Scandinavian Journal of Caring Sciences最新文献_第7页

Detection of delirium in older patients—A point prevalence study in surgical and non‐surgical hospital wards 老年患者谵妄的检测--在医院外科和非外科病房进行的点流行率研究

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-05-04 DOI: 10.1111/scs.13270

Irene Instenes, Leslie S. P. Eide, Hege Andersen, Nina Fålun, Trond Pettersen, Anette H. Ranhoff, James L. Rudolph, Ole Martin Steihaug, Tore Wentzel‐Larsen, Tone M. Norekvål

Aims and ObjectivesTo (i) determine the prevalence of delirium and identify delirium subtypes in surgical and non‐surgical patients aged ≥65 years, (ii) determine whether certain precipitating factors affect the prevalence of delirium and (iii) review patients' medical records for description of delirium symptoms and the presence of International Classification of Diseases (ICD‐10) coding for delirium in discharge summaries.Methodological Design and JustificationsDespite being a robust predictor of morbidity and mortality in older adults, delirium might be inadequately recognised and under‐reported in patients' medical records and discharge summaries. A point prevalence study (24‐h) of patients ≥65 years from surgical and non‐surgical wards was therefore conducted in a tertiary university hospital.Ethical Issues and ApprovalThe study was approved by the Data Protection Officer at the university hospital (2018/3454).Research Methods, Instruments and/or InterventionsPatients were assessed for delirium with 4AT and delirium subtypes with the Delirium Motor Subtype Scale. Information about room transfers, need and use of sensory aids and medical equipment was collected onsite. Patients' medical records were reviewed for description of delirium symptoms and of ICD‐10 codes.ResultsOverall, 123 patients were screened (52% female). Delirium was identified in 27% of them. Prevalence was associated with advanced age (≥85 years). The uncharacterised delirium subtype was most common (36%), followed by hypoactive (30%), hyperactive (24%) and mixed (9%). There were significant associations between positive screening tests and the need and use of sensory aids. Delirium symptoms were described in 58% of the patients who tested positive for delirium and the ICD‐10 code for delirium was registered in 12% of these patients' discharge summaries.ConclusionsThe high prevalence of delirium and limited use of discharge codes highlight the need to improve the identification of delirium in hospital settings and at discharge. Increased awareness and detection of delirium in hospital settings are vital to improve patient care.

目的和目标(i)确定年龄≥65岁的手术和非手术患者中谵妄的发生率并识别谵妄亚型；(ii)确定某些诱发因素是否会影响谵妄的发生率；(iii)审查患者的医疗记录，以了解谵妄症状的描述以及出院摘要中是否存在国际疾病分类（ICD-10）谵妄编码。尽管谵妄是预测老年人发病率和死亡率的可靠指标，但在患者的医疗记录和出院摘要中，对谵妄的认识和报告可能不足。因此，我们在一家三级大学医院对外科和非外科病房中年龄≥65岁的患者进行了一项点流行率研究（24小时）。研究方法、工具和/或干预使用4AT对患者进行谵妄评估，并使用谵妄运动亚型量表对谵妄亚型进行评估。现场收集有关房间转移、感官辅助设备和医疗设备的需求和使用情况的信息。对患者的病历进行了审查，以了解谵妄症状的描述和 ICD-10 编码。其中 27% 的患者被发现患有谵妄。发病率与高龄（≥85 岁）有关。未定性谵妄亚型最常见（36%），其次是低能（30%）、多能（24%）和混合（9%）。筛查测试呈阳性与感官辅助工具的需求和使用之间存在明显关联。58%的谵妄检测呈阳性的患者描述了谵妄症状，12%的患者在出院摘要中登记了谵妄的ICD-10编码。在医院环境中提高对谵妄的认识和检测对于改善患者护理至关重要。

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引用次数: 0

The urge for a caritative caring science in a wider perspective 从更广阔的视角促进关爱科学的发展

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-05-04 DOI: 10.1111/scs.13266

Susanne Knutsson

引用次数: 0

Enhancing nurse retention: Insights from “SHOULD I STAY OR SHOULD I GO” 提高护士留任率：从 "我应该留下还是离开 "中得到的启示

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-29 DOI: 10.1111/scs.13265

Shu‐Mei Wang, Lien‐Chung Wei

引用次数: 0

Contextual influences on knowledge translation capacity in a nursing home organisation: A phenomenological hermeneutical study. 养老院组织中知识转化能力的环境影响因素：现象学诠释学研究。

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-26 DOI: 10.1111/scs.13264

Trine-Lise Dræge Steinskog, Oscar Tranvåg, D. Ciliska, Birgitte Graverholt

INTRODUCTIONThe demand for advanced clinical care in nursing homes (NHs) is increasing. Evidence-based practices and knowledge translation (KT) initiatives are growing to bridge the gap between what is known and what is done. However, research on contextual influence on KT has primarily focused on hospital settings.AIMTo expand our understanding of contextual influences on KT capacity in a NH organisation.DESIGN AND METHODSLindseth and Norberg's phenomenological hermeneutical method was used to explore and describe practice development nurses' experiences, perspectives and practices regarding how contextual factors influence KT capacity in NHs. Focus group interviews, participant observations, in-depth interviews and non-participant observations provided the data.RESULTSTwo main themes and four subthemes were identified. (1) Continuous limited resources are a cultural condition that inhibits KT readiness; prioritising keeping the NH machinery running at all costs and having contrasting care philosophies undermines KT. (2) Organisational prioritisations leave KT as a missing cogwheel in the machinery; retaining a system of fragmented KT strategies and lacking a structure for collective KT effort.CONCLUSIONThe study showed that KT held a minor role in the fast-paced NH machinery. Contradicting values characterise the NH organisation, resulting in a lack of a common vision and priorities. Building a sustainable KT capacity and providing evidence-based practice necessitates explicit responsibilities, dedicated resources and robust organisational support. Management has a critical role in strengthening the position of KT. Incorporating KT in daily NH practice can help staff become adaptable and confident, capable of meeting the increasing challenges of advanced care that alleviates suffering and promote the health and well-being of NH patients.

引言疗养院（NHs）对高级临床护理的需求与日俱增。以证据为基础的实践和知识转化（KT）计划不断发展，以弥补已知与实际之间的差距。设计与方法采用Sindseth和Norberg的现象学诠释法来探索和描述实践发展护士关于环境因素如何影响疗养院KT能力的经验、观点和实践。结果确定了两个主题和四个次主题。(1) 持续有限的资源是阻碍知识共享准备就绪的文化条件；不惜一切代价保持国家医疗机构机器运行的优先次序和截然不同的护理理念削弱了知识共享。(2) 组织上的优先考虑使 KT 成为机器中缺失的齿轮；保留了零散的 KT 战略系统，缺乏集体 KT 努力的结构。国家卫生机构的价值观相互矛盾，导致缺乏共同的愿景和优先事项。建立可持续的知识、技术和能力以及提供循证实践需要明确的责任、专门的资源和强有力的组织支持。管理层在加强 KT 的地位方面发挥着关键作用。将知识、态度和价值观融入到国家卫生机构的日常实践中，可以帮助员工提高适应能力和自信心，有能力应对高级护理方面日益严峻的挑战，从而减轻痛苦，促进国家卫生机构病人的健康和福祉。

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引用次数: 0

Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards 在复杂的实践中为安全出院做准备：对两个肺科病房护士处理慢性阻塞性肺病患者出院问题的定性研究

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-15 DOI: 10.1111/scs.13262

Nanna Vendelboe Gregersen, Birgit Refsgaard, Dorthe Sørensen

It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge.

在丹麦医院接受治疗的慢性阻塞性肺病（COPD）急性加重期患者中，有 17% 的人在 30 天内再次入院，其原因至今仍不清楚。出院是多方面的。然而，准备过程和护士的努力可能是确保成功出院的关键。

引用次数: 0

In the footstep of the old patient from hospital to home: A qualitative field observation study 老年患者从医院到家庭的足迹：定性实地观察研究

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-13 DOI: 10.1111/scs.13257

Sanne Have Beck, Grethe Eilertsen, Karen Andersen‐Ranberg, Astrid Janssens, Dorthe Susanne Nielsen

BackgroundOlder people often have multiple health conditions and therefore extended care needs. The transition from the hospital back to their home requires careful planning. The fragmented healthcare system and rapid discharge from the hospital can result in limited involvement of the older patient in the discharge planning process. We aimed to explore how older hospitalised patients experienced the transition from hospital to home and how possibilities and constraints in interactions with relevant parties in the transition affected their everyday lives.MethodAn ethnographic participant observation study including interviews was conducted with 10 older hospitalised patients. The theoretical perspective in the study is critical psychology and data were analysed using the condition‐, meaning‐ and reasoning analysis.ResultsThree themes were identified: (1) Lost in transition – the person's ability to act is limited, (2) In transition – the relatives become important, (3) At home – the home transforms into a workplace.ConclusionLack of involvement becomes a condition for older patients as some struggle to create meaning in their transition, affecting their everyday lives. The patients experienced their relatives as important as they ensured that the HCPs got to know their values and wishes. This knowledge is important for HCPs working closely with older people both at the hospital and at home ensuring active involvement of the older person with respect and acknowledgement of the older person's wishes, needs, resources and vulnerability.

背景老年人通常患有多种疾病，因此需要更多的护理。从医院返回家中的过渡需要精心策划。分散的医疗保健系统和快速出院可能导致老年患者在出院规划过程中的参与度有限。我们旨在探讨老年住院病人如何经历从医院到家庭的过渡，以及在过渡过程中与相关方互动的可能性和制约因素如何影响他们的日常生活。方法我们对 10 名老年住院病人进行了包括访谈在内的人种学参与观察研究。研究的理论视角是批判心理学，采用条件分析、意义分析和推理分析法对数据进行分析：(结论缺乏参与成为老年患者的一种状况，因为有些人在努力创造过渡时期的意义，这影响了他们的日常生活。病人认为他们的亲属很重要，因为他们能确保保健护理人员了解他们的价值观和愿望。这些知识对于在医院和家中与老年人密切合作的保健专业人员来说非常重要，可以确保老年人积极参与，并尊重和承认老年人的愿望、需求、资源和脆弱性。

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引用次数: 0

Informal caregivers' experiences of support from a tailored primary healthcare unit for older adults – A focus group study 非正规护理人员从为老年人量身定制的初级保健单位获得支持的经验--焦点小组研究

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-09 DOI: 10.1111/scs.13260

Ulrika Westerling, Mikko Hellgren, Liselotte Hermansson, Emma Nilsing Strid

BackgroundInformal caregivers are an essential part of health and social care systems worldwide. As such, they may need professional support.AimThe aim of this study was to describe informal caregivers’ experiences and need for support from a tailored primary health care (PHC) unit.MethodsThis is a qualitative descriptive study using data collected from five semi‐structured focus group discussions with a purposeful sample of 16 informal caregivers of older relatives. Respondents were recruited from a tailored PHC unit for people aged 75 years or older in a region in central Sweden. The data were analysed by qualitative content analysis with an abductive approach, based on the principles of the patient‐ and family‐centred care framework.ResultsThe overarching theme was ‘Striving for partnership’. The findings indicate that informal caregivers to some extent felt supported by the healthcare professionals. However, the caregivers expressed a need to be further acknowledged by the professionals in order to participate in the care of their older relatives in the way they wanted. Moreover, insufficient information regarding the older adult's health condition and care provided by the professionals had a negative impact on the caregiver's participation in care.ConclusionsInformal caregivers have unmet needs for support and strive for a partnership with the PHC professionals. PHC professionals should be more attentive and invite informal caregivers to participate in the care of the older adult in order to meet their support needs and build an equal partnership. The patient‐ and family‐centred care framework may be of guidance when providing care for older adults in a PHC context.

背景非正式护理人员是全球医疗和社会护理系统的重要组成部分。本研究的目的是描述非正规护理人员的经历以及他们对定制初级卫生保健（PHC）机构提供的支持的需求。方法这是一项定性描述研究，通过五次半结构化焦点小组讨论收集数据，并有针对性地抽样调查了 16 名老年亲属的非正规护理人员。受访者来自瑞典中部一个地区为 75 岁或以上老年人量身定制的初级保健单位。根据以患者和家庭为中心的护理框架原则，采用归纳法对数据进行了定性内容分析。研究结果表明，非正式护理人员在一定程度上感受到了医护人员的支持。然而，护理人员表示需要得到专业人员的进一步认可，以便以他们希望的方式参与对老年亲属的护理。此外，有关老年人健康状况和专业人员提供的护理服务的信息不足也对护理者参与护理工作产生了负面影响。初级保健专业人员应更加关注并邀请非正规护理人员参与老年人的护理工作，以满足他们的支持需求并建立平等的伙伴关系。以病人和家庭为中心的护理框架可为在初级保健中为老年人提供护理提供指导。

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引用次数: 0

‘Like a torch that enlightens new parents along a narrow and winding path into parenthood’ – Midwives' experiences by an interview study 就像一把火炬，照亮了初为父母者通往为人父母的狭窄而曲折的道路"--助产士通过访谈研究获得的经验

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-06 DOI: 10.1111/scs.13261

Margareta Johansson, Li Thies‐Lagergren

BackgroundThe core of postnatal care is that midwives recognise the needs of women and new‐born babies and provide the highest possible quality of care and medical safety to optimise the health and well‐being of new families. The study aimed to describe midwives' experiences in providing postnatal care for families during the first week after the birth of their baby.MethodsAn interview study included 18 midwives who interchangeably worked within the models of traditional hospital care, hotel‐based care, home‐based care, hospital‐based check‐ups, and specialist care at a breastfeeding clinic at one university hospital in Sweden. Data collected were analysed using thematic analysis according to Braun and Clarke.FindingsThe main theme: ‘Like a torch that enlightens new parents along a narrow and winding path into parenthood – a midwife's transitional support’ was explored and comprised two themes: (1) Strengthening parents' self‐confidence in their parental role by handling over parental responsibility; and (2) Challenging to facilitate parents' understanding of their parental role.ConclusionsMidwives expressed that supporting parents in the parental transition was a delicate task and included balancing mothers', babies', and partners' needs. The midwives guided parents into parenthood during postnatal care in a strategic manner by strengthening parents in their parental role. Postnatal care delivered by midwives is crucial for new parents and their babies.

背景产后护理的核心是助产士认识到产妇和新生儿的需求，并提供尽可能高质量的护理和医疗安全，以优化新家庭的健康和福祉。本研究旨在描述助产士在婴儿出生后第一周内为家庭提供产后护理的经验。研究方法：本研究对瑞典一所大学医院的 18 名助产士进行了访谈，她们在传统的医院护理、酒店护理、家庭护理、医院检查和母乳喂养诊所专家护理等模式下交替工作。根据布劳恩（Braun）和克拉克（Clarke）的专题分析法，对收集到的数据进行了分析。研究结果探讨了 "助产士的过渡支持 "这一主题，其中包括两个主题：(1) 通过接手父母的责任，加强父母对其父母角色的自信心；(2) 挑战父母的角色，促进父母对其父母角色的理解。结论助产士们表示，在为人父母的过渡时期为父母提供支持是一项细致的工作，包括平衡母亲、婴儿和伴侣的需求。助产士在产后护理中以策略性的方式引导父母进入为人父母的角色，加强父母的亲职角色。助产士提供的产后护理对新父母及其婴儿至关重要。

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引用次数: 0

Experiences of caring after religious disaffiliation: A qualitative study based on the DEW model 脱离宗教后的关爱体验：基于 DEW 模式的定性研究

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-04-04 DOI: 10.1111/scs.13259

Maria Björkmark, Malin Andtfolk, Linda Nyholm

Background and AimLeaving a religious community may occasionally lead to suffering in a human being's life and difficult existential life issues, such as loss of social relationships, identity and well‐being. Only a few studies have been conducted on what kind of care and support human beings who are suffering need in this context. The aim of this study was to increase the understanding of what a human being perceives as caring after religious disaffiliation.MethodsIn‐depth interviews were conducted with 18 participants who had left different religious communities in Finland. The material was analysed through a deductive thematic analysis according to Braun and Clarke, based on the Dressing an existential wound model by Rehnsfeldt and Arman.Results and ConclusionThe results show that what human beings experience as caring after religious disaffiliation is encountering a care professional who understands the needs of someone in this life situation. Based on these needs, caring is described through seven themes.Care professionals need to understand the impact religious disaffiliation may have on clients' lives and respond to their needs. Understanding the suffering of a human being calls for a care professional's holistic view and caring for the whole human being, including spiritual dimensions. This new knowledge can be used by care professionals to develop caring for clients after religious disaffiliation.

背景和目的离开宗教团体有时会导致人的生活遭受痛苦，并引发一些棘手的生存问题，如社会关系、身份认同和幸福感的丧失。在这种情况下，遭受痛苦的人需要什么样的关怀和支持，这方面的研究很少。本研究的目的是进一步了解人类在脱离宗教后认为什么是关怀。研究方法对 18 名脱离芬兰不同宗教团体的参与者进行了深入访谈。结果与结论结果表明，人类在脱离宗教后所体验到的关怀是遇到一位能够理解处于这种生活境况中的人的需求的专业护理人员。护理专业人员需要了解宗教分离可能对客户生活造成的影响，并对他们的需求做出回应。要理解一个人的痛苦，就需要护理专业人员具有全局观念，对包括精神层面在内的整个人给予关怀。护理专业人员可以利用这一新知识来发展对宗教分离后的服务对象的护理。

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引用次数: 0

For the good of the children-Life and ethical values when undergoing paternal alienation and involuntary loss of paternity. 为了孩子的利益--经历父权疏离和非自愿丧失父权时的生命和伦理价值。

IF 1.9 4区医学 Q2 Medicine

Scandinavian Journal of Caring Sciences

Pub Date : 2024-03-01 Epub Date: 2023-07-10 DOI: 10.1111/scs.13191

C Koskinen, G C Wallgren, K M Thorkildsen, K Kaldestad

Background and aim: Today there is an aspiration and desire for fathers to be caring masculinities that build long-term father-child relationships and emotional presence with their children. Previous research shows that life changes where fathers are deprived of the opportunity for equal parenting and close contact with their children affect the fathers' lives and mental health. The aim of this caring science study is thereby to gain a deeper understanding of life and ethical values when undergoing paternal alienation and experiencing involuntary loss of paternity.

Design, research methods, and participants: The study has a qualitative design. The data collection was carried out in 2021 through individual in-depth interviews according to Kvale and Brinkmann. The five fathers who participated in the interviews had experiences of undergoing paternal alienation and involuntary loss of paternity. The interviews were analysed with a reflexive thematic analysis according to Braun and Clarke.

Results: Three main themes emerged. Putting yourself aside includes forgetting one's own needs and prioritising the children's and being the best version of oneself for them. In playing with the cards you have been dealt lies an acceptance of life as it has become and also a responsibility not to let the grief take over, by creating new patterns for everyday life and holding up hope. Keeping your dignity as a human being includes being heard, affirmed and consoled, and a form of re-awakening one's dignity as a human being.

Conclusion: It is fundamental to understand the grief, longing and sacrifice that paternal alienation and involuntary loss of paternity cause human life and how every day can be a struggle to hold on to hope, find comfort and reconcile with the situation. The fundamental foundation that makes life worth living is love and responsibility for the good of the children.

背景和目的：如今，人们渴望并希望父亲成为关爱子女的男子汉，与子女建立长期的父子关系和情感存在。以往的研究表明，如果父亲被剥夺了平等养育子女和与子女亲密接触的机会，生活的变化就会影响父亲的生活和心理健康。因此，这项关爱科学研究的目的是深入了解经历父权疏离和非自愿丧失父权时的生活和伦理价值：本研究采用定性设计。根据 Kvale 和 Brinkmann 的方法，数据收集工作于 2021 年通过个人深度访谈进行。参与访谈的五位父亲都有经历过父权疏离和非自愿丧失父权的经历。根据布劳恩（Braun）和克拉克（Clarke）的方法，对访谈进行了反思性主题分析：结果：出现了三大主题。把自己放在一边，包括忘记自己的需要，优先考虑孩子的需要，为他们做最好的自己。在玩牌的过程中，既要接受生活的现状，也有责任不让悲伤占据上风，为日常生活创造新的模式并抱有希望。保持作为人的尊严，包括倾听、肯定和安慰，也是重新唤醒作为人的尊严的一种形式：要理解父子关系疏远和非自愿丧失父子关系给人类生活带来的悲伤、渴望和牺牲，以及如何每天都在努力坚持希望、寻找安慰并与现状和解，这一点至关重要。为了孩子的利益，爱和责任是让生活有价值的根本基础。

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引用次数: 0