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Biomedical subjects

I R Hallberg

Publications and source records attributed to I R Hallberg.

At least 55 records · Page 3Linked to original sources

The relationship of vocally disruptive behavior and previous personality in severely demented institutionalized patients.

The aim of this study was to explore the previous personalities of patients, their behavior during the course of the disease, and the relationship between the previous personality and vocally disruptive behavior of severely demented patients. Twenty-one severely demented patients identified as vocally disruptive and 19 severely demented control subjects who were matched for gender and ward were studied. A family member or close relative who knew the patient very well described the patient's personal characteristics from what they judged to be the "best" period in the patient's life and responded, on behalf of the patient, to the 57 items in a modified version of the Eysenck Personality Inventory. The results of this study can be interpreted to indicate that a previous personality described as introverted, rigid, and with a tendency to control emotions, as remembered retrospectively by a close family member, may correlate to current disruptive behavior. Despite the limitations of this study, the findings indicated that a patient's previous personality characteristics need to be taken into consideration because they may partially explain vocal activity and are therefore important for the provision of nursing care. Further research has to be performed to highlight the impact of previous personality characteristics on various kinds of behavior during the course of the disease.

Aged↗

Experiences of daily life and life quality in men with prostate cancer. An explorative study. Part I.

Eleven men with prostate cancer were randomly chosen and interviewed during an in-patient period at a southern Swedish hospital. The interview focused on functional health status in relation to daily life and life quality. In addition the sense of coherence scale was used, as well as the European Organization or Research and Treatment of Cancer (EORTC) QLQ C-30 questionnaire. The interview findings were analysed from a phenomenological-hermeneutic perspective and interpreted within the concept of transition. The entry to transition was marked by the men when experiencing an altered life continuum in terms of physical and existential fatigue, pain, micturition problems and an altered sex life. The passage phase was marked by descriptions of a new lifestyle where hope was a central internal resource, creating a positive illusion of life in order to endure. Their external resources were wives and family who supported physically (household matters, gardening) and psycho-logically (comfort, encouragement). The exit phase meant continuously adapting to a new life style, living with a slowly deteriorating functional health status, a new sense of dependency on others, daily life routine broken by in-patient hospital periods and contacts with primary health care. Thus the findings pointed more at continuously facing new passages than a stable exit, i.e. an ongoing transition. The areas of life imbalance described may serve as a basis for care assessment and intervention as well as supplying support of the transitional process.

Activities of Daily Living↗

Met and unmet nursing care needs in men with prostate cancer. An explorative study. Part II.

Men with prostate cancer (n = 11) were interviewed during an in-patient period at a urological clinic, about their experiences of met and unmet needs from health professionals. Their perception of quality of life and sense of coherence were also assessed. The findings were analysed from a phenemenological-hermeneutic perspective and interpreted within the concept of transition. It was interpreted that objective functional health needs were mostly met by health professionals and subjective existential needs were mostly not met. The analysis revealed patients as passive or active receivers of care. Passive receivers were explicitly and implicitly stating unmet needs, or explicitly stating satisfaction with nursing care at the same time as implicitly contradicting, referring to their needs as bagatelles, unimportant, whereas active receivers talked about their needs explicitly with the staff and did not state implicit unmet needs. This suggests that nurses need to be aware of and have sensitive ears to undertones in statements and actively seek for patients' needs. The most important nursing care areas seemed to be to provide solutions to physical problems together with staff support including information, and acting to increase confidence in staff and staff availability. This encourages patient, wives and families, in cooperation, towards a healthy exit of transition.

Aged↗

Survivors of acute leukaemia and highly malignant lymphoma--retrospective views of daily life problems during treatment and when in remission.

Fifty-four former patients, in remission after acute leukaemia or highly malignant lymphoma, responded to a questionnaire covering their physical problems, their view of the help they received, who was most helpful to them during the treatment phase, and the impact of the disease and treatment on their current life. Energy loss and nutritional problems were most troublesome during the treatment phase, signifying many other physical problems. Patients with acute leukaemia had more problems, and thought the care was worse than did patients with highly malignant lymphoma. Serious physical problems correlated with low satisfaction with practical help received, indicating that the nurses failed to meet the needs of those suffering the most. Reduced psychological and sexual energy persisted in remission, showed no correlation with the extent of physical problems during the treatment phase, but correlated with co-existing problems and sensitivity to infections, with a great need for intimate help and counselling and with a low sense of coherence. Family relationships were said to have improved, while work and finances were negatively affected. The results indicate that nursing care should actively focus on physical problems, especially on energy loss and nutritional problems. The overwhelming fatigue hinders patients in taking physical care of themselves, and may be overlooked by the nurse since their motor capability seems intact. The long-term effect of the illness means a reduced psychological and sexual energy and a high degree of existential problems and sensitivity to infections, which indicates the importance of follow-up care, and perhaps especially of counselling for the long-term reactions and disturbance of equilibrium.

Activities of Daily Living↗

Patients' satisfaction with surgical care impaired by cuts in expenditure and after interventions to improve nursing care at a surgical clinic.

Between 1991 and 1994 the number of beds in the surgical clinic at a central hospital in Southern Sweden was cut back by almost 50%. To develop the nursing care and to control the effects of the budgetary cuts, an intervention, including nursing care development, of an organization that would secure continuity in the nurse-patient relationship, individually planned care and quality assurance for aspects believed to be crucial to the quality of nursing care was implemented. The aim of this study was to analyse patients' satisfaction with surgical nursing care between, under and after the last cut in expenditure and the concluded intervention. A patient satisfaction questionnaire covering such areas as: patient satisfaction with information and decision-making; patient satisfaction with contact and the staff-patient relationship; patient satisfaction with ward facilities and the physical treatment or examination and patient satisfaction with various other aspects of care, was administered (1993 n = 131; 1994 n = 128). Subsample analysis showed lower scores for patient satisfaction if the respondents were women, young, or acutely ill when admitted. While surveys carried out between 1991 and 1993 showed an overall improvement in the quality of care, as measured by patient satisfaction, it remained at the same level in 1994 as in 1993, or decreased, regarding patient contacts with staff and physicians, involvement in decision-making, anxiety before examination/treatment, anxiety regarding professional secrecy, opportunity to influence the solution to their physical problems, chance to get sleep without being disturbed, physical nursing care and preparations before discharge. Thus a deterioration in quality seemed to take place in 1994 indicating that the cuts in expenditure may have been too hard and had been made at the expense of patient satisfaction.

Adult↗

Systematic clinical supervision, working milieu and influence over duties: the psychiatric nurse's viewpoint--a pilot study.

This pilot study describes nurses' experiences of the effects of clinical supervision on psychiatric health care, their views on their working milieu and duties, and the relationship between the nurses' experiences and perceptions. The sample consisted of 26 trained nurses (nine registered nurses and 17 licensed mental nurses) who took part in a clinical supervision intervention programme pursued in two wards at a psychiatric clinic. The effects of clinical supervision were evaluated using a questionnaire. The analysis showed that there were no relationships between the effects of clinical supervision and variables relating to working milieu and duties. It was concluded that implementation of clinical supervision based on a theoretical structure influences both nurses' sensibility towards their patients, and their personal growth.

Adult↗

Clinical supervisors' views of their leadership role in the clinical supervision process within nursing care.

The purpose of this study was to investigate nurse supervisors' views of their supervisory styles, their personal qualities and their leadership role, and the development of these styles. The sample consisted of 18 clinical nurse supervisors. The data were collected by interviews using 15 open-ended questions, and a 10-item questionnaire, and the analysis was a combination of hermeneutical and factor analysis. The analysis revealed two specific styles: the emotional and the cognitive supervisory style. The supervisor's personal qualities were: willingness and preparedness to show understanding, bringing out genuine feelings and 'confirming', the latter being the most important in the nurse supervisors' styles. The supervisors' views of their leadership role showed that high values were given to the following three factors: techniques in providing clinical supervision, responsibility for facilitating process, responsibility for creating a climate conducive to supervision and focusing on the main themes.

Attitude of Health Personnel↗

Burnout, empathy and sense of coherence among Swedish district nurses before and after systematic clinical supervision.

The relationships between, on the one hand, burnout, empathy and sense of cohoerence (SOC) and, on the other, personality traits were investigated, together with the effects of systematic clinical supervision on these phenomena among Swedish district nurses. The results in the supervisory group (n = 21) were compared with those of a comparison group (n = 12) in a quasi-experimental design. Personality traits were assessed by means of the Karolinska Scales of Personality. The results indicated some correlations between personality traits and burnout, empathy, and SOC, as well as correlations between the latter three phenomena. There were no significant effects of clinical supervision on burnout, empathy, or SOC. More research is needed regarding the effects of clinical nursing supervision.

Burnout, Professional↗

Effects of clinical supervision on nurse-patient cooperation quality: a controlled study in dementia care.

An intervention consisting of individualized planned care for patients and regular clinical systematic supervision for nurses was carried out on a ward for dementia care (the experimental ward, EW). On a similar control ward (CW), no changes were made. Observations of nurse-patient cooperation during morning care were collected at both wards, before and during the intervention. The observations (N = 107) were analyzed blindly and sorted into already-developed categories. The distribution of the cooperation-style categories was then analyzed statistically. The patients who survived throughout the study period (N = 18) were also compared over time. Nurse-patient cooperation at the EW improved significantly during the intervention period, whereas, at the CW, it deteriorated (p = .02). Status of surviving patients followed the same pattern (p = .001). The findings indicate that such interventions can improve the quality of nurse-patient cooperation in dementia care.

Aged↗

Narratives by district nurses about elder abuse within families.

Twenty-one district nurses (DNs) narrated 44 cases of elder abuse within families. A phenomenological-hermeneutical analysis revealed that the experiences were complex and often included families providing care for an elderly person. The abuse seemed to be related to the inability of one party to meet the care demands required by the elderly, by him- or herself, or by the situation. It also seemed to be related to an inhibiting dependency between the parties, a negative execution of power over the weaker party, and a history of violence. When the experiences were considered within the perspective of Lögstrup's ethics, it appeared that the DNs tried to remain neutral by not consciously reflecting on the ethical demands in the abuse situations. The findings suggest that nurses need support to enable them to decide about provision of care at home and to judge "the core" in abuse situations. They might gain this support through reflection on a meta-level, taking various perspectives into account, and thus making it possible to achieve new dimensions for decision making.

Adult↗

Acute leukaemia and malignant lymphoma patients' experiences of disease, treatment and nursing care during the active treatment phase: an explorative study.

Five acute leukaemia or highly malignant lymphoma patients at a hospital in southern Sweden were interviewed about their daily living problems, their coping strategies and their opinions about the nursing care they received during the active phase of their treatment. In addition the EORTC QLQ-C30, the Global Life Quality and the Sense of Coherence scales were administered. The data were analysed from a hermeneutic phenomenological perspective and interpreted to indicate that the patients sensed a threat to their lives, loss of control, and having to live with uncertainty stemming from the disease and the treatment. They had problems with fatigue, diarrhoea, nausea and vomiting, loss of appetite, sore mouth and high temperature. However, they seemed to minimize the importance of these problems and instead focused on gaining control of the situation, developing their knowledge of the disease and relying on the support of their family. Contradictions appeared in their statements about the quality of care, the information given was said to be good but difficult to understand; although the quality of the nursing care was judged to be high it had to be asked for. That is, help was received on request. The patients' perspective of the family and the nurses should be studied in further research in order to fully understand the patients' coping strategies and how nursing care can support them.

Activities of Daily Living↗

Nurses' satisfaction with nursing care and work at three care units for severely demented people.

The aim of this study is to investigate the degree of job satisfaction, burnout and strain among nurses (n = 134) working in three care units for demented people in southern Sweden. Three questionnaires were used: the Maslach burnout inventory (MBI), the work-related strain inventory (WRSI), and a recently developed measure for assessing job satisfaction. Based on principal component analysis, an eight-factor job satisfaction scale was chosen. Nurses in general were found to be satisfied, with registered nurses (RNs) being most satisfied with their work and the nursing care provided. The nurses in one of the care units were more satisfied than the nurses on the other two. The MBI and WRSI results showed a low degree of burnout and work-related strain and there was little difference between the care units or the categories of nurses. Job satisfaction scores were relatively independent from the MBI and WRSI scores. However, scores from these two inventories of burnout and strain at work were positively correlated. The results of the questionnaires seem to indicate that positive work experience and negative experience are not opposites. This particular method of evaluating job satisfaction needs further development. However, it seems important to include one specific measure for job satisfaction when action is taken in connection with the working situation of nurses.

Adult↗

Initiating and terminating verbal interaction between nurses and severely demented patients regarded as vocally disruptive.

The care of demented patients requires clear communication during care procedures. Earlier studies have shown that nurses were often vague in their verbal communication and unpublished observations indicated that in some cases demented patients continued to be verbally active after the nurses had left. This study aimed at exploring further the initiating and terminating phases of verbal interaction episodes between nurses and severely demented patients, to explore any relationship between nurses' communication style and vocally disruptive patients. Nine severely demented patients identified as vocally disruptive were tape-recorded between 07.00 h and 13.00 h. Any nurse-patient interaction episode lasting more than 30 s (n = 58) during care procedures was transcribed verbatim and its verbal communication activity was analysed for content and meta communication, and a communication index was calculated. The results showed strong task orientation and decreased verbal interaction during the course of the interaction. The data supported the assumption that the nurses' communication style increases or decreases patients' vocal activity. Vocal activity after the actual interaction episode seemed to coincide with the parties' communication on various levels, with a different focus of content, and with several nurses being involved in the same procedure. Nurses may become impatient and stressed by their patients' severe communication problems and therefore need to be relieved of this stress and supported so that they can remain close to the patient and be able to interpret his/her communication.

Aged↗

Cooperation during morning care between nurses and severely demented institutionalized patients.

Nurse-patient cooperation during morning care in two wards for the care of severely demented patients (107 observations) were analyzed by using a hermeneutic-phenomenological approach. Nurse-patient cooperation was found to be characterized by their acting in mutuality or unilaterality and in or out of pace with each other. When acting iri pace and mutuality, the nurse and patient turned to each other as persons as well as to the task. This theme related to confirming nurse actions and actions that provided opportunities for the patient to participate. When acting out of pace and unilaterality, cooperation was mainly task oriented and related to acts of resistance, the use of force, loss of attention or turning to others, or the patient wanted to escape. The findings were interpreted within the contexts of power, empowerment, and powerlessness and may serve as indicators of low- or high-quality nurse-patient cooperation during morning care provided for demented patients.

Adult↗

Systematic clinical supervision in a child psychiatric ward: satisfaction with nursing care, tedium, burnout, and the nurses' own report on the effects of it.

The effects of systematic clinical supervision on all nurses (n = 11) at a ward for child psychiatric care was evaluated by means of open-ended questions, the tedium measure, Maslach's burnout inventory (MBI), and the satisfaction with nursing care at baseline, and after 6 and 12 months of supervision. Two main themes emerged: (1) being understood and understanding others led to improved cooperation and self-confidence and, (2) broadened and better knowledge base led to increased goal-oriented and active nursing actions in their clinical work. The nurses' satisfaction increased significantly regarding responsibility, organization, quality of care, cooperation, and comfort in the work group. The degree of tedium decreased significantly regarding mental exhaustion, whereas there were no significant changes in the degree of burnout as measured by MBI. The data point to the fact that systematic clinical supervision may be a way to show and use the knowledge embedded in practice and to improve the efficiency, the climate, and the cooperation of a work group.

Adolescent↗

Nurses' creativity, tedium and burnout during 1 year of clinical supervision and implementation of individually planned nursing care: comparisons between a ward for severely demented patients and a similar control ward.

The aim of this study was to study creativity and innovative climate, tedium and burnout among the nurses on two wards during 1 year of systematic clinic supervision combined with the implementation of individualized care on an experimental ward (EW) for severely demented patients, as compared with a similar control ward (CW). EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned, documented and evaluated. The intervention was evaluated by means of the Creative Climate Questionnaire, Burnout Measure and the Maslach Burnout Inventory. Creativity and innovative climate improved significantly among the EW nurses (n = 19) in eight out of 10 factors during the year of intervention while there was no change on the control ward (n = 20). Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses. It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care. It also increases nurses' creativity, which, in turn, may benefit patient care. The findings of this study point to the necessity for a support system that focuses on the work itself, i.e. the nursing care. Individualized planned care and systematic clinical supervision may offer this kind of support.

Adult↗

Patient satisfaction with nursing care, evaluation before and after cutback in expenditure and intervention at a surgical clinic.

After a major cutback in the budget and staffing of a surgical clinic in southern Sweden there was intervention to improve the quality of nursing care and to evaluate the outcome. The intervention consisted of the implementation of: (1) nursing care organized in such a way that it would secure continuity of the nurse-patient relationship, (2) individually planned care by means of diagnostic reasoning, and (3) quality assurance for aspects believed to be connected with quality of care. Patient satisfaction before and after the intervention was assessed by means of a patient questionnaire survey (May 1991; n = 105 and May 1992; n = 137). Patient satisfaction improved significantly in variables related to nursing care viz. overall satisfaction and satisfaction with information and decision making; satisfaction with contact and staff-patient relationship; ward facilities and physical treatment or examinations; and satisfaction with physical nursing care. The results were interpreted to mean that the intervention may have counteracted any negative impact the reduced budget might have had such as the higher patient turn-over and the shorter in-patient periods, and thus seemed to have improved the quality of the nursing care in terms of patient satisfaction.

Continuity of Patient Care↗