Explaining variance in health literacy among people with type 2 diabetes: the association between health literacy and health behaviour and empowerment.

BACKGROUND: To reflect the health literacy (HL) skills needed for managing type 2 diabetes (T2DM) in everyday life, HL in people with T2DM should be measured from a broader perspective than basic skills, such as proficiency in reading and writing. The HLS-Q12, based on the European Health Literacy Survey Questionnaire (HLS-EU-Q47), assesses four cognitive domains across three health domains. International studies on people with T2DM show inconsistent results regarding the association between HL and general health and the association between HL and glycaemic control. Moreover, knowledge is needed related to the link between HL and empowerment for those with T2DM. The aims of this study were to examine the association between i) HL and general health and diabetes outcomes, ii) HL and health behaviours and iii) HL and empowerment in people with T2DM. METHODS: During March and April 2015, 388 adults with T2DM responded to a paper-and-pencil self-administered questionnaire. A sequential multiple regression analysis was applied to explore the association between HL, as measured by the HLS-Q12, and health conditions, HbA1c, health behaviours and empowerment. RESULTS: For people with T2DM, higher levels of HL were associated with higher levels of education, better overall health conditions and higher self-perceived empowerment. No empirical evidence strengthening either the link between HL and glycaemic control or the link between HL and health behaviours was found. CONCLUSIONS: The independent variables education level, overall health condition and empowerment explained about one-third of the total observed variance in HL.

Development and Validation of the Ambulance Nurse Competence Scale.

INTRODUCTION: In recent decades, major competency shifts have taken place in prehospital care in Sweden because staffing ambulances with registered/specialized nurses has become a priority. The aim of this study was to develop and validate a new instrument to measure the self-reported professional competency of specialist ambulance nursing students and registered/specialist nurses working in prehospital care. METHODS: This study used a quantitative cross-sectional design to evaluate psychometric properties of a new instrument. The sample included 179 registered/specialist ambulance nurses and 34 specialist ambulance nursing students. RESULTS: The analyses resulted in the Ambulance Nurse Competence (ANC) scale, consisting of 43 items and covering 8 factors: Nursing Care (n = 8), Value-based Nursing Care (n = 5), Medical Technical Care (n = 5), Care Environment's Community (n = 4), Care Environment's Serious Events (n = 8), Leadership Management (n = 3), Supervision and Professional Conduct (n = 4), and Research and Development (n = 6). All factors except Leadership Management achieved a Cronbach's alpha value greater than 0.71, explaining 59.62% of the total variance. DISCUSSION: The ANC scale was systematically tested and showed satisfactory psychometrical properties. The ANC scale can be used in the education programs of future registered/specialist ambulance nurses as a tool for self-reflected learning and could also be of potential use in identifying competence gaps in registered/specialist ambulance nurses, which could direct the design of introductory programs. The scale could also be used as an outcome measure together with other instruments.

Workplace bullying among healthcare professionals in Sweden: a descriptive study.

Workplace bullying is a taboo event which occurs worldwide, although the prevalence varies significantly between and within countries. Nurses have been regarded an occupational risk group for bullying at the work place. Bullying in health and social care contexts is sometimes reported as frequent and, other times, as not occurring, which sparked our interest in mapping the occurrence of bullying in the health and social care system in Sweden. Thus, the purpose of the study was to examine the prevalence of bullying, and to discuss cultural traditions and environmental factors that affect bullying in workplaces. The sample (n = 2810) consisted of employees at inpatient wards at four hospitals, and employees at municipal eldercare wards in Sweden. A questionnaire including NAQ-22 R was distributed and subsequently analysed with descriptive statistics using SPSS. The youngest group of respondents scored higher than the older groups. Using contrasting estimates of bullying, the prevalence varied between 4.1 and 18.5%, with the lowest prevalence in regards to self-reported exposure. According to the cut-off scores, NAQ-22 R, 8.6% of the respondents were occasionally exposed to bullying while 2.3% were considered to be victims of severe bullying. Work-related negative acts were more common than personal negative acts. The variations in prevalence of bullying as a result of contrasting estimation strategies are discussed from perspective of the 'law of Jante', the 'tall poppy syndrome' and shame. Bullying deteriorates the working conditions which may have an impact on quality of patient care.

Managing bullying in Swedish workplace settings: A concealed and only partially acknowledged problem.

AIM: The purpose of this article was to explore workplace routines and strategies for preventing and managing bullying in the context of health and elderly care. BACKGROUND: Bullying is a serious problem in workplaces with consequences for the individual, the organisation and the quality of care. METHOD: Open-ended interviews were conducted with 12 participants, including managers and specialists within one hospital and three municipalities. The interviews were analysed with qualitative content analysis. RESULTS: Bullying was often concealed, due to avoidance, unclear definition and lack of direct strategies against bullying. No preventative work focusing on bullying existed. Psychosocial issues were not prioritized at workplace meetings. The supervisor had the formal responsibility to identify, manage and solve the bullying problem. The most common decision to solve the problem was to split the group. CONCLUSIONS: The findings showed that bullying was a concealed problem and was first acknowledged when the problem was acute. IMPLICATIONS FOR NURSING MANAGEMENT: Crucial strategies to prevent and combat bullying consist of acknowledgement of the problem, transformational leadership, prioritization of psycho-social issues, support of a humanistic value system and work through bullying problems to achieve long-term changes.

Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: latent trait analyses applying Rasch modelling and confirmatory factor analysis.

BACKGROUND: The European Health Literacy Survey Questionnaire (HLS-EU-Q47) is widely used in assessing health literacy (HL). There has been some controversy whether the comprehensive HLS-EU-Q47 data, reflecting a conceptual model of four cognitive domains across three health domains (i.e. 12 subscales), fit unidimensional Rasch models. Still, the HLS-EU-Q47 raw score is commonly interpreted as a sufficient statistic. Combining Rasch modelling and confirmatory factor analysis, we reduced the 47 item scale to a parsimonious 12 item scale that meets the assumptions and requirements of objective measurement while offering a clinically feasible HL screening tool. This paper aims at (1) evaluating the psychometric properties of the HLS-EU-Q47 and associated short versions in a large Norwegian sample, and (2) establishing a short version (HLS-Q12) with sufficient psychometric properties. METHODS: Using computer-assisted telephone interviews during November 2014, data were collected from 900 randomly sampled individuals aged 16 and over. The data were analysed using the partial credit parameterization of the unidimensional polytomous Rasch model (PRM) and the 'between-item' multidimensional PRM, and by using one-factorial and multi-factorial confirmatory factor analysis (CFA) with categorical variables. RESULTS: Using likelihood-ratio tests to compare data-model fit for nested models, we found that the observed HLS-EU-Q47 data were more likely under a 12-dimensional Rasch model than under a three- or a one-dimensional Rasch model. Several of the 12 theoretically defined subscales suffered from low reliability owing to few items. Excluding poorly discriminating items, items displaying differential item functioning and redundant items violating the assumption of local independency, a parsimonious 12-item HLS-Q12 scale is suggested. The HLS-Q12 displayed acceptable fit to the unidimensional Rasch model and achieved acceptable goodness-of-fit indexes using CFA. CONCLUSIONS: Unlike the HLS-EU-Q47 data, the parsimonious 12-item version (HLS-Q12) meets the assumptions and the requirements of objective measurement while offering clinically feasible screening without applying advanced psychometric methods on site. To avoid invalid measures of HL using the HLS-EU-Q47, we suggest using the HLS-Q12. Valid measures are particularly important in studies aiming to explain the variance in the latent trait HL, and explore the relation between HL and health outcomes with the purpose of informing policy makers.

Validating the European Health Literacy Survey Questionnaire in people with type 2 diabetes: Latent trait analyses applying multidimensional Rasch modelling and confirmatory factor analysis.

AIM: To validate the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in people with type 2 diabetes mellitus. BACKGROUND: The HLS-EU-Q47 latent variable is outlined in a framework with four cognitive domains integrated in three health domains, implying 12 theoretically defined subscales. Valid and reliable health literacy measurers are crucial to effectively adapt health communication and education to individuals and groups of patients. DESIGN: Cross-sectional study applying confirmatory latent trait analyses. METHODS: Using a paper-and-pencil self-administered approach, 388 adults responded in March 2015. The data were analysed using the Rasch methodology and confirmatory factor analysis. RESULTS: Response violation (response dependency) and trait violation (multidimensionality) of local independence were identified. Fitting the "multidimensional random coefficients multinomial logit" model, 1-, 3- and 12-dimensional Rasch models were applied and compared. Poor model fit and differential item functioning were present in some items, and several subscales suffered from poor targeting and low reliability. Despite multidimensional data, we did not observe any unordered response categories. CONCLUSION: Interpreting the domains as distinct but related latent dimensions, the data fit a 12-dimensional Rasch model and a 12-factor confirmatory factor model best. Therefore, the analyses did not support the estimation of one overall "health literacy score." To support the plausibility of claims based on the HLS-EU score(s), we suggest: removing the health care aspect to reduce the magnitude of multidimensionality; rejecting redundant items to avoid response dependency; adding "harder" items and applying a six-point rating scale to improve subscale targeting and reliability; and revising items to improve model fit and avoid bias owing to person factors.

Preventive Strategies and Processes to Counteract Bullying in Health Care Settings: Focus Group Discussions.

The aim of the present study was to explore preventive strategies and processes to counteract bullying in workplaces. Data were collected by individual interviews and focus group discussions at one hospital and two nursing home wards for elderly, a total of 29 participants. In the analysis of the interviews we were inspired by constructivist grounded theory. Persistent work with a humanistic value system by supervisor and coworkers, raising awareness about the bullying problem, strong group collaboration, and conflict management, along with an open atmosphere at the workplace, appears to be imperative for accomplishing a policy of zero tolerance for bullying.

Public health nurses' perception of their roles in relation to psychotropic drug use by adolescents: a phenomenographic study.

AIMS AND OBJECTIVES: The purpose of the paper was to describe the perceptions of public health nurses' roles in relation to psychotropic drug use by adolescents. BACKGROUND: Mental health problems among adolescents are documented with studies indicating an increased use of psychotropic drugs. In Norway, care for such adolescents may fall naturally into the remit of public health nurses. DESIGN: A phenomenographic approach was used to analyse the data. METHOD: A qualitative interview study was made of 20 Norwegian public health nurses, strategically chosen using phenomenographic methodology. RESULTS: The public health nurses described three categories: discovering public health nurses who become aware of psychotropic drug use in the health dialogue with adolescents and choose to either act or not act in relation to psychotropic drug use. Those public health nurses who take action are cooperating public health nurses, who cooperate with adolescents, their families, schools and others. If cooperation has been established, supporting public health nurses teach and support the adolescent in relation to psychotropic drug use. CONCLUSION: The public health nurses who do not act can hinder or delay further treatment. Public health nurses need to acquire knowledge about psychotropic drugs, to fulfil their role in nursing mental health problems among adolescents and the increasing use of psychotropic drugs. RELEVANCE TO CLINICAL PRACTICE: The results demonstrated that public health nurses, working in health centres and schools, have the responsibility and the opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others, e.g. parents and siblings. Intervention studies are needed with regard to health promotion programmes aimed at fortifying young people's mental health.

Implementation of patient-focused care: before-after effects.

PURPOSE: The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate. DESIGN/METHODOLOGY/APPROACH: The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment. FINDINGS: No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. RESEARCH LIMITATIONS/IMPLICATIONS: Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. PRACTICAL IMPLICATIONS: An important requirement for both practice and research is to tailor PFC to various health and social care contexts. ORIGINALITY/VALUE: The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

Caregivers in older peoples' care: perception of quality of care, working conditions, competence and personal health.

The aim was to describe and compare nursing assistants', enrolled nurses' and registered nurses' perceptions of quality of care, working conditions, competence and personal health in older peoples' care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient's Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers' different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours.

Research utilisation and critical thinking among newly graduated nurses: predictors for research use. A quantitative cross-sectional study.

AIM: The aim was to describe research utilisation among newly graduated nurses and to explore critical thinking dispositions and other individual and contextual factors as possible predictors for research use. BACKGROUND: Nurses are expected to be research users, and variations in research utilisation are explained by individual and contextual factors. To our knowledge, critical thinking dispositions have not earlier been explored as predictors for research use. DESIGN: A cross-sectional design was chosen. METHODS: Data collection was carried out from October 2006 to April 2007 using the Research Utilization Questionnaire (RUQ) and the California Critical Thinking Disposition Inventory (CCTDI). The response rate was 33% (n =617). Pearson's chi-square test and regression analyses were used for statistical calculations. RESULTS: The respondents reported a positive attitude towards research, but only 24% (n = 148) were defined as research users. A significantly higher proportion of research users reported high critical thinking scores. Critical thinking explained 20% of the variance in attitude towards research and 11% of the variance in research use. Availability and support to implement research findings was the second strongest predictor for research use. CONCLUSIONS: Critical thinking, a significant predictor for attitude towards research and for the use of research, should be recognised and strengthened in nursing education and clinical practice. Contextual factors seem to be important for newly graduated nurses' use of research. RELEVANCE TO CLINICAL PRACTICE: Nurse leaders play an important role in nurturing newly graduated nurses' critical thinking and assisting them in transferring their positive attitude towards research into research use. Nurse educators play a significant role in supporting, challenging and supervising nursing students to be critical thinkers and strong believers in research utilisation.

Sense of coherence and other predictors of pain and health following laparoscopic cholecystectomy.

INTRODUCTION: Pain is the most common symptom following laparoscopic cholecystectomy (LC) and might delay discharge from hospital after day surgery. A patient's ability to manage stressful situations can be assessed by the sense of coherence (SOC) and has been proposed to predict health. The aim of this study was to investigate predictors of average pain the first postoperative week after LC, and predictors of changes in perceived health, with special reference to individual coping resources measured by the Sense of Coherence Scale. Furthermore, a test-re-test was performed on SOC to evaluate the stability in the context of LC surgery. METHOD: Seventy-three patients completed questionnaires about SOC, health status, pain, anxiety, symptom occurrence and symptom distress preoperatively, postoperative day 1-7 and after 1 and 6 months following LC. RESULTS: By multiple regression, 23% of the variability in pain intensity could be explained by the variables age, SOC and education. Age was the strongest predictor. Further, 19% of the change in health between day 7 and 1 month could be explained by the two variables symptom distress the first postoperative day and SOC. The test-re-test of SOC had a correlation coefficient (r) of 0.55. Forty-six patients (63%) remained within ±10% of their preoperative SOC score at 6 months, 11 patients (15%) decreased and 16 patients (22%) increased their SOC values. CONCLUSION: SOC was found to be a significant but weak predictor of pain intensity the first week after LC. Furthermore, patients scoring low SOC values experienced a delay in their health improvement. SOC was more unstable over time than previously suggested. Further, interventional studies are needed to clarify if SOC might be a clinically useful measure to identify vulnerable patients undergoing LC surgery.

Critical thinking dispositions among newly graduated nurses.

AIM: The aim of the study was to describe critical thinking dispositions among newly graduated nurses in Norway, and to study whether background data had any impact on critical thinking dispositions. BACKGROUND: Competence in critical thinking is one of the expectations of nursing education. Critical thinkers are described as well-informed, inquisitive, open-minded and orderly in complex matters. Critical thinking competence has thus been designated as an outcome for judging the quality of nursing education programmes and for the development of clinical judgement. The ability to think critically is also described as reducing the research-practice gap and fostering evidence-based nursing. METHODS: A cross-sectional descriptive study was performed. The data were collected between October 2006 and April 2007 using the California Critical Thinking Disposition Inventory. The response rate was 33% (n = 618). Pearson's chi-square tests were used to analyse the data. RESULTS: Nearly 80% of the respondents reported a positive disposition towards critical thinking. The highest mean score was on the Inquisitiveness subscale and the lowest on the Truth-seeking subscale. A statistically significant higher proportion of nurses with high critical thinking scores were found among those older than 30 years, those with university education prior to nursing education, and those working in community health care. CONCLUSION: Nurse leaders and nurse teachers should encourage and nurture critical thinking among newly graduated nurses and nursing students. The low Truth-seeking scores found may be a result of traditional teaching strategies in nursing education and might indicate a need for more student-active learning models.

Registered nurses' use of research findings in the care of older people.

AIMS: To describe registered nurses' reported use of research in the care of older people and to examine associations between research use and factors related to the elements: the communication channels, the adopter and the social system. BACKGROUND: Research use among registered nurses working in hospital settings has been reported in many studies. Few studies, however, have explored the use of research among registered nurses working in the care of older people. DESIGN: A cross-sectional survey. METHODS: In eight municipalities, all registered nurses (n = 210) working in older people care were invited to participate (response rate 67%). The Research Utilisation Questionnaire was adopted. Questions concerning the work organisation and research-related resources were sent to the Community Chief Nurse at each municipality. Descriptive statistics and logistic regression were applied. RESULTS: The registered nurses reported a relatively low use of research findings in daily practice, despite reporting a positive attitude to research. The registered nurses reported lack of access to research reports at the work place and that they had little support from unit managers and colleagues. Registered nurses working in municipalities with access to research-related resources reported more use of research than registered nurses without resources. The factors 'Access to research findings at work place', 'Positive attitudes to research' and 'Nursing programme at university level' were significantly associated with research use. CONCLUSIONS: There is a great potential to increase registered nurses' use of research findings in the care of older people. Factors which were linked to the communication channels and the adopter were associated with research use. RELEVANCE TO CLINICAL PRACTICE: Strategies to enhance research use should focus on access to and adequate training in using information sources, increased knowledge on research methodology and nursing science and a supportive organisation.

Cooperation in the care for patients with home enteral tube feeding throughout the care trajectory: nurses' perspectives.

AIM: The aim of this study was to explore how the planning, daily care and follow-up procedures work in the care trajectory for patients treated with home enteral tube feeding, from the perspective of hospital and community care nurses. BACKGROUND: Discharge planning for patients in need of home enteral tube feeding is a complex process. Several studies have described routines for discharge and care of patients with home enteral tube feeding in the care trajectory, but few studies have investigated how this really works. METHOD: A qualitative method with a phenomenographic approach was used. Interviews, with open-ended questions, with ten nurses from both hospitals and communities were performed. FINDINGS: One main category, 'cooperation', emerged, which describes an hierarchical relationship to three description categories: 'nurses' knowledge', 'nurses' view of responsibility' and 'nurses' professional awareness and commitment'. Each of these contained two sub-categories showing a positive and a negative pole. CONCLUSIONS: Cooperation in the care of patients with home enteral tube feeding throughout the care trajectory was influenced by the nurses' knowledge about enteral tube feeding, the discharge-planning process, and whether their responsibility was clearly distributed. Whether nurses had a patient- or task-oriented attitude was also important. Inefficient cooperation was considered having negative effects on the quality of care regarding home enteral tube feeding. RELEVANCE TO CLINICAL PRACTICE: This study has stressed the need for improving cooperation and communication between nurses at hospitals and in communities, as well as for increasing nurses' level of knowledge, to make home enteral tube feeding work in a safe way. It also has illuminated the urgent need to clarify responsibility distribution at the workplace, which is a question for nurse managers. Discussions should be undertaken among nurses about guidelines for tube feeding care and discharge process, as this is the responsibility of all professional nurses.

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.

Validating the Functional, Communicative, and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis.

BACKGROUND AND PURPOSE: The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. METHODS: Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. RESULTS: Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. CONCLUSION: This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best.

Food hypersensitivity and quality of life.

PURPOSE OF REVIEW: The present article presents an accessible review of research results on food hypersensitivity and quality of life (QoL), including 15 original articles on the subject. RECENT FINDINGS: Research on food hypersensitivity and QoL covers children and their parents, adolescents and adults. Several domains of QoL are affected, such as family and social activities, emotional issues and family economy. Food-hypersensitive children are to a large extent limited in their autonomous social activities. Food-allergic adolescents have a higher number of weeks absent from school compared with a control group, and a relatively high percentage of food-allergic young adults do not participate in the labour market. Comorbidity has to be taken into consideration when assessing QoL in food-hypersensitive individuals. Research on gender differences in food hypersensitivity and QoL are scarce. SUMMARY: Although development in this research field has only just begun, it is obvious that food hypersensitivity has a significant impact on individuals' and families' QoL. An important advance is the disease-specific QoL measure instruments that have been created. There is still, however, a need for a more in-depth knowledge as a basis for further development of QoL instruments, and as a basis for societal interventions and family/individual support.

Evidence-based practice and determinants of research use in elderly care in Sweden.

RATIONALE AND OBJECTIVE: Evidence-based practice is a strategic ingredient in today's health care. Despite extensive efforts to produce and disseminate clinical guidelines, research uptake is still a difficult task. In Sweden, elderly care (EC) has shifted from hospital care to community-based care, and the major nursing-staff group in EC has no university education. These and other factors make implementation of evidence-based care particularly challenging in EC settings. The purpose of this study was to identify determinants of research utilization in EC. METHOD: Two questionnaires that cover research utilization and organizational climate were mailed to all staff (n = 132) working in seven EC units. The response rate was 67%. RESULTS: Of all respondents, 28% reported that they used research findings in daily practice (the RU group). Remaining respondents constituted the non-RU group. Significant differences existed between the RU group and the non-RU group as per six individual and six organizational factors. Using logistic regression models, four factors were significantly related to research utilization, namely: attitudes toward research (OR = 5.52, P = 0.004); seeking research that is related to clinical practice (OR = 5.56, P = 0.019); support from unit manager (OR = 4.03, P = 0.044) and access to research findings at work place (OR = 6.65, P = 0.005). CONCLUSIONS: Individual and organizational factors were associated with the use of research in EC. Despite distinguishing conditions in EC settings, identified factors reflect well-known determinants of research use that, as in many other health care contexts, should be considered in the endeavours of evidence-based practice.

Adolescents' experiences of being food-hypersensitive: a qualitative study.

BACKGROUND: Experiencing or being at risk of adverse reactions to certain food items is a common health issue, especially among children and adolescents. Research has shown that living with the risk of food reactions and always having to take measures to avoid certain food in one's diet has a negative impact on quality of life. The aim of this study was to illuminate adolescents' experiences of being food hypersensitive. METHODS: Three focus group interviews and six individual interviews were carried out with all together 17 adolescents, 14-18 years of age, who had exclusion diets at school due to food hypersensitivity. The interviews were taped and transcribed verbatim and a qualitative content analysis was carried out. RESULTS: Five categories with subcategories, and one pervading theme, emerged. The categories were: Perceiving oneself as being particular, Feeling constrained, Experiencing others' ignorance, Keeping control, and Feeling it's okay. A pervading theme was conceptualised as Striving to normalise the experience of being food-hypersensitive. The adolescents regarded themselves as competent and courageous, but also described how they avoided the extra attention it implied to ask for special food considerations taken into account. Their self-conceptions were probably essential for their management of and attitude toward the hypersensitivity condition. They felt deprived, and those at risk of severe food reactions experienced insecurity and fear. Feelings of being disregarded were expressed, as well as facing unreliability and a lack of understanding from others. The continual work of constant vigilance and decision-making was described as time-consuming and frustrating. However, the adolescents also experienced considerate and supportive surroundings and were at pains to tone down the negative experiences and consequences of being food-hypersensitive. CONCLUSION: Food avoidance by itself, and not only the somatic food reactions, brings about consequences with significant impacts on adolescents' lives. The findings from this study have implications for all of those who deal with adolescents who are food-hypersensitive, and not only health professionals. A deeper insight into adolescents' experiences gives an understanding which can improve the care-givers' efforts.