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Biomedical subjects

Bodil Wilde Larsson

Publications and source records attributed to Bodil Wilde Larsson.

At least 19 recordsLinked to original sources
PubMed2006

Intrapartal care in a Swedish maternity unit after a quality-improvement programme.

OBJECTIVES: to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births. DESIGN: an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period. SETTING: a conventional maternity unit in Western Sweden. FINDINGS: an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage. CONCLUSION AND IMPLICATIONS FOR PRACTICE: a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.

Adult↗
PubMed2006

A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation.

OBJECTIVES: to further compare acupuncture treatment and care interventions for the relief of inflammatory symptoms of the breast during lactation and to investigate the relationship between bacteria in the breast milk and clinical signs and symptoms. DESIGN: randomised, non-blinded, controlled trial of acupuncture and care interventions. SETTING: a midwife-led breast feeding clinic in Sweden. PARTICIPANTS: 205 mothers with 210 cases of inflammatory symptoms of the breast during lactation agreed to participate. The mothers were randomly assigned to one of three treatment groups, two of which included acupuncture among the care interventions and one without acupuncture. All groups were given essential care. Protocols, which included scales for erythema, breast tension and pain, were maintained for each day of contact with the breast feeding clinic. A Severity Index (SI) for each mother and each day was created by adding together the scores on the erythema, breast tension and pain scales. The range of the SI was 0 (least severe) to 19 (most severe). FINDINGS: no significant difference was found in numbers of mothers in the treatment groups, with the lowest possible score for severity of symptoms on contact days 3, 4 or 5. No statistically significant differences were found between the treatment groups for number of contact days needed until the mother felt well enough to discontinue contact with the breast feeding clinic or for number of mothers prescribed antibiotics. Significant differences were found in the mean SI scores on contact days 3 and 4 between the non-acupuncture group and the two acupuncture groups. Mothers with less favourable outcomes (6 contact days, n=61) were, at first contact with the midwife, more often given advice on correction of the baby's attachment to the breast. An obstetrician was called to examine 20% of the mothers, and antibiotic treatment was prescribed for 15% of the study population. The presence of Group B streptococci in the breast milk was related to less favourable outcomes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: if acupuncture treatment is acceptable to the mother, this, together with care interventions such as correction of breast feeding position and babies' attachment to the breast, might be a more expedient and less invasive choice of treatment than the use of oxytocin nasal spray. Midwives, nurses or medical practitioners with specialist competence in breast feeding should be the primary care providers for mothers with inflammatory symptoms of the breast during lactation. The use of antibiotics for inflammatory symptoms of the breast should be closely monitored in order to help the global community reduce resistance development among bacterial pathogens.

Acupuncture Therapy↗
PubMed2006

Registered nurses' and student nurses' assessment of pain and distress related to specific patient and nurse characteristics.

Previous studies examining the influence of patient and nurse characteristics on assessments of pain and distress are not consistent in their results. Few studies have focused on the influence of nurses' personality factors on the assessment of pain and distress. The aims of this study were to compare registered nurses' and student nurses' assessments of patients' pain and distress and to identify if the assessment relate to specific patient and nurse characteristics. Seventy-one registered nurses and 184 student nurses assessed pain and distress in three hypothetical cases and responded to personality factors scales. The assessments of pain and distress regarding the patients showed significant differences. The respondents were divided into two groups, respectively, for each patient according to whether the patient's experiences of pain and distress were assessed as more or less intense. Both the groups of registered nurses and student nurses showed significantly differences on personality factors. The groups of student nurses also differed on nursing experience. Patients' age, and type and stage of illness, personality factors, and nursing experience influenced the respondents' assessments. These findings can be used to help educators in nursing to develop strategies to improve skills and knowledge in the assessment at pain and distress.

Adult↗
PubMed2006

Touch-screen versus paper-and-pen questionnaires: effects on patients' evaluations of quality of care.

PURPOSE: The aim of the paper is to compare the computer administration method (touch-screen) with the original paper-and-pen approach when measuring patients' perceptions of care quality. DESIGN/METHODOLOGY/APPROACH: The study group consisted of 199 patients who responded to touch-screen and 219 who responded to paper-and-pen questionnaires, receiving care between January and March 2003 at two out-patient clinics in one county in Sweden. The response rate was 75 per cent. A modified version of the quality from the patient's perspective questionnaire was used. FINDINGS: Two main findings emerged: first, both methods yielded almost identical results in quality of care ratings, and second, the touch-screen method was perceived to be easier to use and to take less time to complete. ORIGINALITY/VALUE: The paper shows that both methods are acceptable, but the touch-screen method appears to be preferred by patients.

Adult↗
PubMed2006

Patients' perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study.

AIM: The aim was to describe how patients perceived the concept of quality of care in psychiatric care. BACKGROUND: It is important to include patients' experiences in defining quality of care and in the development of instruments measuring quality of psychiatric care, as patients have unique information. But only a limited number of studies have directly involved patients. DESIGN: It was a qualitative interview study with 20 adult in and outpatients from psychiatric care. METHOD: A phenomenographic approach was used for the analysis of the interviews. RESULTS: The results showed that quality of care was perceived as a positive concept, namely as 'good' quality of care. The normative component was striking. Five descriptive categories emerged: The patient's dignity is respected; The patient's sense of security with regard to care; The patient's participation in the care; The patient's recovery; and The patient's care environment. Two conceptions emerged that had not emerged explicitly in earlier studies of quality of care: Being helped to reduce the shame and Being looked upon as like anyone else. CONCLUSIONS: The findings emphasize the importance of the interpersonal relationship between patients and staff. There is a need for further exploration of central aspects of quality in psychiatric care. RELEVANCE TO CLINICAL PRACTICE: It is important that the knowledge about how patients perceived the quality of care in psychiatric care is included in the planning and evaluation of care. The guidelines should designate quality of care from the patient perspective as the goal of interventions.

Adult↗
PubMed2005

Intrapartal care documented in a Swedish maternity unit and considered in relation to World Health Organization recommendations for care in normal birth.

OBJECTIVES: To describe documented intrapartal care in relation to the World Health Organization (WHO) recommendations for care in normal birth, and to compare intrapartal care for pregnant women at low and high risk in a conventional maternity unit. DESIGN: Retrospective examination of 212 consecutive childbirth records using an audit instrument developed from WHO's recommendations. SETTING: A conventional maternity unit in Western Sweden. FINDINGS: Practices that are demonstrably useful and should be encouraged were mostly documented, except for physical assessments, such as pulse and temperature and emotional aspects. Vaginal examinations were carried out more often than recommended, and fetal heart rates were seldom monitored intermittently. Practices classified as harmful, practices with insufficient evidence and practices frequently used inappropriately, were used to a large extent. There were high rates of interventions regardless of the women's risk level. The interventions were carried out without a rational documented indication. According to the documentation, only two-thirds of the women were in active labour on admission to the labour ward. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The recommendations from WHO were only partly adhered to. The instrument is considered useful for systematic audit of documented intrapartal care, and may help to identify areas in need of improvement. Improvements suggested by this study were as follows: inclusion of emotional aspects in the documentation, differentiation in cardiotocographic (CTG) surveillance for women at low and high risk, documentation of explicit indications for interventions and guidelines for admission to the maternity unit.

Birthing Centers↗
PubMed2005

A grounded theory study of Swedish women's experiences of inflammatory symptoms of the breast during breast feeding.

OBJECTIVE: to gain an understanding of the experiences of women who have had an episode of inflammatory symptoms of the breast during lactation. DESIGN: a grounded theory approach, inspired by Glaser and Strauss, was used in an interview study. SETTING: the study was carried out at a midwife-led breast-feeding clinic in Sweden. PARTICIPANTS: the strategic sample consisted of 14 mothers, all of whom had had an episode of breast inflammation between 10 and 22 weeks before the interview. Nine were primiparous. Ages ranged between 24 and 38 years. FINDINGS: the analysis resulted in the emergence of one core category and five conceptual categories. The core category was 'the will to breast feed', and the five conceptual categories were 'perspectives on breast feeding', 'personal strategies', 'enduring and adjustment', 'support' and 'causal frameworks'. The core category was reflected in all the other categories and was dependent on them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: an episode of breast inflammation is a possible threat to the maintenance of breast feeding, but the will to breast feed may make it possible for mothers to withstand physical and emotional difficulties caused by the illness. Breast-feeding mothers may have chosen a goal for the length of time they wish to breast feed, and the attainment of this goal is prestige-filled. Midwives, throughout the chain of care, could improve the amount and type of information given about the demands and possible complications of breast feeding. The availability of immediate clinical expertise for these mothers is an important factor, and health-care planners should be aware of this.

Adult↗
PubMed2005

Enteral nutrition in intensive care nurses' perceptions and bedside observations.

The aims of this descriptive study were to examine (1) nurses' perceptions of responsibility, knowledge and documentation focusing on enteral nutrition and (2) nursing practice regarding enteral feeding in the intensive care unit. Forty-four nurses in three intensive care units responded to a questionnaire (response rate 70%) and 40 bedside observations were performed. The nurses' primary source of knowledge was consultation with colleagues. Regarding responsibility, knowledge and documentation, the focus was more on planning, implementation and prevention than on the assessing phase of the nursing process. Gastric residual volumes were almost never checked, and none of the tubes were labelled. Seven out of 40 bedside observations revealed a backrest elevation of 30 degrees or more. Mean backrest elevation was 20.7 degrees. Comparisons between nurses in the three hospitals revealed significant differences. This study indicates that enteral nutritional nursing care within intensive care has its strength in planning, implementation and prevention of complications. Regarding nutritional assessment, the registered nurses (RNs) scored low. There are gaps between recommended nursing care and nursing practice regarding enteral nutrition. Knowledge and awareness of responsibilities in combination with a systematic documentation could increase the optimal nutritional care of the intensive care patient.

Adult↗
PubMed2005

International comparisons of patients' views on quality of care.

PURPOSE: To compare patients' views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing. DESIGN/METHODOLOGY/APPROACH: Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n=1236), France (n=1051), Norway (n=226), and Sweden (n=428). Day surgery patients: England (n=887), France (n=544), Norway (n=101), and Sweden (n=742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire "Quality from the patient's perspective" (QPP) was used (modified short version). FINDINGS: Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes. ORIGINALITY/VALUE: Cross-national comparisons of patients' views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.

Adult↗
PubMed2005

Adolescents' perception of the quality of orthodontic treatment.

The aim was to describe quality of care from a patient perspective among adolescents receiving orthodontic treatment and to assess the relationship between quality of care and outcome-related aspects. The research design was cross-sectional. The sample consisted of 151 young people (mean age 17.1 years, SD: 2.2; 53% girls and 47% boys) receiving orthodontic treatment in the Stockholm region in Sweden (response rate 75%). Data were collected using the Quality from the Patient's Perspective questionnaire. The highest quality of care perceptions were noted on items dealing with receiving the best possible orthodontic treatment and being treated with respect. Less favourable perceptions of the quality of care were found regarding the opportunity to participate in the decisions related to the orthodontic treatment. In order to improve the quality of care a more active involvement of these patients in the decision-making process is suggested. The item 'I received the best possible orthodontic treatment' noted the highest subjective importance rating. The youngest participants reported the most favourable scores and the oldest the least. The majority (74%) reported that they were 'completely satisfied' with the result of the orthodontic treatment. However, 52% claimed that they had not followed all of the advice obtained during the treatment period, and 29% indicated some or more hesitation about attending the same dentist for future treatment.

Adolescent↗
PubMed2005

Quality of care after ostomy surgery: a perspective study of patients.

Ostomy surgery affects life on a variety of levels. Clinicians need to facilitate the patient's adaptation to life with a stoma and provide information and support to ease the transition. To prospectively assess ostomy patients' perceptions of the quality of care received as well as the importance they ascribe to care conditions, 49 patients from nine Swedish hospitals completed a postoperative "Quality of Care from the Patient's Perspective" questionnaire modified to include stoma care variables. The questionnaire consists of 49 items covering 17 quality dimensions factors that address medical-technical competence, physical-technical conditions, identity-oriented approach, and socio-cultural atmosphere. The modified version contains an additional 13 ostomy-specific items that have demonstrated face validity. Responses to questions were provided using 4-point scales to assess perceived reality and subjective importance. "Medical treatment" received the highest score on the perceived reality scale; "interest in view-of-life," "care-room characteristics," and "participation" received the lowest scores. On the ostomy-specific section, patients were satisfied with most aspects of care received; "where to get advice and support concerning the ostomy" received the highest score. "Talking about sexuality with the ET nurse" received the lowest score on both perceived reality and subjective importance scales. Although the majority of patients regarded most aspects of care as important and were highly satisfied with the care they received before and following their ostomy surgeries, periodic follow-up will most likely enhance satisfaction and long-term follow-up results may differ from those obtained shortly after surgery.

Adolescent↗
PubMed2004

Midwifery care: development of an instrument to measure quality based on the World Health Organization's classification of care in normal birth.

AIMS AND OBJECTIVES: The aim of the study was to develop an instrument to measure midwifery care in relation to World Health Organization's classification of care in normal birth and to test the instrument for content validity and inter-rater reliability. METHODS: The Delphi method was used for development of the instrument and to elicit evidence of content validity. Six experts from three different geographical regions in Sweden, representing clinically working midwives, lecturers in midwifery and obstetricians, participated in the first part of the study. The instrument was tested for inter-rater reliability in an exploratory study by two midwives and one of the authors. Data were analysed using percentage of agreement level and the Kappa coefficient. RESULTS: Five expert rounds were needed to reach consensus for content validity. The inter-rater reliability test showed high agreement levels (95.9, 94.2 and 95.7%) and good to very good Kappa coefficients (0.74-1.0). The final instrument consisted of 78 items divided into five sections: background (five items); practices which are demonstrably useful and should be encouraged (55 items); practices which are clearly harmful or ineffective and should be eliminated (five items); practices for which insufficient evidence exists to support a clear recommendation and which should be used with caution while further research clarifies the issue (four items); and finally practices which are frequently used inappropriately (nine items). CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: The instrument can be used at a labour ward to measure documented care and quality of midwifery care. The results can be used to identify areas for improvements, to develop guidelines towards evidence-based care and to improve documentation. However, the present study should be regarded as an exploratory study and the feasibility of the instrument remains to be tested in empirical studies.

Attitude of Health Personnel↗
PubMed2004

Advanced home care: patients' opinions on quality compared with those of family members.

BACKGROUND: Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients' opinions congruent with those of family members? AIM: To explore and compare the relationship between patients' perception of the quality of care and close family members' perception of this care as well as their perception of the patients' perception. METHODS: Sixty-seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care. RESULTS: A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members' own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern. CONCLUSION: Patients' views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care-related experiences. The results can be understood in the light of empathic accuracy theory. RELEVANCE TO CLINICAL PRACTICE: The findings of this study have important implications for clinical nursing practice. Family members' perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care-related experiences, otherwise family members' perception tend to be more critical than those of the patients themselves.

Adolescent↗
PubMed2004

Analysis of the decision-making process leading to appendectomy: a grounded theory study.

The aim was to develop a theoretical understanding of the decision-making process leading to appendectomy. A qualitative interview study was performed in the grounded theory tradition using the constant comparative method to analyze data. The study setting was one county hospital and two local hospitals in Sweden, where 11 surgeons and 15 surgical nurses were interviewed. A model was developed which suggests that surgeons' decision making regarding appendectomy is formed by the interplay between their medical assessment of the patient's condition and a set of contextual characteristics. The latter consist of three interacting factors: (1) organizational conditions, (2) the professional actors' individual characteristics and interaction, and (3) the personal characteristics of the patient and his or her family or relatives. In case the outcome of medical assessment is ambiguous, the risk evaluation and final decision will be influenced by an interaction of the contextual characteristics. It was concluded that, compared to existing, rational models of decision making, the model presented identified potentially important contextual characteristics and an outline on when they come into play.

Adult↗
PubMed2003

Family members' perceptions of pain and distress related to analgesics and psychotropic drugs, and quality of care of elderly nursing home residents.

The aims of the present study were: (1) to describe family members' perceptions of nursing homes residents' pain and distress in relation to analgesics and psychotropic drugs; and (2) to compare whether background variables, dementia, help/support, prescribing of analgesics and psychotropic drugs, and quality of care vary between subgroups of residents. Two hundred and thirty-two family members of elderly people in 10 Swedish nursing homes participated in the study. The participants responded to a questionnaire including background variables, pain and distress variables, and the Quality from the Patient's Perspective (QPP) questionnaire. Data on drug prescribing was obtained from the medical records. The head nurse on each ward noted whether or not the resident had a documented or known diagnosis of dementia. The results showed that a high frequency of elderly nursing home residents were estimated as having physical pain and worry. A large number of the residents were prescribed psychotropic drugs. In addition, some of the residents with moderate or severe physical pain were not prescribed any analgesics. The residents were divided into three subgroups based on scores of physical discomfort, physical pain and worry. Subgroup comparisons differed with regard to sex, help/support, drugs and quality of care. Staff have a responsibility to assess the residents' pain and distress since this will form a basis for better pain and distress management. Other suggestions for improving quality of care are the provision of better information to the family members and the residents, meaningful occupation, less task-oriented care, and care that involves residents.

Aged↗
PubMed2003

Quality improvement measures based on patient data: some psychometric issues.

Existing methods for handling patients' opinions as a basis for quality improvement measures tend to be too sophisticated for practical nursing and/or weak psychometrically. An Index of Measures was developed by combining patients' perceptions of actual care conditions with the subjective importance they ascribed to these conditions. Data from Swedish somatic inpatients (n = 4002) indicated that this index gave added value compared to patients' ratings of actual care conditions only. Interpretation of the Index of Measures focused on the proportion of patients who receive the value "deficiency." This value is obtained if a given patient has a subjective importance rating on a given item which is higher than the mean subjective importance score for the whole patient group on that item, as well as a perceived reality rating on the item in question which is lower than the mean perceived reality rating for the whole group on that item. Guidelines are suggested on when improvement actions are necessary and when they are not necessary.

Adult↗
PubMed2002

Development of a short form of the Quality from the Patient's Perspective (QPP) questionnaire.

Patients' views on the quality of care are important and it is desirable that these can be assessed using short, yet valid and reliable instruments. The aim of the work reported here was to develop and test a short version of an established questionnaire: Quality from the Patient's Perspective (QPP). Patients (n=162, 79% response rate) receiving care at medical and surgical departments in two Swedish hospitals responded to the original QPP as well as to a newly developed short version. An ethical research committee approved the study. Pearson correlations were computed between the long and short forms and differences between means were analysed with t-tests. Reliability was estimated by computing Cronbach alpha coefficients. Correlations of acceptable size were found between the short form and the original QPP. The short form also had acceptable reliability coefficients. The strengths of the work are that the items in the short version are derived from a patient perspective and are formulated in words used by patients; the items still have a theoretical foundation, which makes the interpretation of results more meaningful; global formulations such as "What do you think about your care?" have been avoided; the short format should make the questionnaire more attractive for many patients to respond to. Limitations are that results indicate that the short form does not fully measure what the long form does. Therefore, when the short form is used in practice, a two-step procedure is suggested, where a follow-up is done with a selection of items from the original long form. This selection could be restricted to areas where problems may be suspected, based on the results from the short form.

Adolescent↗