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Ernæringskartlegginga i heimesjukepleien kan betrast
No full textBakgrunn: Halvparten av dei eldre med heimesjukepleie er underernærte eller står i fare for å bli det. Nasjonale faglege retningslinjer og Kosthandboka gir råd om korleis helsetenesta kan førebygge og behandle underernæring. Alle pasientar skal få kartlagt ernæringsstatus med jamne mellomrom. Utan gode kartleggingsrutinar kan det vere vanskeleg å oppdage underernæring. Tilsyn syner at kartleggingspraksis varierer frå kommune til kommune, trass i at sjukepleiaren har eit tydeleg ansvar for å kartlegge ernæringsstatus.
Føremål: Å få fram den gode løysinga som forenklar og systematiserer vurdering av ernæringsstatus.
Innhald: Mange eldre pasientar har eit samansett sjukdomsbilde som kompliserer vurderinga av ernæringsstatus. Det viser seg at korte pasientbesøk gjer det vanskeleg å prioritere ernæringskartlegging. Vidare kan mange tilgjengelege kartleggingsverktøy for ernæringsstatus gjere det vanskeleg å velje det som er best eigna. Kortversjonen av Mini Nutritional Assessment (MNA) er vurdert til å vere best. MNA er basert på vekt- og høgdemål (KMI). For enkelte eldre pasientar kan det vere utfordrande å stå på ei vekt. I tillegg kan endra kroppshaldning eller sengeleie gjere høgdemåla usikre. I kortversjonen av MNA kan eit mål av leggomkrins erstatte KMI. Leiarane er i sentral posisjon til å sette kartlegging på dagsorden som del av det tverrfaglege ernæringsarbeidet. Sjukepleiarane ønsker meir ernæringskompetanse og tydelegare ansvarsdeling. Ulike studiar etterlyser kunnskap om kartleggingsverktøy og ein betre standard for dokumentasjon av ernæringsdata i elektronisk pasientjournal (EPJ). Kompetanse er difor sentralt for å styrke og kvalitetssikre ernæringsarbeidet .
Konklusjon: Ernæringskartlegging gjer det lettare å oppdage ernæringsvanskar før det oppstår underernæring. Den gode løysinga er å kartlegge ernæringsstatus med kortversjonen av MNA. Kosthandboka bidreg med nyttige tips
The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
Get PDFSuboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. To compare two different implementation strategies, external facilitation (EF) and educational outreach visits (EOVs), when introducing nutritional guidelines in nursing homes (NHs), and study the impact on staff performance. A quasi-experimental study with baseline and follow-up measurements. The primary outcome was staff performance as a function of mealtime ambience and food service routines. The EF strategy was a 1-year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one-three-hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy
Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey
Get PDFBackground
Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals.
Methods
A web survey was send to 304 RHS health professionals. The questionnaire was based on a theory- and research-based framework of determinants of public health innovations. Main outcomes were guideline use and completeness of use, defined as the number of health topics and checklists used. Associations between determinants and (completeness of) guideline use were explored by multivariate regression models.
Results
The survey was started by 120 professionals (39%). Finally, results from 73 respondents (24%) were eligible for analyses. All 28 Dutch RHS organizations were represented in the final dataset. About half of the respondents (48%) used the guideline. The average score for completeness of use (potential range 1–10) was 2.37 (sd = 1.78; range 1–7). Knowledge, perceived task responsibility and usability were significantly related to guideline use in univariate analyses. Only usability remained significant in the multivariate model on guideline use. Only self-efficacy accounted for significant proportions of variance in completeness of use.
Conclusions
The results imply that strategies to improve guideline use by RHSs should primarily target perceived usability. Self-efficacy appeared the primary target for improving completeness of guideline use. Methods for targeting these determinants in RHSs are discussed
Kunskaper om och attityder till prevention av trycksår hos distriktssköterskor och sjuksköterskor inom kommunal hälso- och sjukvård
Get PDFIntroduction: Pressure ulcer is a common and expensive problem for society which causes suffering and pain for the patient. Registered nurses should promote health, prevent illness and relieve suffering and is responsible for identifying risk and prescribing measures for pressure ulcer prevention. The purpose of this study was to describe and compare district nurses and registered nurses knowledge and attitude to pressure ulcer prevention in municipal health care. The method: Descriptive and comparative design with quantitative approach. A questionnaire was distributed to district nurses and registered nurses who worked in nursing homes and home healthcare in five municipalities. It was 67 out of 150 respondents who participated in the study. The result: The result showed that district nurse and registered nurse’s lack in knowledge about pressure ulcer prevention. Specific in the question about position change that reduces pressure ulcer risk the most, relief of heels on pressure-reducing mattress, the right way to reduce the pressure force when a patient slides down in a chair and that oxygen deficiency causes pressure ulcer. No significant difference between the groups knowledge on pressure ulcer prevention was found. The attitude of both the district nurse and the registered nurse was positive and a significant difference was found between the groups. The district nurse had a more positive attitude compared to the registered nurse. Nurses felt less confident of their ability to prevent pressure ulcer and district nurses responded to a greater extent that pressure ulcer prevention is an important task. Conclusion: In this study, participants have insufficient knowledge about pressure ulcers prevention and the attitude of both the district nurse and the registered nurse was positive to pressure ulcer prevention. A difference between the groups was where the district nurse had a more positive attitude compared to the registered nurse
GLA: D Årsrapport 2017
Get PDFGodt Liv med Artrose i Danmark (GLA:D®) er et nationalt initiativ fra Forskningsenheden for Muskuloskeletal Funktion og Fysioterapi ved Syddansk Universitet.
GLA:D® repræsenter en evidensbaseret behandlingsindsats for patienter med knæ- og hofteartrose bestående af patientuddannelse og neuromuskulær træning og understøtter implementering af de nationale kliniske retningslinjer på området.
GLA:D® tilbydes i hele landet. Ved udgangen af 2017 er 1.109 klinikere uddannet i GLA:D® og 383 enheder heraf 34 kommuner har haft patienter i forløb.
Næsten 30.000 patienter har i løbet af de sidste 5 år deltaget i et GLA:D® -forløb.
I GLA:D® Årsrapport 2017 kan du bl.a. få et overblik over de resultater patienterne har opnået i form af lavere smerte, lavere forbrug af smertestillende medicin, bedre funktion og bedre livskvalitet
Preserving dignity in end-of-life nursing home care: Some ethical challenges
Get PDFA central task in palliative care is meeting the needs of frail, dying patients in nursing homes. The aim of this study was to investigate how healthcare workers are influenced by and deal with ethical challenges in end-of-life care in nursing homes. The study was inspired by clinical application research. Researchers and clinical staff, as co-researchers, collaborated to shed light on clinical situations and create a basis for new practice. The analysis resulted in the main theme, ‘Dignity in end-of-life nursing home care’, and the sub-categories ‘Challenges regarding life-prolonging treatment’ and ‘Uncertainty regarding clarification conversations’. Our findings indicate that nursing homes do not provide necessary organizational frames for the team approach that characterizes good palliation, and therefore struggle to give dignified care. Ethical challenges experienced by healthcare workers are closely connected to inadequate organizational frames.måsjekke
From hospitals to nursing homes – the consequences of the Care Coordination Reform
Get PDFBackground: The coordination reform was introduced in January 2012 to ensure sustainability of health and care services. The transfer of responsibility for treatment from the specialist to the primary health service formed a central pillar of the reform. This study compares the situation before and after the introduction of the coordination reform for frail elderly patients being transferred from hospitals to nursing homes, related to: 1) deaths, and 2) age, sex, days of hospitalization and discharge destination.
Objective: Investigate possible differences in the population of patients transferred from hospitals to nursing homes before and after the introduction of the Care Coordination Reform.
Method: The data were retrieved from a 35-bed short-term ward at one nursing home, where the procedures and staffing were unchanged in the period before and after the reform. Information on the patients' age, sex, days in the nursing home, discharge destination and death in the nursing home was retrospectively collected for 186 patients aged ? 70 years for the period before the introduction of the coordination reform, and for 177 patients after the introduction of the coordination reform.
Results: We found that the number of patients who died in the nursing home after hospitalization doubled (27% versus 13%, p##less_than###0.002) following the introduction of the coordination reform. Compared with the situation before the reform, patients admitted after the reform were older (median 88 years (range 73-103) versus 85 years (range 70-99), p###less_than###0.001). Fewer patients were transferred to a different nursing home (21% versus 45%, p ###less_than### 0.001), and more were discharged to their own home (47% versus 36%, p = 0.04).
Conclusion: Our results show that patients transferred from hospitals to nursing homes after the introduction of the coordination reform were older. Moreover, more patients died during short-term stays in nursing homes after being transferred from hospitals. There is reason to assume that these results have consequences for the needs for competence and staffing in nursing homes.måsjekke
Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider’s perceptions of the teamwork and safety climates
Get PDFBackground: The threefold aim of this study was to (1) describe attitudes to patient safety among healthcare providers in home health nursing (HHN), (2) investigate differences in attitudes due to age, education level, years of healthcare work experience, and years at current workplace, and (3) compare attitudes of these HHN healthcare providers with available benchmark data from other healthcare settings.
Methods: One hundred sixty HHN healthcare providers in Mid-Norway answered a survey covering the teamwork climate and safety climate in the Safety Attitudes Questionnaire (SAQ). Data were analyzed by descriptive statistics, t test, and ANOVA.
Results: The overall mean score was 79.1 for teamwork climate and 72.3 for safety climate. The proportion of positive responses (i.e., scale scores ≥ 75) was 73% on teamwork climate and 53% on safety climate. For teamwork and safety climates, employees with the longest employment at the current workplace had significantly higher mean scores than those with shorter employment. No significant differences were found in mean scores for age, education level, and length of experience in healthcare. Compared to benchmark data from other studies, the mean HHN scores for both safety and teamwork climates were higher than in the vast majority of other healthcare settings and significant differences were found for both dimensions.
Conclusion: HHN has higher scores for both safety climate and teamwork climate compared to the vast majority of other healthcare settings, but there is room for improvement in the patient safety culture within the Norwegian HHN. Further research on patient safety culture in HHN is needed
