Using Fish as a Sentinel in Risk Management of Contaminated Sediments.

Sediments polluted by historical emissions from anthropogenic point sources are common in industrialized parts of the world and pose a potential threat to the function of aquatic ecosystems. Gradient studies using fish as a bioindicator are an option to assess the ecological impact of locally polluted areas. This study investigates the remaining effects of historical emissions on sediments outside ten Swedish pulp and paper mills using perch (Perca fluviatilis). The aim has been to obtain a general picture of the impact area of local deposits of cellulose fiber-rich sediments containing elevated levels of trace metals, e.g., Hg, and organochlorines, e.g., dioxins. In addition to analyzing contaminant levels in muscle and liver tissue, morphological measures in the fish that constitute biomarkers for health and reproductivity were measured. Another aim was to augment existing historical data sets to observe possible signs of environmental recovery. Overall, the results indicate only a minor elevation in contaminant levels and a minor impact on the fish health status in the polluted areas, which in several cases is an improvement from historical conditions. However, exceptions exist. Differences in the ecosystems' responses to pollution loads are primarily explained by abiotic factors such as water turnover rate, bottom dynamic conditions, and water chemistry. Weaknesses in the sampling methodology and processing of data were identified. After minor modifications, the applied survey strategy has the potential to be a management tool for decision-makers working on the remediation of contaminated areas.

Patients' Expressed Nursing Care Needs in a Forensic Psychiatric Setting.

ABSTRACT: The aim of this study was to describe the patients' nursing care needs in a forensic psychiatric setting in line with the NANDA-I classification. Ten patients sentenced to forensic psychiatric care were interviewed. Data were analyzed by means of directed content analysis with a deductive approach, where we used "served time" as a factor in the analysis, thus creating three categories: newly arrived patients with a length of stay of only a couple of years, patients with a length of stay of around 5 years, and patients with a length of stay of more than 5 years. Thirteen NANDA-I diagnoses were identified during the analyses, distributed on seven different domains. When distributing the given NANDA-I diagnoses according to the created categories, an explanatory pattern emerged, and three themes became apparent: denial, insight, and listlessness. Considering the differences in views, the patients' own recognition of what is a problem, a potential, or a risk could improve a "working relation" and, eventually, a recovery. NANDA-I nursing diagnoses may improve individualized and person-centered care as NANDA-I makes care continuously consistent over time.

Nursing Diagnoses Panorama in a Swedish Forensic Psychiatric Setting Using NANDA-International Taxonomy.

More than 1,000 Swedish hospital beds are occupied by patients in forensic psychiatric settings; their average length of hospitalization is 3-7 years. In this context, nursing diagnoses could be extremely useful to make nursing care structured, measurable, and internationally comparable. The study aimed to describe nursing diagnoses in a Swedish forensic psychiatric setting. METHODS: Data were collected from electronic patient records of 55 patients in a medium-secure forensic psychiatric setting in Sweden. Anonymized data were entered into a database where entries were transformed into figures. Descriptive statistics were used, and frequencies, means, and percentages were calculated. The variables employed were characteristics and related factors, according to NANDA-International (NANDA-I) and International Statistical Classification of Dieseases and Related Heatlh Problems, 10th Revision (ICD-10), diagnoses. RESULTS: The patients had between 1 and 13 NANDA-I diagnoses each. Forty-one of the 55 patients had psychosis as the primary ICD-10 code. The identified nursing diagnoses described the patients' status upon arrival in the forensic psychiatric setting. Of the 55 patients, entries in the patient records describing 300 signs and symptoms (i.e., characteristics and related factors) were found. From these signs and symptoms, 371 entries that fit NANDA-I diagnoses were identified, representing 20 different NANDA-I diagnoses. CONCLUSION: NANDA-I diagnoses individualize patient care, making care person centered. NANDA-I is used all over the world and has the potential to make nursing care structured, measurable, and internationally comparable.

'Wouldn't it be easier if you continued to be a guy?' - a qualitative interview study of transsexual persons' experiences of encounters with healthcare professionals.

AIMS AND OBJECTIVES: To describe transsexual persons' experiences of encounters with healthcare professionals during the sex reassignment process. BACKGROUND: Transsexual persons are individuals who use varying means to alter their natal sex via hormones and/or surgery. Transsexual persons may experience stigma, which increases the risk of psychological distress. Mistreatments by healthcare professionals are common. Qualitative studies addressing transsexual persons' experiences of healthcare are scarce. DESIGN: Qualitative descriptive design. METHODS: A Swedish non-clinical convenience sample was used, consisting of six persons who had been diagnosed as transsexual, gone through sex reassignment surgery or were at the time of the interview awaiting surgery. Semi-structured interviews were undertaken, and data were analysed using manifest qualitative content analysis. RESULTS: Three categories and 15 subcategories were identified. The encounters were perceived as good when healthcare professionals showed respect and preserved the transsexual person's integrity, acted in a professional manner and were responsive and built trust and confidence. However, the participants experienced that healthcare professionals varied in their level of knowledge, exploited their position of power, withheld information, expressed gender stereotypical attitudes and often used the wrong name. They felt vulnerable by having a condescending view of themselves, and they could not choose not to be transsexual. They felt dependent on healthcare professionals, and that the external demands were high. CONCLUSIONS: Transsexual persons are in a vulnerable position during the sex reassignment surgery process. The encounters in healthcare could be negatively affected if healthcare professionals show inadequate knowledge, exploit their position of power or express gender stereotypical attitudes. A good encounter is characterised by preserved integrity, respect, responsiveness and trust. RELEVANCE TO CLINICAL PRACTICE: Improved education on transgender issues in nursing and medical education is warranted. Healthcare professionals should be aware of how their attitudes and their level of knowledge affect the care given during the sex reassignment surgery process.

The importance of reciprocity for female caregivers in a super-aged society: a qualitative journalistic approach.

As Japan is facing a super-aged society, Japanese women find themselves on the front line as traditional family caregivers. Our aim was to describe the observations and thoughts of one Japanese woman's experience of living with her elderly parents in the suburbs of Tokyo. One open-ended interview was performed and analyzed using content analysis with a methodological departure in qualitative journalistic interviewing. The case was a single woman in her late 40s living with her aged parents. Reciprocity was identified as the glue holding the joy and burdens of the role of caregiving for elderly parents. Moreover, gender was identified as a motivator for reciprocity from a macro to a micro level in a super-aged society.

Hip fracture patients' cognitive state affects family members' experiences - a diary study of the hip fracture recovery.

BACKGROUND: Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members - spouses, daughters, sons, or even neighbours become informal carers. AIM: To explore how hip fracture patients' cognitive state affect family members' experiences during the recovery period. METHODS: Eleven diaries written by family members' of hip fracture patients were analysed by means of qualitative content analysis. FINDINGS: The analysis generated two main categories with four categories. The first main category was; 'Being a family member of a cognitively impaired patient' with the categories 'Dissatisfaction with lack of support' and 'Emotional distress due to the patient's suffering'. The second main category was 'Being a family member of a cognitively intact patient' with the categories 'Satisfaction with a relative's successful recovery' and 'Strain due to their caring responsibilities'. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients' suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members. CONCLUSIONS: The findings suggest the hip fracture patient's cognitive state is more decisive than the hip fracture itself for the family members' experiences.

Hip fractures and cognitive state: patient outcomes and proxies' perceptions of the rehabilitation period.

Background. Numerous studies are available on hip fracture and rehabilitation outcomes, some mention dementia but very few from a family/proxy perspective. Aim. To investigate whether cognitive state influences the hip fracture patients' rehabilitation outcomes as well as the proxies' perceptions of the 6-month rehabilitation period. Design. A survey with structured and unstructured questions. Statistics and content analysis. Methods. The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairment, 32 replied. Statistics and content analysis were used to analyse the data. Results. In the cognitively impaired group, physical function decreased (P = 0.0241) as well as locomotion (P = 0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P = 0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P = 0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists. Conclusions and relevance for clinical practice. Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.

Documenting the cognitive status of hip fracture patients using the Short Portable Mental Status Questionnaire.

AIMS AND OBJECTIVES: The aim of this study was to describe how nurses document their subjective assessment of the patients' cognitive status in the patients' records and to compare this documentation with an assessment made using a validated evaluation instrument in older patients with a hip fracture. BACKGROUND: There are indications that older people with a hip fracture and impaired cognitive ability do not receive optimal care and that they suffer from a disproportionately high number of complications. Preventing and rapidly detecting confusion is probably an effective strategy for improving care for these patients. To be able to prevent care-related complications and plan for future nursing and medical care, it is necessary to identify patients with impaired cognitive ability. DESIGN: Clinical trial including 362 patients. METHODS: The patients' cognitive function was assessed by a research nurse using a validated instrument, the Short Portable Mental Status Questionnaire, and an independent subjective assessment was made by a ward nurse. The agreement between these assessments was analysed. RESULTS: An assessment of cognitive function by the ward nurse was lacking in 12% of the patients. The assessment made by the nurses did not correspond to the level of orientation according to Short Portable Mental Status Questionnaire in 24% of the patients. In the vast of majority of these cases, the patients were documented as being cognitively alert although they were cognitively impaired according to the Short Portable Mental Status Questionnaire. Among the patients who were cognitively oriented according to the Short Portable Mental Status Questionnaire, the nurses' assessment identified 97% as oriented, but among the patients with impaired cognitive ability according to the Short Portable Mental Status Questionnaire, only 58% were identified as being cognitively impaired by the ward nurses. CONCLUSIONS: An assessment of cognitive function is still lacking in nursing records for a substantial number of older people with a hip fracture and cognitive dysfunction is frequently underdiagnosed in routine health care. RELEVANCE TO CLINICAL PRACTICE: Patient care could be improved if the patients' cognitive function was assessed regularly and objectively by means of a validated evaluation instrument.