Incontinence-Associated Dermatitis (IAD): Prevalence and Associated Factors in 4 Hospitals in Southeast Norway.

PURPOSE: The aim of this study was to investigate the prevalence and severity of incontinence-associated dermatitis (IAD) and associated factors in acute care settings in Southeast Norway. DESIGN: Descriptive, multisite epidemiologic survey. SUBJECTS AND SETTING: The study setting was 29 wards across 4 hospitals, in a hospital trust in the southeast of Norway. Data were collected from 340 patients (age ≥18 years). More than half (56.2%) were 70 years or older (median age category 70-79 years) and 53.3% were male. METHODS: Data collection was conducted in parallel with a pressure injury prevalence study undertaken in 2016. A modified Pressure Injury Prevalence Minimum Data Set, including documentation of fecal or urinary incontinence, use of indwelling fecal collection system or urinary catheter, and presence of IAD, was completed. RNs participating in the study were trained by the researchers on skin assessment and data extraction from the electronic medical record. Descriptive statistics were used for prevalence figures; the Kruskal-Wallis and χ tests were used to determine associated factors. RESULTS: Analysis revealed that 16.5% (56 out of 340) of the sample were incontinent. The prevalence of IAD in the total population was 7.6% (26 out of 340). The prevalence of IAD was 29% (16 out of 56) among patients with urinary or fecal incontinence. Of those identified with IAD, 5.2% (18 out of 340) had category 1 (red intact skin) and 2.4% (8 of 340) had category 2 (red skin with breakdown). Bivariate analysis revealed that fecal incontinence (P < .001), immobility (P < .01), and 70 years or older (P < .03) were associated with IAD. CONCLUSIONS: The overall prevalence (patients with and without incontinence) of IAD was lower than reported in prior studies; frequent use of indwelling urinary catheters and a relatively low prevalence of incontinence may explain this finding. Similar to prior studies, almost 1 in 3 patients who were incontinent suffered from IAD, showing a need for evidence-based guidelines to prevent IAD in hospitalized patients. Findings suggest that particular attention should be given to prevent IAD among patients with fecal incontinence patients, 70 years and older, and those with immobility.

Pressure Ulcer in Norway-A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care.

Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O'Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured.

Subjective sleep quality in relation to objective sleep estimates: comparison, gender differences and changes between the acute phase and the six-month follow-up after stroke.

AIMS: To describe sleep experiences after stroke using subjective and objective indicators and identify possible gender differences in sleep in the acute phase and at 6-month follow-up. BACKGROUND: Sleep disturbances after stoke are recognized, but poorly described. Gender differences in sleep exist in other populations, but have not been reported after stroke. DESIGN: A longitudinal cohort study. METHOD: Subjective sleep quality was measured with the Pittsburgh Sleep Quality Index and objective sleep was estimated with actigraphy in 100 patients in the acute phase and six months after stroke, from April 2007-March 2009. FINDINGS: Subjective sleep quality was better and objective wake percentage was lower at follow-up than in the acute phase after stroke. Actigraphy estimated low sleep efficiency and many awakenings at both time points. Subjective and objective measures were correlated at the 6-month follow-up, but not in the acute phase. Women's subjective sleep efficiency and total score on the Pittsburgh Sleep Quality Index were worse than men's in the acute phase, but actigraphy estimated that women slept more than men in the course of a day. Women's subjective sleep quality was better at follow-up than in the acute phase. Men reported worse subjective sleep quality, but better subjective sleep efficiency at follow-up than in the acute phase, and also had lower objective wake percentage at follow-up. CONCLUSIONS: Subjective sleep quality was poor and actigraphy indicated disturbed sleep-wake patterns in the acute phase and at 6-month follow-up. Gender differences existed in subjective and objective sleep in the acute phase, but not at follow-up.

Depressive symptoms in acute stroke: a cross-sectional study of their association with sociodemographics and clinical factors.

The aim of the study was to estimate the prevalence of post-stroke depression (PSD) in the acute phase following first-ever stroke, and to identify its sociodemographic and clinical correlates. Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patients' medical records. The sample consisted of 109 patients with first-ever stroke. Depressive symptoms after stroke were measured with Beck Depression Inventory II. Mild, moderate or severe depressive symptoms were reported by 27% of the participants. PSD was uniquely associated with post-stroke fatigue, sleep latency and sleep disturbance. Patients with PSD also reported slightly more bodily pain. Stroke type, stroke location, and the sociodemographic characteristics we examined were unrelated to PSD. Further research is needed to assess the role sleep changes, fatigue and bodily pain might have in relation to depression in the acute phase after stroke.

Stroke patients' functions in personal activities of daily living in relation to sleep and socio-demographic and clinical variables in the acute phase after first-time stroke and at six months of follow-up.

AIMS AND OBJECTIVES: To explore first-time stroke patients' degree of independence in activities of daily life in relation to sleep and other essential variables that might influence activities of daily life. BACKGROUND: Sleep has received little attention in rehabilitation of activities of daily life in stroke patients. DESIGN: This is a longitudinal survey and observational study design from the acute phase to six months poststroke. METHODS: First-time stroke patients (n = 90) were recruited from two hospitals in eastern Norway in 2007 and 2008. Data were collected by survey interview, medical records and wrist actigraphy in the first two weeks at the hospital and at six months of follow-up. Actigraph measures patient activity and estimates sleep during the day and night. RESULTS: Linear regression showed that high dependence in personal activities of daily living was directly related to low estimated sleep time at night and higher estimated sleep during the day in the acute phase, controlling for socio-demographic and clinical variables. Furthermore, high estimated numbers of awakenings in the acute phase were related to lower activities of daily life functioning at six months of follow-up after controlling for socio-demographic and clinical variables. Stronger pain and a lower physical functioning showed direct relationships with lower independency level of in activities of daily life both in the acute phase and after six months. CONCLUSIONS: Sleep patterns in the acute phase may influence the patients' activities of daily life functioning up to six months poststroke. Furthermore, pain in the acute phase may influence the level of activities of daily life functioning in stroke patients. RELEVANCE TO CLINICAL PRACTICE: Nurses should pay attention to stroke patients' sleep quality and pain in the rehabilitation period after a stroke. Facilitating good sleep conditions and screening for pain should be an integral part of the rehabilitation programme.

The Course of Fatigue during the First 18 Months after First-Ever Stroke: A Longitudinal Study.

Background. Little is known about the course of poststroke fatigue. Objectives. To describe the course of poststroke fatigue in relation to the patient's level of physical functioning, depressive symptoms, and self-reported history of prestroke fatigue. Methods. A longitudinal study using structured face-to-face interviews, questionnaires, and patients' medical records. Data were collected from 95 patients in Norway with first-ever stroke. Fatigue was measured with the Fatigue Severity Scale 7 item version and assessed for change between the acute phase, six, 12, and 18 months after stroke using 2-way ANOVA repeated-measures analyses. Results. The patients' level of fatigue did not change over time. However, those who reported prestroke fatigue showed a relatively high level of fatigue over time in the poststroke period, while patients with no history of pre-stroke fatigue showed a stable course of relatively low fatigue over time. Conclusion. Studies on poststroke fatigue should control for the patient's pre-stroke fatigue level.

Sleep-Wake Patterns during the Acute Phase after First-Ever Stroke.

This study describes the pattern of day and night sleep and explores relationships between these patterns and sociodemographic and clinical factors as well as sleep environmental context and the patient's subjective sleep quality. Data from 110 patients with first-ever stroke was collected by structured interview surveys, medical record, and objective estimated sleep data from wrist actigraphy. The variability in estimated sleep is large. Half the patients slept either <6 hours or >8 hours per night, and 78% had more than nine awakenings per night. Men slept less than women, and patients sleeping at home had fewer awakenings than those who slept in hospital. It was estimated sleep during daytime in all, except 4, patients. Longer stay in hospital was related to more daytime sleep, and the subjective sleep quality correlated with estimated sleep time, wake time, and wake percentage.

Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke.

PURPOSE: The aim of this study was to describe prevalence of fatigue and its relationship with demographic and clinical variables during the first 2 weeks (acute phase) following a stroke. METHOD: Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patient's medical records. The sample consists of 115 patients with first-ever stroke admitted to two hospitals in Norway in 2007 and 2008. Post-stroke fatigue was measured with the Fatigue Severity Scale (FSS). The FSS measure was applied in the analysis as a continuous variable, and also used to categorise patients into three groups of fatigue intensity: no fatigue (mean FSS-score <4), moderate fatigue (mean FSS-score = 4-4.9) and severe fatigue (mean FSS-score ≥5). Patients who reported fatigue lasting longer than 3 months before the stroke were defined as having prestroke fatigue. RESULTS: Pre-stroke fatigue was reported by 34 patients (30%). After stroke, 24% had severe fatigue, and fatigue was more common for women (57%). Controlling for sex and prestroke fatigue, the multivariate analysis showed that prestroke fatigue, lower physical function and depressive symptoms were related to post-stroke fatigue. CONCLUSION: Pre-stroke fatigue and fatigue during the acute phase needs to be assessed in relation to physical functioning and depression during recovery and the rehabilitation process.

Poststroke fatigue--a review.

Although fatigue is a common complaint after stroke, relatively little is known about how poststroke fatigue is experienced and what its related factors are. An in-depth understanding is necessary to develop effective and patient-centered poststroke rehabilitation programs. This review was undertaken to provide a comprehensive synthesis of knowledge from the literature concerning the description, definition, and measurement of fatigue and its relationship to sociodemographic and clinical factors. A search in PubMed, CINAHL, EMBASE, and PsychInfo was performed using "stroke" or "cerebrovascular accident" as medical subject headings in combination with "fatigue" as a key word. Descriptions of fatigue revealed multiple dimensions of the phenomenon. Although no specific theoretical definition of fatigue as a poststroke condition was found, a case definition has recently been published to be used as a tool to determine the presence of fatigue in poststroke patients. Poststroke fatigue is most frequently measured by using the general fatigue scales such as the Fatigue Severity Scale and a Fatigue Visual Analogue Scale, as there is no scale developed to measure poststroke fatigue specifically. Age, sex, living conditions, and personality were associated with poststroke fatigue, albeit with some conflicting findings. Conflicting results also were found in the relationships between fatigue and stroke-related characteristics such as stroke location/type, the number of strokes, and neurological deficits. There is an indication that prestroke and poststroke fatigue are related. Possible antecedent components identified are personal factors, biomarkers, stroke characteristics, prestroke fatigue, and comorbidity. As knowledge regarding poststroke fatigue remains limited, there is a need to continue empirical research with various theoretical orientations.

Stages of Change--continuous measure (URICA-E2): psychometrics of a Norwegian version.

AIM: This paper is a report of research to translate the English version of the Stages of Change continuous measure questionnaire (URICA-E2) into Norwegian and to test the validity of the questionnaire and its usefulness in predicting behavioural change. BACKGROUND: While the psychometric properties of the Stages of Change categorical measure have been tested extensively, evaluation of the psychometric properties of the continuous questionnaire has not been described elsewhere in the literature. METHOD: Cross-sectional data were collected with a convenience sample of 198 undergraduate nursing students in 2005 and 2006. The English version of URICA-E2 was translated into Norwegian according to standardized procedures. FINDINGS: Principal components analysis clearly confirmed five of the dimensions of readiness to change (Precontemplation Non-Believers, Precontemplation Believers, Contemplation, Preparation and Maintenance), while the sixth dimension, Action, showed the lowest Eigenvalue (0.93). Findings from the cluster analysis indicate distinct profiles among the respondents in terms of readiness to change their exercise behaviour. CONCLUSION: The URICA-E2 was for the most part replicated from Reed's original work. The result of the cluster analysis of the items associated with the factor 'Action' suggests that these do not adequately measure the factor.