset of ACS.Methods: Non-confused patients, greater than or = 65 years of age, undergoing orthopedic hip surgery, were consecutively included in the study (n = 225). Of these, 149 patients were operated on because of acute hip fracture and 76 underwent elective hip-replacement surgery. ACS was diagnosed by the DSM-IV criteria for delirium. Structured observations of ACS onset were performed every 2nd to every 4th hour during the patients' entire hospital stay. A protocol was used to document the observations on sleep, activities, well being and behavior. The Mini-Mental State Examination was used to measure cognitive functioning.Results: Of 225 patients 20% were diagnosed with ACS. The incidence of ACS was 24.3% in the group of hip-fractured patients and 11.7% in the hip-replacement surgery patients. The onset of ACS was postoperative (mean 24 +/- 21 h after surgery) in all but 8 patients. The duration of ACS among recovered patients was generally less than 48 h (mean 42 +/- 43 h). Predisposing factors were older age, cognitive impairment and pre-existing cerebrovascular or other brain diseases. Facilitating factors related to ACS were associated with communication and social isolation, e.g. impaired hearing and sight, reticence and passivity. One precipitating factor, besides surgery, may be the use of psychopharmacological drugs.Conclusion: The incidence of ACS was 20% among hip surgery patients. Older age and social isolation were factors associated with ACS. Increased attention and interaction with older patients could be of value in avoiding ACS during hospitalization. [ABSTRACT FROM AUTHOR]

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence for Swedish student nurses. Each of the randomly sampled 48 student nurses and their corresponding supervisors (48 nurses) assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients (n = 48) were interviewed about their perceived needs. Student nurses' and nurses' assessments were compared with the individual patient's opinion. Both the students' and the nurses' assessments showed close similarities with the patients' own estimations, although certain under- and overestimations for both physical and emotional needs were found, with a predominance of overestimation of emotional needs. Student nurses and nurses also showed uncertainty in some of their assessments, mainly concerning emotional needs. Their assessments were closer than student nurses/patients or nurses/patients, and also closer for physical than for emotional needs. The conformity in student nurses' and their supervisors' assessments might be understood as the supervisors' influence as role models. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care. [ABSTRACT FROM AUTHOR]

Privacy during hospitalization can be jeopardized as caring situations are often intimate. The aims of the current study were to explore patients' and nurses' attitudes towards privacy and to study whether nurses' perceptions of patients' privacy needs corresponded with the patients' own reported needs. Two questionnaires were used for the data collection, which included 120 consecutive patients and 42 nurses responsible for the participating patients' individual care. The main findings indicated that patients and nurses agree in the ratings of the major components of privacy in general, but privacy in hospital was estimated more highly by the nurses than by the patients themselves. Being allowed to talk to the physician in private was given the highest preference. Patients in long-term care had higher privacy preferences than those in acute care. An explanatory approach is needed to study the need for privacy in different caring situations and how privacy needs could be recognized and met by nurses. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate some aspects of care given within the preventive Child Health Services (CHS) during the first 18 months of life. A national random sample performed on child health records of 172 Swedish preschool children born between 1982 and 1987 was analysed regarding services recorded as having been provided and used within and beyond the national programme of health surveillance. Most families had made visits within the core programme of health surveillance to an optimal or at least sufficient extent. First-time parents visited the CHS more frequently than did more experienced parents. Procedures within the programme, such as growth monitoring, hip examination and immunizations, were documented to have been optimally performed on a majority of the children. Conversely, screening for hearing impairment and assessment of developmental milestones were performed less frequently, as were health information and postnatal parental education. To improve the quality of care, national recommendations ought to be more specific regarding both the performance and the documentation of the service. [ABSTRACT FROM AUTHOR]

BACKGROUND: Becoming autonomous is an important aspect of teenagers' psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support. OBJECTIVE: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes. DESIGN AND METHOD: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis. PARTICIPANTS: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes. FINDINGS: The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme 'hovering between individual actions and support of others'. The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme 'confirmation of others' showed that parental encouragement increased the certainty of teenagers' standpoints; peers' acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers' self-esteem. CONCLUSION: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. METHOD: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. FINDINGS: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance-care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. CONCLUSIONS: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients' confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients' confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease. [ABSTRACT FROM AUTHOR]

Aim: To test the validity and reliability of the 'Check your Health by proxy' instrument in parents to children with diabetes aged 8-17 years., Methods: One hundred and ninety-one caregivers and their children, aged 8-17 years, were included. All completed the 'Check your Health' questionnaire measuring quality of life and burden of diabetes, DISABKIDS self- or proxy version, and 45 completed the same questionnaires 2 weeks later., Results: Test-retest reliability on the 'Check your Health' questionnaire by proxy was moderate to strong (r = 0.48-0.74), p < 0.002). Convergent validity was weak to moderate (r = 0.15-0.49, p < 0.05). The instrument showed acceptable discriminant validity. Parents reported lower scores than the children on emotional health and social relations and higher scores on physical and emotional burden and higher burden on quality of life. Poorer social relationships and quality of life were associated with higher reported disease severity. The diabetes burden domain of the questionnaire correlated to perceived severity of diabetes and to perceived health. Discriminant validity showed that poorer social relationships and quality of life were associated with higher severity of the disease. The diabetes burden domain of 'Check your Health' by proxy showed discriminant validity on perceived severity of diabetes., Conclusions: The instrument 'Check your Health' by proxy showed acceptable psychometric characteristics in parents to young people (8-17 years of age) with diabetes. We also concluded that parents reported that their children had lower health and higher burden of diabetes than the children did, and it correlated to reported disease severity., (© 2016 Nordic College of Caring Science.)

Check Your Health was constructed as four-two-sided vertical thermometers (0-100) measuring physical and emotional health, social well-being and quality of life today and before onset of diabetes. Burden of diabetes was calculated as the difference between the two scores (today and before onset of diabetes). The aim was to examine concurrent and discriminant validity and reliability of Check Your Health in a convenience sample of 180 people with diabetes, who visited the diabetes clinic during a 3-month period. A randomly selected subsample of 43 of the 180 patients responded to the questionnaire twice (test-retest). Besides Check Your Health, three additional questionnaires were mailed to the patients, the EVGFP scale (EVGFP stands for Excellent-Very good-Good-Fair-Poor health) for measuring concurrent validity, the Diabetes Empowerment Scale (Swe-DES-23) and an attitude measure, Semantic Differential in Diabetes (SDD) for calculation of discriminant validity. There was significant agreement between Check Your Health and the five EVGFP health groups. The instrument discriminated well between patients with and without late diabetic complications. The measure on burden of diabetes showed that the higher the burden of diabetes, the lower the quality of life. The same pattern was found for both Swe-DES 23 and SDD; the higher the burden, the lower the sense of empowerment and the lower the burden, the more positive the attitudes towards diabetes. Check Your Health showed good stability (0.88-0.68). The results indicate that Check Your Health can be used as an acceptable and sufficiently accurate method for detecting health distress in people with diabetes., (© 2013 Nordic College of Caring Science. Published by Blackwell Publishing Ltd.)

Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

Objective: This study was conducted to determine the psychometric properties of the Swedish version of the Diabetes Empowerment Scale (Swe-DES-23)., Research Design and Methods: A convenience sample of 195 patients with type 1 and type 2 diabetes completed the Swe-DES-23 questionnaire. To establish discriminant validity, Swe-DES subscales were compared with the Semantic Differential in Diabetes scale (SDD) and a general health scale (EVGFP). Construct validity was tested using factor analyses. To determine unidimensionality of the subscales, inter-item correlations were calculated. Internal consistency was tested by the use of the Crohnbach-alpha coefficient., Results: The factor analysis resulted in four factors (empowerment subscales) with eigenvalues >1.0, explaining 60% of the variance. The four empowerment subscales: goal achievement, self-awareness, stress management and readiness to change showed Crohnbach-alpha values ranging from 0.68 to 0.91. Patients with good self-reported health and low burden of diabetes scored significantly higher on almost all empowerment subscales. Only weak correlations were found between metabolic control and the empowerment subscales., Conclusions: The SWE-DES-23 scale had acceptable validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Further testing is needed to shorten the questionnaire.

Background: In his Welfare Theory of Health Nordenfelt describes health as a person's ability to fulfil vital goals in different life areas. In order to use the theory in nursing, a semi-structured interview guide was constructed including questions about which vital goals Type 2 diabetic patients have and believe are important for their own welfare in different life areas., Aim: The aim of the study was to carry out preliminary validation of the interview guide. Two hypotheses were formulated: (i) Dissatisfied or unhealthy diabetic persons score lower on health-related quality of life (HRQL) than do those classified as healthy; (ii) A person with diabetes who uses avoidance as his/her main coping strategy restructures his/her vital goals in order to avoid failure and thereby dissatisfaction increases., Methods: Interviews with 155 randomly selected Type 2 diabetic patients were conducted using the interview guide. HRQL and coping were also measured. The interview data were analysed using content analysis., Results: The results were in accordance with the health theory, i.e. a person with Type 2 diabetes may be unhealthy, but still satisfied with life as a whole. Our two hypotheses were confirmed: Dissatisfied or unhealthy subjects with Type 2 diabetes had HRQL scores in all domains but physical functioning and bodily pain that were lower than scores of those who were satisfied or healthy, and a person with Type 2 diabetes who uses avoidance as his/her main coping strategy does seem to restructure his/her vital goals to avoid failure., Conclusion: The theory-based interview guide tested in this study seemed to reflect the notion that health includes fulfilment of vital goals.