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Scand J Caring Sci; 2012; 26; 113-122 Self-care ability among home-dwelling older people in rural areas in southern Norway Introduction: The growing number of older people is assumed to represent many challenges in the future. Self-care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self-care ability is closely related to perceived health, sense of coherence and nutritional risk. Aim: The aim of this study was to describe self-care ability among home-dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. Methods: A cross-sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health-related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. Results: A total of 780 persons were found to have higher self-care ability and 240 to have lower self-care ability using the Self-care Ability Scale for the Elderly. Self-care ability was found to be closely related to health-related issues, self-care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self-care ability were to have higher self-care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. Conclusions: When self-care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency. [ABSTRACT FROM AUTHOR]

athlin e., larsson m. & söderhamn o. (2012) Journal of Nursing Management 20, 90-101 A model for a national clinical final examination in the Swedish bachelor programme in nursing Aim To describe the development and evaluation of a model for a national clinical final examination in the bachelor nursing education. Background After the transfer of nursing education to the academy, concerns have been raised among nurses, nurse leaders, lecturers and researchers about the nursing students' clinical competence at the entrance to professional life. Methods During 2003 to 2005, a collaborative project was carried out between four universities and adjunctive health-care areas supplying clinical placements in Sweden. A two-part examination was agreed upon comprising a written theoretical test and a bedside test. An assessment tool for the bedside test was created. Nursing students, nurses and clinical lecturers participated voluntarily in the evaluation. Results The model was highly appreciated, and its relevance, usability, and validity were considered quite good for the assessment of nursing students' clinical competence at the final stage of their education. Several deficiencies were revealed, which led to further development of the model. Conclusions and implications for nursing management The development and first evaluation of the model proved encouraging for further use, but it needs further evaluation. Involvement of nursing managers is necessary in order to satisfy new demands on competence and staffing of clinical nurses. [ABSTRACT FROM AUTHOR]

FEX A, FLENSNER G, EK A-C and SÖDERHAMN O. Nursing Inquiry 2011; 18: 336-347 Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 253-261 This study aimed to elucidate meanings of health-illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self-care while using different sorts of advanced medical technology at home, knowledge about health-illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self-care at home, either using long-term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health-illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health-illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health-illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 523–532 Older home nursing patients’ perception of social provisions and received care Social loneliness and isolation may be some of the consequences that older people experience regarding age-related changes and losses, and nurses should be engaged in identifying social networks and social needs in this group. The aims of this study were to describe perceived social provisions in a group of older home-dwelling care–dependent patients, and to explore the relationship between perceived social provisions, physical functioning, mental state and reception of formal and informal care. The sample consisted of 242 persons aged 75+ years from seven municipalities in southern Norway, all receiving home nursing. Data were collected by means of structured interviews. Social support was assessed using the revised Social Provisions Scale. Physical functioning was assessed using the Barthel Index, and mental state using questions about loneliness, depressive symptoms and anxiety. Types and frequencies of social network contacts and formal and informal care were registered. Descriptive statistics, Mann–Whitney U-tests, Cronbach’s alpha coefficient and stepwise multiple regression were used in the analyses. In general, the level of perceived social provisions and togetherness in the study group was high, especially among women and the married. Decreased physical functioning and declined mental state were related to lower level of social provisions. The majority of the individuals had frequently contacts with several types of social networks, like friends, neighbours and religious communities, in addition to close family. Contact with these informal networks was found to be close related to perceived social support and togetherness. Reduced social provisions was related to increased amount of home nursing, which could indicate that demand for home care may work as a strategy to gain social contact. In this sense, dependence in daily life functioning could possibly contribute to social contact rather than reduce it. [ABSTRACT FROM AUTHOR]

The aims of this study were to test the Norwegian version of Goldberg's 30-item General Health Questionnaire (GHQ-30) in a group of older, care-dependent individuals living at home; to describe self-reported mental health; and to relate mental health to receiving home nursing, home help, and family care. A sample of 234 home nursing patients in Norway aged 75 years and older was interviewed. Mental state was assessed using the GHQ-30. Reliability and validity were calculated with Spearman's rank correlations, Cronbach's alpha coefficient, and Mann–Whitney U-test. The factor analysis was performed using the principal components analysis with varimax rotation and Kaiser normalization. Demographic characteristics and amounts of formal and family care were recorded, and descriptive statistics and stepwise multiple regression were used in the analyses. Cronbach's alpha coefficient for the GHQ was 0.92. The item–total correlations were generally acceptable. For items concerning depression and anxiety, the item–total correlations ranged from rs = 0.60 to 0.77. The factors extracted in the factor analysis explained 70% of the variance in the group. Females <85 years of age living in urban areas were associated with reduced mental health. There were no associations between general mental health and the amounts of formal and family care provided. [ABSTRACT FROM AUTHOR]

Fatigue is not only a complex phenomenon accompanying different illness conditions but is also a common complaint among individuals in the general population. Among individuals diagnosed with the chronic neurological disease multiple sclerosis (MS), one-third describe fatigue as the very first symptom, however it is invisible to others. When adopting an action-theoretic approach to health, fatigue may be considered to influence the individual’s goals of life and subjectively perceived health. The aim of this study was to describe perceived fatigue in relation to perceived health among working-aged individuals diagnosed with MS (n = 155), and in a comparative group of individuals randomly selected from the general population living in the same geographical area (n = 190). A self-report questionnaire including the Fatigue Impact Scale, a checklist of six symptoms, questions covering perceived health and levels of and perceptions of fatigue was used for the data collection. The responses on perceived health were dichotomized into two categories: ‘good health’ and ‘ill health’. Of the individuals with MS, 50% graded their perceived health as ill compared with 18% in the reference group (p < 0.001), and 68% graded fatigue as one of their worst symptoms compared with 21% in the reference group. In both groups, higher presence of symptoms and impact of fatigue in daily activities correlated negatively to perceived health. Compared with the individuals in the reference group, the individuals with MS reported higher impact of fatigue in physical areas in both the category of ‘good health’ (p < 0.001) and ‘ill health’ (p < 0.01). The perceived impact of fatigue was mirrored in increased problems in social and family activities. In conclusion, individuals with MS perceive fatigue as one of their worst symptoms three times as often as individuals in the general population. However, individuals with MS probably also adapt themselves or shift in their response to fatigue more than individuals in the general population. [ABSTRACT FROM AUTHOR]

In Antonovsky's salutogenic theory, the major concept sense of coherence (SOC) is constituted of three core components called comprehensibility, manageability, and meaningfulness. Several scales that are intended to measure SOC are available and used by researchers in health and caring sciences all over the world. When using a scale, evidence of its quality in different study groups is needed in order to get reliable and valid data. The aim of this study was to test reliability and construct validity of the Swedish version of Antonovsky's original 29-item sense of coherence (SOC) scale in a group of physically active older people. The scale was tested with a convenience sample of 140 physically active older individuals, who took part in different fitness-training groups in eastern Sweden. Reliability was assessed as item to total correlations and with the Cronbach's alpha coefficient. Construct validity was assessed with the known groups technique, confirmatory factor analysis, and with logistic regression analysis. The results showed that in the studied group of older individuals, the instrument was a very reliable tool with a Cronbach's alpha coefficient of 0.92. Construct validity of the scale was supported by the fact that the global concept sense of coherence was found to be hierarchically organized in a model that consisted of the three core components of comprehensibility, manageability, and meaningfulness. Furthermore, perceived health could be explained to some degree by sense of coherence, but even more by comprehensibility, in both cases independently of chronological age. The results clearly corroborated Antonovsky's theory. Söderhamn, O. & Holmgren, L. (2004). Testing Antonovsky's sense of coherence (SOC) scale among Swedish physically active older people . Scandinavian Journal of Psychology 45, 215–221. [ABSTRACT FROM AUTHOR]

Perioperative nursing roles continue to change rapidly as we enter the 21st century. The need for good leadership skills, expert clinical skills, creative management and ongoing education and research, continues to grow in many surgical departments. Perioperative nursing roles are evolving in response to healthcare reforms, technological developments, patient demands and changing opportunities for advanced nursing practice. The aim of this study was to investigate the attitudes of a group of operating room nurses and nurse anaesthetists towards perioperative conversation. A questionnaire, which included a specific attitude scale, was constructed and used in the collection of data. The informants were 86 operating room nurses and nurse anaesthetists. The results showed that the nurses had a positive attitude towards perioperative conversation. There were significant differences in attitudes related to age, gender, educational level, category of profession and working hours. Reliability, measured using the Cronbach's alpha coefficient for the attitude scale, was 0.96. The validity of the scale was high. [ABSTRACT FROM AUTHOR]

The aims of this study were to describe a group of nurses’ influence on the quality of care in postoperative pain management and to elucidate the meaning of exercising this influence. Fifteen protocols, written by experienced clinical nurses, describing complex postoperative pain situations where the nurses’ actions influenced the outcome were analysed by using two different phenomenological methods. The results showed that the general meaning structure of the nurses’ influence on the quality of care in postoperative pain management consisted of (i) the nurses’ perception of an unsatisfactory situation concerning the pain management of the surgical patients; (ii) that the nurses personally intervened; and (iii) that they changed the outcome of the situation in a positive direction. The meaning of exercising this influence was interpreted as an aspiration to relieve the patients from their suffering by exercising professional skills and knowledge in a creative, problem-solving, caring process. [ABSTRACT FROM AUTHOR]

Reliability and validity of the nutritional form for the elderly (NUFFE) Aim. The aim of this study was to test the reliability and validity of the Nutritional Form for the Elderly (NUFFE). Background. The prevalence of undernutrition among older people in nursing homes and hospitals reaches high levels. Assessment of older patients’ nutritional status is an important task for nurses in clinical care. To use a simple nutritional assessment instrument for older people is one approach for nurses. Examples of such instruments are the well validated Mini Nutritional Assessment (MNA) and the newly developed NUFFE. Methods. A total of 114 consecutively chosen, newly admitted older patients in an elder care rehabilitation ward in western Sweden were interviewed using the NUFFE and MNA. Arm and calf circumferences, body mass index (BMI), and presence of pressure sores and skin ulcers were noted as part of the MNA on admission. Weight was monitored and BMI calculated on discharge. Serum albumin levels on admission and discharge were used if these were available in the records. Reliability of the NUFFE was measured as homogeneity. Criterion related validity, concurrent validity, construct validity, and predictive validity were assessed with different statistical methods. The regional research ethics committee approved the study. Results. The results showed that the NUFFE is a fairly reliable and valid instrument for identifying actual and potential undernutrition among older patients. Conclusion. The NUFFE is a simple tool for nurses to use to assess older patients with the aim of detecting undernourished individuals and those at risk for undernutrition. When doing a nutritional assessment with the NUFFE, the BMI ought also to be calculated. The assessment could also be combined with food intake recording for a period of time. [ABSTRACT FROM AUTHOR]

Undernutrition among elderly patients is a significant problem in nursing care. The aims of this study were to develop and test an instrument for identifying actual and potential undernutrition among elderly patients in clinical nursing care. A Likert-type scale consisting of 15 items was constructed. A consecutive sample of 56 elderly patients (>65 years) in a geriatric rehabilitation ward in western Sweden were interviewed with the instrument. The data were mainly analysed with non-parametric statistical methods. The results showed that the instrument was a fairly reliable scale with a Cronbach's alpha coefficient of 0.72. Evidence of validity concerning face validity, criterion-related validity—including concurrent and predictive validity—and construct validity was shown in the study group. Further testing is required if the instrument is to be used in clinical nursing care and research. [ABSTRACT FROM AUTHOR]

Standardized and well-tested instruments are needed in order to study attitudes toward old people. One scale that has been widely used is Kogan's Old People scale. A Swedish version of the scale has been available since 1987. The aim of this study was to test this Swedish version of the scale for reliability and validity, in a sample consisting of students and different health-care professionals. A convenience sample of 319 individuals in western Sweden took part in the study, and data were collected by means of a questionnaire that included the scale. Reliability was assessed as homogeneity and validity as construct validity. All but 4 of the 34 items were found to have significant item-total correlations. The Cronbach's alpha coefficient for the total scale was 0.79. Some evidence of construct validity was found in a three-factor solution, which explained 30% of the variances. Strong evidence of construct validity was shown in the scale's capability to differentiate between individuals who rather preferred to work with old people (p <> ATTITUDES ELDERLY SCALE TESTING . [ABSTRACT FROM AUTHOR]