Stuck in tradition-A qualitative study on barriers for implementation of evidence-based nutritional care perceived by nursing staff.

AIMS AND OBJECTIVES: To explore the barriers for nutritional care as perceived by nursing staff at an acute orthopaedic ward, aiming to implement evidence-based nutritional care. BACKGROUND: Previous studies indicate that nurses recognise nutritional care as important, but interventions are often lacking. These studies show that a range of barriers influence the attempt to optimise nutritional care. Before the implementation of evidence-based nutritional care, we examined barriers for nutritional care among the nursing staff. DESIGN: Qualitative study. METHODS: Four focus groups with thirteen members of the nursing staff were interviewed between October 2013-June 2014. The interview guide was designed according to the Theoretical Domains Framework. The interviews were analysed using qualitative content analysis. RESULTS: Three main categories emerged: lacking common practice, failing to initiate treatment and struggling with existing resources. The nursing staff was lacking both knowledge and common practice regarding nutritional care. They felt they protected patient autonomy by accepting patient's reluctance to eat or getting a feeding tube. The lack of nutritional focus from doctors decreased the nursing staffs focus leading to nonoptimal nutritional treatment. Competing priorities, physical setting and limited nutritional supplements were believed to hinder nutritional care. CONCLUSION: The results suggest that nutritional care is in a transitional state from experience- to evidence-based practice. Barriers for nutritional care are grounded in lack of knowledge among nursing staff and insufficient collaboration between nursing staff and the doctors. There is a need for nutritional education for the nursing staff and better support from the organisation to help nursing staff provide evidence-based nutritional care. RELEVANCE TO CLINICAL PRACTICE: This study contributes with valuable knowledge before the implementation of evidence-based nutritional care. The study provides an understanding of barriers for nutritional care and presents explanations to why nutritional care has failed to become an integrated part of the daily treatment and care.

Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden.

BACKGROUND: Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden. METHODS: This is a cross-sectional study using a postal questionnaire to all Thai women (18-64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used. RESULTS: The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16-3.54), having low trust in others (OR = 1.61, CI: 1.10-2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02-2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32-5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94-9.34) and living without a partner (OR = 2.53, CI: 1.30-4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %). CONCLUSIONS: The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services. However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.

Possibilities for maintaining a strong self - a grounded theory study of relational experiences among Thai women in Sweden.

BACKGROUND: Due to increasing globalization and Internet communication, the number of international marriages has increased. In Sweden, 75% of the Thai population are women, among whom 80% are partnered with Swedish or other Scandinavian men. Previous studies have indicated that lack of autonomy, social isolation, and stigma are important risk factors for poor mental health for foreign-born women as well as for women in international marriages. OBJECTIVES: To explore what characterizes the processes, choices, challenges and relational conditions that Thai women, partnered with Swedish or Danish men, experience during their first years in Sweden. METHOD: A qualitative study using a Constructivist Grounded Theory approach based on fourteen individual interviews with Thai women partnered with Swedish or Danish men and residing in Sweden. RESULTS: The core category 'possibilities to maintain a strong self in Sweden' is linked to five categories characterizing the process that the women go through over time. The subcategories illustrate different paths taken even if there were possibilities to change paths along the way. The women had, for different reasons, reached a turning point that made them leave Thailand. In Sweden, they started in dependency and struggled in different ways to adjust to relational norms and handle prejudice. Toward the end of the timeline, differing ways of recognizing life choices depended on access to social networks and partners' attitudes. CONCLUSION: Our study showed the crucial role of economical, emotional and social support from partners and networks for Thai women's possibilities to maintain a strong self and good health after migration. This implies a need for supporting Thai women to be more independent by providing access to language education, employment and community involvement. The current requirement for becoming a permanent resident should also be reviewed not to jeopardize women international marriages possibilities' to leave unhealthy relationships.

Increased Risk of Mortality Due to Interpersonal Violence in Foreign-Born Women of Reproductive Age: A Swedish Register-Based Study.

Violence against women is an increasing public health concern, with assault leading to death as the most extreme outcome. Previous findings indicate that foreign-born women living in Sweden are more exposed to interpersonal violence than Swedish-born women. The current study investigates mortality due to interpersonal violence in comparison with other external causes of death among women of reproductive age in Sweden, with focus on country of birth. Foreign-born women and especially those from countries with low and very low gender equity levels had increased risk of mortality due to interpersonal violence, thus implicating lack of empowerment as a contributing factor.

Intimate partner violence and poor mental health among Thai women residing in Sweden.

OBJECTIVES: The current aim is to examine the prevalence of intimate partner violence (IPV) among Thai women residing in Sweden and its association with mental health. We also investigate the potential influence of social isolation and social capital regarding the association between IPV and mental health outcome. DESIGN: A public health questionnaire in Thai was distributed by post to the entire population of Thai women, aged 18-64, residing in two regions in Sweden since 2006. Items included aspects related to IPV (physical/sexual/emotional), sociodemographic background, physical health, mental health (GHQ-12), social isolation, and social capital (i.e. social trust/participation). RESULTS: The response rate was 62.3% (n=804). Prevalence of lifetime reported IPV was 22.1%, with 20.5% by a previous partner and 6.7% by a current partner. Previous IPV exposure was significantly related to current IPV exposure, and all IPV exposure measures were significantly related to poor mental health. However, Thai women experiencing IPV by a current partner were more at risk for poor mental health than Thai women with previous or without any experience of IPV. Also, among all women exposed to IPV, those with trust in others and without exposure to social isolation seemed to have partial protection against the adverse mental health consequences associated with IPV. CONCLUSIONS: Most Thai women had never been exposed to IPV, and after migrating to Sweden, women had lower IPV exposure than in Thailand. However, the increased risk for poor mental health among those Thai women exposed to IPV suggests the need for supportive measures and targeted interventions to prevent further injuries and adverse health consequences. Although poor mental health in Thai women represents an obstacle for integration, the potential resilience indicated in the group with high social trust and without exposure to social isolation suggests that such aspects be included in the program designed to facilitate integration.

Perceived threat of violence and exposure to physical violence against foreign-born women: a Swedish population-based study.

BACKGROUND: Violence against women is an increasing global phenomenon. Little is known about violence against foreign-born women, despite a possible increased concentration of risk factors in this group. METHODS: This study investigated prevalence of perceived threat of violence and exposure to physical violence and its relation to country of birth among women (18-64 years) residing in southern Sweden, using data obtained from the 2004 Public Health Survey in Scania, Sweden. FINDINGS: Foreign-born women reported significantly higher rates of both perceived threat of violence and exposure to physical violence compared with Swedish-born women. Foreign-born women exposed to violence originated primarily from middle/low-income countries (versus high-income countries). The risk of perceived threat of violence remained significantly increased among foreign-born even after further adjustment for potential confounders, such as marital status and disposable income. After similar adjustment, increased exposure to physical violence was no longer significantly related to foreign-born status, but instead was largely attributable to marital status and low levels of disposable income. Foreign-born women, however, had a greater risk of physical violence in the home than Swedish-born women, and violence in the home was the most frequently reported setting for violence exposure among foreign-born women. CONCLUSION: Migration may confer an increased risk of interpersonal violence against women. Although the underlying causes of this increased risk are unknown, a complex set of factors may be involved, including socioeconomic disadvantage.