Högskolan i Skövde

The aim of this study was to describe motivating factors and barriers for older adults to adhere to group exercise in the local community aiming to prevent falls, and thereby gain knowledge about how health professionals can stimulate adherence. The motivation equation was used as a theoretical framework. Data were collected from individual semi-structured interviews (n = 10). The interviews were taped, transcribed, and thereafter analysed by using a descriptive content analysis consisting of four steps. The results showed that motivating factors to adhere to recommended exercise were perceived prospects of staying independent, maintaining current health status, and improving physical balance and the ability to walk. Barriers were reduced health status, lack of motivation, unpleasant experience during previous exercise group sessions, and environmental factors. All participants wanted information from health professionals on the benefit of exercise. Many considered individual variations in functional skills within each group as a disadvantage. The knowledge gained from this study suggests a greater involvement from all health professionals in motivating older adults to attend exercise groups. The results also suggest that physical therapists should be more aware of the importance of comparative levels of physical function when including participants in exercise groups.

Background: The aim of the study was to investigate whether urinary tract infection (UTI) in a representative sample of 85-, 90- and ≥95-year-old women is associated with delirium.

Methods: In 504 out of 643 women (78.4%) it was possible to evaluate UTI and delirium. Assessments such as the Organic Brain Syndrome (OBS) Scale, the Geriatric Depression Scale-15 (GDS-15) and the Mini-mental State Examination (MMSE) were performed during home visits. Delirium, dementia and depression were diagnosed according to the DSM-IV criteria. A diagnosed, symptomatic UTI with or without ongoing treatment, documented in medical records or detected in association with the assessments, was registered.

Results: Eighty-seven of 504 women (17.2%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half of them (44.8%) were diagnosed to be delirious or having had episodes of delirium during the past month. One hundred and thirty-seven of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed to have a UTI. In a multivariate logistic regression model, delirium was significantly associated with Alzheimer's disease (OR = 5.8), multi-infarct dementia (OR = 5.4), depression (OR = 3.1), heart failure (OR = 2.3) and urinary tract infection (OR = 1.9).

Conclusions: A large proportion of very old women with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering among old women.

Clarification of the concept self-harm is needed in order to enable research and theory development and facilitate the development and evaluation of medical interventions and nursing care for individuals who self-harm. This study presents such a conceptual analysis. Articles from 1997 to 2007 were sought from the Medline, PubMed, Cinahl, and PsychINFO search engines by entering the search words ‘self-harm’, ‘self-harming’, and ‘psychiatric care’. 25 medicine and 23 nursing science articles were chosen for inclusion and analysed. Rodgers’ evolutionary concept analysis process was used to delineate and clarify the concept’s context, surrogate terms, antecedents, attributes, and consequences, as well as to determine implications for further research. Attributes of self-harm may include repetitive injury of mouth or exterior body, that is to say the infliction of physical pain to alleviate mental pain, and time spent self-harming. Antecedents may be gender, mental pain, substance abuse and relational problems. Consequences often include the need for medication and help with altering coping behaviour. Some self-harm patients met with negative attitudes from nurses. Individualized care and treatment is recommended. Accordingly, inter-professional collaboration and postgraduate education is needed in order to provide better care and treatment for self-harm patients. Furthermore, better understanding is needed to help enable health care personnel understand why individuals self-harm. The conceptual analysis presented in this study may be helpful as regards theory development within this still rather unexplored field.

Aim: This paper examines how clinical nurse specialists assessed their competences in relief of symptoms, and explores factors affecting good care routines in palliative care. Methods: A prospective survey among 235 former post-bachelor (response rate 50.6 %) students at two university colleges in Norway. Results: Correlations between the measured concepts showed a medium to high correlation between all the five competences. Use of care routines correlated with all the other factors. The ability to identify lack of care showed significant correlation with one concept: time available for nursing. The results from the regression analysis supported a model with good care routines as dependent variable (F=22.59, df=91, P<0.001). The independent variables in the model explained almost 57% of the variance in using care routines. Competences dealing with mouth problems, nausea, anxiety and the use of the Edmonton symptom assessment system (ESAS) had a positive effect on care routines. On the other hand, the ability to identify lack of care had a significant negative effect on the use of care routines. Conclusion: The importance of systematic assessment of the palliative patient's care needs and symptom management are emphasized, and use of the ESAS, and good care routines was affected by post-bachelor competences.

The aim of this study was to investigate and describe the experiences of the first advanced practice nurses (APNs), a new profession for Swedish health care, and of their supervising general practitioners (GPs), regarding the new role and scope of practice of APNs in primary health care. Individual interviews were conducted with the four first APNs and one focus group interview was conducted with five supervising physicians. The material was transcribed verbatim and analysed using latent content analysis. The respondents expressed confidence and trust in the new role of APNs. Some opposition to this new role from the GPs and other colleagues was observed, but was nonetheless overcome. The experiences of the APN role indicate that the new role is clearly demarcated from the role of physicians. The APNs were considered an extra resource for both the GPs and other nurses, which contributed to an increased availability of care for patients. The APN role requires an explicit definition and demarcation in relation to responsibility and roles among colleagues. Further development of the APN role presupposes the right to prescribe medication and order treatments, as well as an evaluation of patient, organizational and inter-professional perspectives on the matter. © 2010 Blackwell Publishing Asia Pty Ltd.

Aims: The aim of the present study was to describe personnel's attitudes to change processes between a regional hospital and the primary health care centre as well as investigate these results with regards to theories pertaining to change and leading change. Background: Leadership has three crucial dimensions: focusing on personnel, results/key processes and the ethical base of activities. Methods: A survey was conducted in 2003 using a comprehensive questionnaire. The total sample consisted of the personnel (n = 899) at the two organizations (answering rate was 68.8%). The data were analysed descriptively. Results: Approximately two-thirds of the respondents understood why the merger was occurring. Only one-third expressed that they had received sufficient information regarding the merger. In total 67% felt that the merger would create conflict while approximately one-fourth expressed uncertainty. Despite such negative responses, approximately two-thirds felt there were advantages to the merger. Significant differences were seen between the groups. Conclusions: In times of change personnel expect leaders to focus on dialogue with their personnel and to anchor the vision of the change process amongst the personnel. Implications for nursing management: By identifying the 'prison of thought' and creating an atmosphere where reflection and discussion are valued the nurse leader can help prevent resistance to change.

As pertains to life orientation, the study's conceptual framework demonstrates the importance of close relationships, meaning in life, and the strength of individuals to look forward and make plans for future. The aim of this study is to discover, in relation to background factors such as language, living situation, and culture, how people aged 65 and 75 experience life orientation. The study is a population-based cross-sectional survey with its material taken from 3,370 questionnaires which included the six-question Life Orientation scale. The SPSS static program, version 14.0, was used for all calcuations and the Chi-squared test was applied to determine if any significant differences between the groups existed. As seen in this study, most respondents aged 65 (85%) and 75 (73.2%) experienced a high degree of positive life orientation, clearly expressing a zest for life (93.5%), overall satisfaction with their lives (88.4%), and feelings of being needed (83.7%). Lower scores were given for never/seldom being depressed/sad (55.3%) and never/seldom feeling lonely (71.8%). Approximately every second respondent (51.9%) had plans for the future. A clear decreasing trend was seen in all questions for respondents aged 75 in comparison to those aged 65: only ``are you satisfied with life?'' showed no significant differences. Language/culture seems to clearly affect experiences of life orientation and well-being. Additionally, older people living alone reported significantly more negative response to all dimensions of life orientation. Positive life orientation is an important inner health resource for older. Accordingly, health promotion for older people should focus on facilitating the maintenance of important and close relationships and should include supporting older people's need to be needed.

The aim of this study was to describe the prevalence of urinary tract infection (UTI) and associated factors among very old women. In a cross-sectional, population-based study in Sweden and Finland, 532 women were asked to participate and 395 (74.2%) were possible to evaluate for UTI. Data were collected from structured interviews and assessments made during home visits, from medical charts, caregivers and relatives. UTI diagnosis documented in medical records during the preceding 1 and 5 years was registered. About one-third (117/395, 29.6%) were diagnosed as having suffered from at least one UTI in the preceding year and 60% in the preceding 5 years. In a multivariate logistic regression model, UTI in the preceding year, was associated with vertebral fractures (odds ratio (OR) = 3.2; 95% confidence interval (95% CI) = 1.4–7.1), incontinence (OR = 2.8; 95% CI = 1.8–4.5), inflammatory rheumatic disease (OR = 2.8; 95% CI = 1.4–5.7) and multi-infarct dementia (OR = 2.4; 95% CI = 1.3–4.5). UTI is a major public health problem in very old women and were independently associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might indicate that UTI is not a harmless disease.

In order to measure actual care needs in relation to resources required to fulfill these needs, an instrument (Time in Care) with which to evaluate care needs and determine the time needed for various care activities has been developed with the aim of assessing nursing intensity in municipal care for older people. Interreliability (ICC=0.854) of time measurements (n = 10´546) of 32 nursing activities in relation to evaluated care levels in two nursing homes (staff n = 81) has been determined. Nursing intensity for both periods at the two nursing homes comprised on average a direct care time of 75 (45%) and 101 (42%) minutes, respectively. Work time was measured according to actual schedule (462 hours per nursing home during two weeks). Given that the need for care was high, one must further investigate if the quality of care the recipients received was sufficiently addressed.

This study has two aims: (i) to explore and evaluate the health-promoting effect of preventive home visit (PHV) by analysing the activities conducted during the PHV and the reported results, and (ii) to critically analyse if PHV is characterized by an individualized health resource perspective. The material was compiled through a systematic literature search in the databases Ebsco, CINAHL, Medline, Science Direct and CSA from the period 1984 to 2004. The result of the systematic database search was a total number of 49 scientific research articles, of which 18 are included in this study. The analysing method was a four-step integrating research review. The review describes the following content concerning (i) activities during home visits: screening, observation and evaluation, guidance, support, referral to care and other services, follow-up and individual aim; (ii) positive effects: reduced mortality, improved ability to function, improved life quality, improved subjective health, fewer admittances for care, older people's experiences of home visits and increased knowledge on health and (iii) unclear/negative effects: admittance to care, no effect on mortality, unaffected ability to function, unaffected general health and uninfluenced life quality. PHVs had been implemented based on an individual perspective in a total of 13 studies out of 18. The focus on sickness was surprisingly clear, and in 10 studies out of 18 a health resource perspective was lacking. The effects of PHVs have been questioned. Despite this, current research results imply that this method has a positive affect on older people's health and well-being. This form of care must still be developed to include extensive screenings and interventions, as well as a health resource perspective where the starting point during every home visit is the older person's individual needs and wishes.