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A review of 106 nursing records from 12 wards was conducted to categorize and quantify the content of the documentation and to consider the comprehensiveness of the recording for individual nursing problems. Audit instruments, based on a model for nursing documentation were developed and applied. The results show that admission assessment was missing in slightly less than half of all records, two-thirds had no nursing care plan and about one-third had no documentation on nursing outcome. About 90% of the records had no nursing diagnosis, no objective or no nursing discharge note. Notes on nursing status and nursing interventions were most common. Only one-third of the nursing problems identified had recording that gave information about the progress of the patient's problem. The analyses performed give information on the quality of nursing records which may be used to evaluate the quality of nursing care.

More detailed knowledge is needed in Sweden about how the service and care needs of elders are met and to what extent the help is provided as formal or informal support. A study of elders (75+) living at home in a rural municipality, showed that the major, Addresses: JOHANSSON L, UNIV UPPSALA, S-75105 UPPSALA, SWEDEN. SWEDISH PLANNING & RATIONALIZAT INST HLTH & SOCIAL SERV, S-10726 STOCKHOLM, SWEDEN.

Patient questionnaires are commonly used to assess patient satisfaction. This study reports on methodological experiences based on practical use of a Swedish questionnaire. The material consists of questionnaires from five different studies at some 60 wards in three hospitals. Four of the studies were performed by "routine procedure", while one was performed specially to study sampling, non-response and other losses. The results showed that a large number of patients were not given a questionnaire despite the fact that they should have been included according to the sampling criteria. In the special study barely half of those discharged answered a questionnaire corresponding to only about one in four in some studies performed routinely. Many of the patients excluded were probably in a difficult situation and their needs ought to be particularly noticed. This was true of patients who were old or confused, had language difficulties, were seriously ill, or who died during the care episode.

To an increasing extent ethical controversies affect and sometimes obstruct public health work and epidemiological research. In order to improve communication between the concerned parties a model for identification and analysis of ethical conflicts in individual-based research has been worked out in co-operation between epidemiologists and moral philosophers. The model has two dimensions. One dimension specifies relevant ethical principles (as beneficence, non-maleficence, autonomy and justice). The other dimension specifies the groups of persons involved in the conflict under consideration (for example: the study-population, individuals who may benefit from the results, the researchers and their personnel, the community at large). The model has been applied to the problem of legitimacy of case-register research and to problems in psychiatric health services research as well as epidemiological research.

Avoidable mortality in Sweden 1974-1985 was analysed using a European Community (EC) Working Group list of 'avoidable death indicators." The list includes causes of death that in certain age groups were defined as indicators of the outcome of medical care intervention or for some conditions, indicators of the national health policies. About 10 out of 14 medical health care indicators occurred in less than 50 cases per year. Death rates decreased over the 12-year period studied for most avoidable death indicators. For women, however, the death rate for malignant neoplasms of the trachea, bronchus and lung increased significantly. Swedish total mortality for ages 5-64 years was lower than the EC standards 1974-1978 and 1980-1984. Most of the avoidable causes of death had a relatively low standard mortality rate (SMR) when compared to both the EC standard and to the Swedish SMR for total mortality. For asthma, however, the Swedish SMR was higher. The development and implementation of the avoidable death concept and methodology is discussed.

The use of individual-based data in research has recently come in for much discussion. The basic issue of the discussion is how to balance between different legitimate interests: the interest in improving knowledge on matters important to human health and the interest in respecting individual autonomy. In this paper we will use a model for description and analysis of ethical conflicts in individual-based research. The model consists of two dimensions: the first specifies the persons involved in the conflict, the second specifies the relevant ethical principles. We have chosen the case of the Rönnskär study as an example. For illustration we distinguish between: no study, a study without informed consent and a study with informed consent. In the Rönnskär study the decision between the three situations rests upon an assessment of the conflict between two obligations: to improve the working environment and to respect autonomy.