Self-reported competence among advanced practice nursing students in Denmark, Finland and Norway: a cross-sectional multicentre study.

BACKGROUND: The health care systems in the Nordic countries and worldwide are under pressure due to increased longevity and a shortage of nurses. Providing nurses with a high level of education, such as advanced practice nursing, is of great importance to ensure effective, safe and high-quality care. AIM: The aim of this study was to investigate self-reported competence using the Nurse Professional Competence Scale Short-Form for the first time among master's students of advanced practice nursing in the Nordic countries and to relate the findings to age, work obligations, child-rearing responsibilities, level of education and clinical nursing experience. METHODS: A multicentre, cross-sectional design was used in this study conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form consisting of six competence areas was used with a maximum score of 7 per item for the analysis of single items and a transformed scale from 14.3 to 100 for analysing the competence areas (higher score equals higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. RESULTS: The highest mean score was found for the competence area 'Value-based nursing care'. Students living with home-dwelling children (≤ 18 years) reported significantly higher competence in 'Nursing care', while students ≥33 years reported significantly higher competence in 'Nursing care' and 'Value-based nursing care'. No significant differences were found between students working and those not working alongside their studies, between students with and without further nursing-related education, or between students with long and short experience as nurses. CONCLUSIONS: The findings from this study might help to further develop curricula in advanced practice nursing master's programmes to ensure high-quality nursing and sustainable health care in the future. Future high-quality master's programmes might benefit from systematic collaboration between Nordic higher education institutions as also Sweden is planning master's programme. Higher age, having children at home and working while studying should not be considered causes for concern.

Predictive markers for humoral influenza vaccine response in patients with common variable immunodeficiency.

BACKGROUND: A subgroup of patients with common variable immunodeficiencies (CVIDs) responds to vaccination. The aim of this study was to try to identify predictive markers for those with a humoral immune response after influenza vaccination. METHODS: Forty-eight patients with CVID (29 female and 19 male patients; mean age, 57.7 years) were vaccinated with the A(H1N1) influenza vaccine Pandemrix (GlaxoSmithKline, Wavre, Belgium) and boosted after 1 month. Blood samples were collected before each vaccination and 2 months later. Patients with a 4-fold titer increase in results on the hemagglutinin inhibition test (≥1:40) were considered responders and compared with nonresponders for clinical, immunologic, and genetic markers. RESULTS: Eight (16.7%) patients responded to the vaccination. A significantly higher proportion of the responders, who showed a EUROclass SmB-Trnorm21norm profile (P = .03) with a post-germinal center B-cell pattern (P = .04) in blood, experienced enteropathies (P = .04) compared with nonresponders. On the other hand, bronchiectasis was found exclusively among nonresponders (n = 7), as was autoimmune cytopenia (n = 5). Nonresponders with a EUROclass SmB-Trnorm21low profile (P = .02) had a significantly greater prevalence of progressive antibody deficiency (P = .048) and, at diagnosis, a higher mean serum IgM level (P = .03), lower mean serum IgG1 level (P = .007), expansion of absolute counts of cytotoxic CD8+ T cells (P = .033), and increased proportion of memory CD8+ T cells (P = .044) in blood. CVID-associated HLA markers were not detected in responders (P = .03). CONCLUSION: About one fifth of the patients with CVIDs achieved protective antibody levels after A(H1N1) vaccination and selected clinical, and immunologic markers were identified that might predict a positive outcome of influenza vaccination. Patients with CVID should be offered vaccination also against seasonal influenza because of the potential severity of the infection and risk for bacterial complications.

Patient-reported preferences for subcutaneous or intravenous administration of parenteral drug treatments in adults with immune disorders: a systematic review and meta-analysis.

Aim: Several studies have found subcutaneous (SC) and intravenous (IV) administration of similar drugs for long-lasting immunological and autoimmune diseases to have similar clinical effectiveness, meaning that what patients report they prefer is, or should be, a major factor in treatment choices. Therefore, it is important to systematically compile evidence regarding patient preferences, treatment satisfaction and health-related quality of life (HRQL) using SC or IV administration of the same drug. Materials & methods: PubMed database searches were run on 15 October 2021. Studies involving patients with experience of both home-based SC and hospital-based IV administration of immunoglobulins or biological therapies for the treatment of any autoimmune disease or primary immunodeficiencies (PIDs) were included. The outcomes assessed were patient preferences, treatment satisfaction and HRQL. Preference data were meta-analyzed using a random-effects model. Results: In total, 3504 citations were screened, and 46 publications describing 37 studies were included in the review. There was a strong overall preference for SC over IV administration, with similar results seen for PIDs and autoimmune diseases: PID, 80% (95% confidence interval [CI], 64-94%) preferred SC; autoimmune diseases, 83% (95% CI: 73-92%); overall, 82% (95% CI: 75-89%). The meta-analysis also found that 84% (95% CI: 75-92%) of patients preferred administration at home to treatment in hospital. Analysis of treatment satisfaction using the life quality index found consistently better treatment interference and treatment setting scores with SC administration than with IV administration. Conclusion: Compared with IV infusions in hospital, patients tend to prefer, to be more satisfied with and to report better HRQL with SC administration of the same drug at home, primarily due to the greater convenience. This study contributes to evidence-based care of patients with autoimmune diseases or PIDs.

COVID-19 vaccination in patients with primary immunodeficiencies: an international survey on patient vaccine hesitancy and self-reported adverse events.

Introduction: The Sars-CoV-2 pandemic caused great concern for this novel virus among patients with primary immunodeficiency (PID) or inborn errors of immunity (IEI) and their families. When COVID-19 vaccination program started, no data existed on adverse events (AEs) in this particular patient population, nor if patients felt hesitancy being vaccinated. Objectives: To explore i) reasons for COVID-19 vaccination hesitancy, ii) the number and symptoms of AEs and their severity, durability and management. Method: The organisations International Patient Organisation for Primary Immunodeficiencies (IPOPI), European Society for Immunodeficiencies (ESID) and International Nursing Group for Immunodeficiencies (INGID) distributed a global self-administered online survey. Results: The survey was completed by 1317 patients (mean 47, range 12-100, years) from 40 countries. 41.7% of the patients denoted some hesitancy to COVID-19 vaccination, mainly having doubts about postvaccination protection related to their underlying PID and concerns about negative long-term effects. More women (22.6%) reported "very" or "pretty much" hesitancy compared to men (16.4%) (P<0.05). The most common systemic AEs were fatigue, muscle/body pain and headache, usually the same day or the day after the vaccination and lasting for 1-2 days. 27.8% of the respondents reported severe systemic AEs after any dose of COVID-19 vaccine. Only a minority (7.8%) of these patients visited a health-care professional and 20 patients (1.5%) were hospitalized or seen at emergency room without specifying subsequent admission at the hospital. Significantly more local and systemic AEs were reported after the second dose. No differences regarding AEs were observed across different PID subgroups or vaccine types. Conclusion: At the time of the survey, almost half of the patients reported having felt hesitancy to COVID-19 vaccination highlighting the importance and need of developing joint international guidelines and education programs about COVID-19 vaccination. The types of AEs were comparable to healthy controls, but more frequent AEs were reported. Clinical studies and prospective, detailed registration of AEs related to COVID-19 vaccines in this patient population is of great importance. It is crucial to elucidate whether there is a coincidental or causal association between COVID-19 vaccine and some severe systemic AEs. Our data do not contradict that patients with PID can be advised to be vaccinated against COVID-19, in accordance with applicable national guidelines.

Documented assessments and treatments of patients seeking emergency care because of pain.

STUDY RATIONALE: Pain is one of the most frequent symptoms for which people seek emergency care. Studies show that pain management in emergency clinics is insufficient. No previous studies regarding pain documentation at emergency clinics in the Nordic countries have been undertaken. OBJECTIVES: The main purpose was to investigate the extent to which pain assessment, pain treatment and pain relief were documented in patient records. DESIGN: Patient records were reviewed using a study-specific protocol. SETTING: Emergency unit at a Swedish university hospital. PARTICIPANTS: A total of 698 patient records randomly selected were reviewed using a study-specific protocol. According to Swedish law and the university hospital's quality and safety guidelines, there should be a note in each patient record regarding whether or not the patient was in pain on arrival. The guideline stresses the importance of using patient self-assessment by a visual analogue scale (VAS). RESULTS: In 361/698 (52%) records, there was a note by a doctor or a nurse as to whether or not the patient had been experiencing pain on arrival. In 319 of these 361 records (88%), a full pain assessment had been documented. In 15/319 (5%) cases, the pain assessment included patient VAS assessment. In 54/319 (17%) patient records, a note regarding pain treatment was found. Significantly more notes regarding pain treatment were found in the records with an initial documented pain assessment, when compared with the records without any such assessment (p < 0.01). In the 54 records with notes regarding pain treatment, 10 (19%) included documentation regarding the effect of the treatment. CONCLUSIONS: The results show an alarming lack of documentation regarding pain assessments, pain treatments and follow-ups. This is in marked contrast to Swedish law, which clearly stipulates the responsibility of health care staff to document information relevant to providing safe care. Prompt action to improve pain documentation is warranted.

Functional status, health-related quality of life and symptom severity in patients with chronic intestinal pseudo-obstruction and enteric dysmotility.

OBJECTIVE: To investigate whether patients with chronic intestinal pseudo-obstruction (CIP) differ from those with enteric dysmotility (ED) regarding self-reported measures of functional status, health-related quality of life (HRQoL) and gastrointestinal symptoms. MATERIAL AND METHODS: The study comprised 28 patients with CIP (median age 48, range 28-80 years) and 26 with ED (median age 50, range 20-75 years). Three self-administered questionnaires were used: the Sickness Impact Profile (SIP), the Swedish HRQoL Questionnaire (SWED-QUAL) and the Gastrointestinal Symptom Rating Scale (GSRS). RESULTS: Patients with CIP reported significantly greater functional impairment in the aggregated physical dimension of SIP (15.4 SD 19.7) than did patients with ED (5.0 SD 7.2, p<0.01). They also reported significantly poorer general health (SWED-QUAL) (28.0 SD 20.8) compared to those with ED (44.8 SD 25.2, p <0.01). Symptom severity correlated with several measures of HRQoL and functional status in patients with CIP but abdominal pain severity was the only independent predictor of HRQoL. Abdominal pain alone explained between 21% and 67% of the variance in SWED-QUAL subscales. Likewise, the severity of indigestion symptoms among patients with CIP explained 20-24% of the variance in the SIP subscales, emotional behaviour and work. Much less correlation between symptom severity and functional impairment or HRQoL was found in patients with ED. We found no difference in symptom severity (GSRS) between the two groups. CONCLUSIONS: Patients with CIP reported a greater impairment of functional status and HRQoL than did patients with ED. Symptom severity had a stronger influence on functional status and HRQoL in patients with CIP.

Standardized care plans in Swedish health care: their quality and the extent to which they are used.

OBJECTIVES: To investigate the quality of standardized care plans and the extent to which they are used within Swedish in-hospital somatic care. Further, to examine the quality of the knowledge summaries on which existing standardized care plans were supposed to be based. DESIGN: Submitted documents were reviewed with study-specific protocols. SETTING: A national survey, based on a structured selection of Swedish hospitals. PARTICIPANTS: A total of 25 Swedish hospitals participated, and were asked to submit all documents in use that were labelled standardized care plan. RESULTS: Only 4% (34 out of 782) of the reviewed documents fulfilled the criteria for being a standardized care plan. None of the 34 knowledge summaries (an accompanying document with a compilation of scientific facts and reliable experience) was evidence-based. CONCLUSIONS: There is a lack of knowledge regarding what a standardized care plan is, and how such a document should emanate from evidence-based knowledge. Our results raise the question of how recent developments in research are used to create standardized care plans for the best possible care. In the process of developing standardized care plans it is important to acknowledge that staff who develop these plans need scientific training and experience. Standardized care plans are in the early stages of development, and at this stage it seems appropriate to initiate a discussion regarding possible cooperation at national level when developing standardized care plans for certain large groups of patients suffering from specific diseases, or undergoing the same treatment.

Health care use in patients with chronic intestinal dysmotility before and after introducing a specialized day-care unit.

BACKGROUND & AIMS: Patients with chronic intestinal dysmotility (CID) have a lifelong disease, and no curative treatment is available. Interventions are needed to improve the care and support of the patients. The aim of this study was to measure health-care consumption in adult patients with CID before and after the introduction of a specialized day-care unit. METHODS: Retrospective analysis was made of medical and nursing records from 3 different health-care delivery systems: period I, traditional care (1987-1996); period II, outpatient clinic (1997-1999); and period III, specialized day-care unit (2000-2002). There were 54 patients (44 women) with a median age of 47 years (range, 22-80 years). RESULTS: The need for admissions to hospital care decreased from 80% to 35% of the patients after the introduction of the specialized day-care unit (P < .002). Also, the mean number of days in hospital care per patient and year was reduced from 39.4 to 3.3 days. The number of outpatient visits remained unaltered. The average cost per patient-year decreased from $32,698 during traditional health-care services to $9,681 after introducing the specialized day-care unit (P < .002). Irrespective of the form of care delivery, the majority of patients (67%-77%) needed daily treatment with analgesics, and 81%-84% needed nutritional support on a regular basis. CONCLUSIONS: Individually tailored care at a specialized day-care unit leads to substantially decreased needs for hospital stays and lower costs in patients with CID.

Factors of importance for work satisfaction among nurses in a university hospital in Sweden.

The shortage of registered nurses in the healthcare sector is a problem in most countries. Swedish nurses tend to leave or seek new positions. However, few Swedish studies have addressed questions regarding what factors are of importance for nurses to perceive work satisfaction although satisfied nurses are linked to many positive organizational outcomes, e.g. improved quality of patient care. The aim of this study was to investigate what factors are of importance for nurses at a university hospital to perceive work satisfaction. Eight hundred and thirty-three nurses responded to the mailed Quality Work Competence questionnaire and the Huddinge University Hospital Model Questionnaire. Regression analyses identifies five factors linked to the head nurses leadership contributing to the nurses' feelings of work satisfaction: 'professional competence is made good use of', 'feeling of satisfaction with immediate superior regarding support for nursing research and development', 'opportunities for developing one's own competence for the current job', 'career opportunities in one's own profession' and 'yearly dialogue for performance appraisal with immediate superior'. The nurses also reported work-related exhaustion. Few saw opportunities for making a career as a nurse. In conclusion, the study identified specific amenable factors linked to the head nurses leadership that are of importance in creating attractive workplaces for nurses.