Quality of life of older people in nursing homes in China-evaluation and application of the Chinese version of the life satisfaction questionnaire.

BACKGROUND: Chinese and global populations are aging, and more older people are living in nursing homes in China. However, there is a lack of research measuring nursing home residents' quality of life (QOL), and especially associations with nursing home types (publicly versus privately run). Therefore, this study aimed to determine the construct validity and internal consistency of the Chinese version of the life satisfaction questionnaire (LSQ-Chinese) and determine the associations between nursing home types (publicly versus privately run), residents' sociodemographic characteristics, and their QOL. METHODS: A cross-sectional survey measuring QOL among older people living in nursing homes was conducted (n = 419). Confirmatory factor analysis and Cronbach's alpha were used to assess the construct validity and reliability of the LSQ-Chinese. In addition, multivariate regression analysis was used to examine these associations. RESULTS: Confirmatory factor analysis indicated acceptable goodness-of-fit statistics for the seven-factor LSQ solution. All factors and the total scale had good internal consistency, with Cronbach's alpha values > 0.70. The two factors with the highest QOL scores (higher scores indicate a more desirable state) were "physical symptoms" and "socioeconomic situation," and those with the lowest QOL scores were "quality of close-friend relationships" and "quality of daily activities fun". Residents living in privately run nursing homes had higher LSQ scores overall and for all factors except "physical symptoms" and "sickness impact" compared with publicly run nursing homes. Multivariate analyses indicated that marital status, number of chronic diseases, education level, main source of income, and nursing home type significantly contributed to the variance in the total LSQ scores. The associated sociodemographic variables differed between the factors, and the variable publicly versus privately run was significant for five of the seven factors. CONCLUSIONS: The LSQ is a suitable instrument for measuring the QOL of Chinese nursing home residents. The total LSQ score was higher among residents in privately run nursing homes than in publicly run ones. According to residents' needs, staff should work for person-centered activities, and facilitate residents' social interactions with friends, as both these aspects were scored relatively low.

A survey of nursing teachers' awareness of discrimination and inequity in telephone nursing care.

BACKGROUND: Nursing care should be respectful of and unrestricted by patients' age, ethnicity, gender, dis/abilities or social status, and such values should be taught to nursing students. Nursing teachers are crucial as role models, and their values are essential. In telephone nursing, only age, sex and ethnicity are known to the registered nurses, which can be challenging. The aim of this study was to explore awareness of discrimination and inequity in telephone nursing among nursing teachers. METHODS: A study specific survey was filled in by 135 nursing teachers from three universities in Sweden. The survey included short descriptions of 12 fictive persons who differed in age, ethnicity and sex and with questions about their estimated life situation. The teachers' estimations of life situation were ranked from lowest probability to highest probability. A 'good life index' was constructed and calculated for each fictive person. It included quality of life, power over one's own life and experience of discrimination. RESULTS: The results indicate that the nursing teachers were aware of how power and age, ethnicity and sex are related; that is, they were aware of discrimination and inequity in healthcare. The persons assessed to be most likely to lead a good life were males of Swedish origin, followed by females of Swedish origin. Persons with non-European origin were estimated to have the highest probability of experiencing discrimination. CONCLUSIONS: The nursing teachers were aware of discrimination and inequity in healthcare. They were able to estimate a fictive person's life situation based on the limited knowledge of age, ethnicity and sex. This is important, as their values are pivotal in theoretical and practical nursing education.

Self-reported competence in female and male nursing students in the light of theories of hegemonic masculinity and femininity.

BACKGROUND: In most parts of the world, nursing historically has been considered an occupation for women. Gender stereotypes are associated with the nursing profession. AIM: The aim was to describe and compare the self-reported competence in female and male nursing students. The students were also compared according to their different background college educations. The theoretical framework of hegemonic masculinity and femininity was used. DESIGN: A cross-sectional design with a questionnaire was used at two points in time, 2012 and 2017. METHODS: Nursing students completed a questionnaire on graduation from a 3-year university nursing program from 12 universities/university colleges in Sweden. In total, 1810 students were participating, 1577 female and 227 male students. The Nurse Professional Competence scale was used for data collection. RESULTS: There were statistically significant differences in the self-reported competence between female and male students (t tests and ANOVAs). These differences are in agreement with the patterns of hegemonic masculinity and femininity. Female students estimated their competence in giving value-based nursing care as higher than males. Male students estimated their competence in development and leadership higher than females. CONCLUSION: The pattern of hegemonic masculinity and femininity could be identified. This indicates a difference in power between female and male students. IMPACT: The study addresses the self-reported competence of female and male nursing students. The results indicated that male students possibly looked on themselves as superior to the female students. In order to change the image of nursing as a woman´s work, the self-images should be discussed in nursing education as well as in college education. Women interested in development, research, and leadership and men interested in nursing care and administration must feel that nursing is a suitable profession for them. The stereotypical image of nursing as a women's work is a barrier to nurses' professional development.

From denial to awareness: a conceptual model for obtaining equity in healthcare.

BACKGROUND: Although Swedish legislation prescribes equity in healthcare, studies have reported inequalities, both in face-to-face encounters and in telephone nursing. Research has suggested that telephone nursing has the capability to increase equity in healthcare, as it is open to all and not limited by long distances. However, this requires an increased awareness of equity in healthcare among telephone nurses. The aim of this study was to explore and describe perceptions of equity in healthcare among Swedish telephone nurses who had participated in an educational intervention on equity in health, including which of the power constructs gender, ethnicity and age they commented upon most frequently. Further, the aim was to develop a conceptual model for obtaining equity in healthcare, based on the results of the empirical investigation. METHOD: A qualitative method was used. Free text comments from questionnaires filled out by 133 telephone nurses before and after an educational intervention on equity in health, as well as individual interviews with five participants, were analyzed qualitatively. The number of comments related to inequity based on gender, ethnicity or age in the free text comments was counted descriptively. RESULTS: Gender was the factor commented upon the least and ethnicity the most. Four concepts were found through the qualitative analysis: Denial, Defense, Openness, and Awareness. Some informants denied inequity in healthcare in general, and in telephone nursing in particular. Others acknowledged it, but argued that they had workplace routines that protected against it. There were also examples of an openness to the fact that inequity existed and a willingness to learn and prevent it, as well as an already high awareness of inequity in healthcare. CONCLUSION: A conceptual model was developed in which the four concepts were divided into two qualitatively different blocks, with Denial and Defense on one side of a continuum and Openness and Awareness on the other. In order to reach equity in healthcare, action is also needed, and that concept was therefore added to the model. The result can be used as a starting point when developing educational interventions for healthcare personnel.

Development of the PHASE-Proxy scale for rating drug-related signs and symptoms in severe cognitive impairment.

OBJECTIVES: The need for assessment of possible drug-related signs and symptoms in older people with severe cognitive impairment has increased. In 2009, the PHASE-20 rating scale for identifying symptoms possibly related to medication was the first such scale to be found valid and reliable for use with elderly people. In this project, the aim was to develop and examine the psychometric properties and clinical utility of PHASE-Proxy, a similar scale for proxy use in assessing elderly people with cognitive impairment. METHODS: Three expert groups revised PHASE-20 into a preliminary proxy version, which was then tested for inter-rater reliability, internal consistency, and content validity. Its clinical usefulness was investigated by pharmacist-led medication reviews. Group interviews and a study-specific questionnaire with nursing home staff were used to investigate the feasibility of use. RESULTS: The PHASE-Proxy scale had satisfactory levels of inter-rater reliability (Spearman's rank correlation coefficient; rs = 0.8), and acceptable internal consistency (Cronbach's alpha coefficient; α = 0.73). The factor analysis resulted in a logical solution with seven factors, grouped into two dimensions: signs of emotional distress and signs of physical discomfort. The medication reviews, interviews, and questionnaires also found the proxy scale to be clinically useful, and feasible to use. CONCLUSION: The PHASE-Proxy scale appears to be a valid instrument that enables proxies to reliably assess nursing home residents who cannot participate in the assessment, to identify possible drug-related signs and symptoms. It also appears to be clinically useful and feasible for use in this population.

Impact of telephone nursing education program for equity in healthcare.

BACKGROUND: The Swedish Healthcare Act prescribes that healthcare should be provided according to needs and with respect for each person's human dignity. The goal is equity in health for the whole population. In spite of this, studies have revealed that Swedish healthcare is not always provided equally. This has also been observed in telephone nursing. Therefore, the aim of the present study was to investigate if and how an educational intervention can improve awareness of equity in healthcare among telephone nurses. METHODS: The study had a quasi-experimental design, with one intervention group and one control group. A base-line measurement was performed before an educational intervention and a follow-up measurement was made afterwards in both groups, using a study specific questionnaire in which fictive persons of different age, gender and ethnicity were assessed concerning, e.g., power over one's own life, quality of life and experience of discrimination. The educational intervention consisted of a web-based lecture, literature and a seminar, covering aspects of inequality in healthcare related to gender, age and ethnicity, and gender and intersectionality theories as explaining models for these conditions. RESULTS: The results showed few significant differences before and after the intervention in the intervention group. Also in the control group few significant differences were found in the second measurement, although no intervention was performed in that group. The reason might be that the instrument used was not sensitive enough to pick up an expected raised awareness of equity in healthcare, or that solely the act of filling out the questionnaire can create a sort of intervention effect. Fictive persons born in Sweden and of young age were assessed to have a higher Good life-index than the fictive persons born outside Europe and of higher age in all assessments. CONCLUSION: The results are an imperative that equity in healthcare still needs to be educated and discussed in different healthcare settings. The intervention and questionnaire were designed to fit telephone nurses, but could easily be adjusted to suit other professional groups, who need to increase their awareness of equity in healthcare.

To Receive or Not to Receive Analgesics in the Emergency Department: The Importance of the Pain Intensity Assessment and Initial Nursing Assessment.

Patients seeking emergency care for abdominal pain still experience poor pain management. Pain intensity is not always seen as a mandatory parameter in the initial nurse assessment. Despite the development of nurse-initiated analgesic protocols, many patients do not receive analgesics in the emergency department. The aim of this study was to describe initial nursing assessment related to pain management and to identify predictors for receiving or not receiving analgesics in the emergency department. The sample consists of 100 patients from an intervention group in a previously undertaken Swedish intervention study. The main findings were that the registered nurses assessed 62 patients as being in need of analgesics, and that 52 of these obtained analgesics. The majority of the patients assessed as not being in need of analgesics did not receive analgesics because they did not want medication. Median value for pain intensity at initial assessment was 6 on the numerical rating scale. The results for the logistic regression (n = 80) showed significant differences between receiving analgesics/not receiving analgesics and the predictor pain intensity (measured at initial nurse assessment). Nurses in emergency departments play a crucial role, in that their initial assessment is of specific importance for the patient's further care and whether the patient may or may not receive analgesics. However, more attention has to be paid to patients' experiences and their expectations regarding the pain management in the emergency department. These complex questions have to be studied further in a more systematic way.

Goals of telephone nursing work--the managers' perspectives: a qualitative study on Swedish Healthcare Direct.

BACKGROUND: Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD. METHODS: The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis. RESULTS: The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: 'create feelings of trust', 'achieve patient safety', 'assess, refer and give advice', and 'teach the caller'. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given. CONCLUSIONS: The interviewed managers mainly echoed the organisational goals of TN work. The managers' expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.

Communication difficulties and the use of communication strategies: from the perspective of individuals with aphasia.

BACKGROUND: To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of communication strategies. AIMS: To explore how people with aphasia experience having conversations, how they handle communication difficulties, and how they perceive their own and their communication partners' use of communication strategies. METHODS & PROCEDURES: Semi-structured interviews were conducted with four women and seven men with chronic aphasia (n = 11). Interviews were video-recorded, transcribed verbatim and analysed by qualitative content analysis. OUTCOMES & RESULTS: Informants appreciated having conversations despite the fact that they perceived their aphasia as a serious hindrance. Different factors related to the informants, the conversation partners, the conversation itself and the physical environment were perceived to impact on conversations. The importance of the communication partners' knowledge and understanding of aphasia and their use of supporting conversation strategies were acknowledged by the informants. The informants' views on using communication aid devices or strategies varied considerably. Four themes that characterized the informants' narratives were: loss and frustration, fear and uncertainty, shared responsibility based on knowledge, and longing for the past or moving forward. CONCLUSIONS & IMPLICATIONS: The informants longed to regain their former language ability and role as an active participant in society. To enhance participation of persons with aphasia, it is suggested that communication partner training should be an important and integral part of aphasia rehabilitation. Important elements of such training are reflecting on communication behaviours, training in real-life situations, and acknowledging each individual's special needs and preferences. To deal with the consequences of aphasia, counselling and psychological support may be needed.

The multidrug-resistant bacteria attitude questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses.

AIM: To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses' knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers' and politicians' responsibility for adherence to preventive measures for infection control. BACKGROUND: Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. DESIGN: Descriptive and correlational cross-sectional survey. METHOD: Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. RESULTS: Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. CONCLUSION: The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. RELEVANCE TO CLINICAL PRACTICE: There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

Depression and post-traumatic stress disorder after aneurysmal subarachnoid haemorrhage in relation to lifetime psychiatric morbidity.

INTRODUCTION: Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH). MATERIALS AND METHODS: Eighty-three SAH patients without apparent cognitive dysfunction were assessed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) after their SAH. Diagnoses were assessed for three time periods, 'lifetime before SAH', '12 months before SAH' and '7 months after SAH'. RESULTS: Forty-five percentage of patients with SAH reported at least one lifetime psychiatric disorder. After SAH, symptoms of depression and/or post-traumatic stress disorder (PTSD) were seen in 41%, more often in those with a psychiatric history prior to SAH (p = 0.001). In logistic regressions, depression after SAH was associated with a lifetime history of major depression, or of anxiety or substance use disorder, as well as with lifetime psychiatric comorbidity. Subsyndromal or full PTSD was predicted by a lifetime history of major depression. After the SAH, 18 patients (22%) had received psychotropic medication and/or psychological treatment, 13 of whom had a disorder. Those with a lifetime history of major depression or treatment with antidepressants before SAH had lower return to work rates than others (p = 0.019 and p = 0.031, respectively). This was also true for those with symptoms of depression and/or PTSD, or with antidepressant treatment after SAH (p = 0.001 and p = 0.031, respectively). CONCLUSIONS: Depression and PTSD are present in a substantial proportion of patients 7 months after SAH. Those with a history of psychiatric morbidity, any time before the SAH, are more at risk and also constitute a risk group for difficulties in returning to work.

Swedish mothers and fathers of children with cancer: perceptions of well-being, social life, and quality care.

The overall aim was to describe and compare well-being, social life, and quality care among parents of children with cancer with respect to mothers versus fathers and whether the children were on versus. off treatment. The Life Situation Scale for Parents (LSS-P) was answered by 320 parents, comprising 85 mothers and 71 fathers of children on treatment, and 93 mothers and 71 fathers of children off treatment. The results show that the well-being of parents of children with cancer is affected by their child's situation, and that they experience such things as economic strain and a sense of being dependent on the care provided, especially during the child's treatment phase. Mothers whose children are receiving treatment see their life situation as less satisfying, and report being sadder and having lower self-esteem.

Coping strategies, health-related quality of life and psychiatric history in patients with aneurysmal subarachnoid haemorrhage.

PURPOSE: Subarachnoid haemorrhage (SAH) reduces health-related quality of life (HRQoL) and increases the risk of psychiatric sequels such as depression and posttraumatic stress disorder. Especially those with a psychiatric history and those using maladaptive coping strategies are at risk for such sequels. The extent to which HRQoL after SAH was related to a history of psychiatric morbidity and to the use of various coping strategies was assessed. METHODS: Patients admitted to the Uppsala University Hospital with aneurysmal SAH (n = 59) were investigated prospectively. Seven months after SAH, data were collected using the Structured Clinical Interview for DSM-IV axis I disorders, the Short Form-36 (SF-36) Health Survey and the Jalowiec Coping Scale. RESULTS: Patients with SAH had lower HRQoL than the general Swedish population in all eight domains of the SF-36. The lower HRQoL was almost entirely in the subgroup with a psychiatric history. HRQoL was also strongly correlated to the use of coping. Physical domains of SF-36 were less affected than mental domains. Those with a psychiatric history used more coping than the remainder with respect to all emotional coping scales. Coping and the presence of a psychiatric history were more strongly related to mental than to physical components of HRQoL. CONCLUSIONS: A psychiatric history and the use of maladaptive emotional coping were related to worse HRQoL, more to mental than to physical aspects.

Is nurse-patient agreement of importance to cancer nurses' satisfaction with care?

AIM: This paper is a report of a study of situational (nurse-patient agreement), personal and occupational factors of potential importance to oncology nurses' satisfaction with care provided and general work satisfaction. BACKGROUND: Nurses have a general tendency to attribute to patients with cancer more problems and suffering than patients themselves report. However, little is known about whether dis/agreement between oncology nurses and patients with cancer concerning perceptions of patients' situation is of importance to nurses' satisfaction with their work. METHODS: The study had a comparative and prospective design. Data were collected in 2005 using self-administrated questionnaires with 81 consecutively recruited nurse-patient pairs. Data were analysed with non-parametric tests (for comparison between subgroups) and with multiple regression analyses (for identifying predictors). RESULTS: Initial nurse-patient agreement concerning patients' emotional distress, coping resources and quality of life did not appear to be important to nurses' subsequent satisfaction with the care directed at a specific patient. However, higher satisfaction with care provided as well as general work satisfaction was reported by nurses with more experience of cancer care and with a lower workload. CONCLUSION: To improve oncology nurses' opportunities to provide high quality cancer care, novice nurses and advanced beginners in particular should receive support and nurses' working conditions must be improved. Further research is needed to examine whether there are other aspects of the nurse-patient relationship that contribute to oncology nurses' satisfaction with the care provided to specific patients.

Perceived recovery after aneurysmal subarachnoid haemorrhage in individuals with or without depression.

AIMS: The aims of the study were to describe what patients with no or only minor neurological deficits after aneurysmal subarachnoid haemorrhage (SAH) perceived to be important for recovery, and perceived consequences of the illness. BACKGROUND: Quantitative studies indicates unfavourable outcomes after aneurysmal SAH, concerning for example mental health and return to everyday life, among patients expected to recover completely. Thus, it is important to investigate the perceptions of patients and to give them the opportunity to communicate what they consider important for recovery. DESIGN: Qualitative descriptive design. METHOD: Semi-structured interviews with 20 aneurysmal subarachnoid haemorrhagic patients were conducted approximately 12 months after the onset. Analyses were carried out in two steps, beginning with a qualitative content analysis. Due to the findings in the initial content analysis, a structured clinical interview for psychiatric disorders was used as a second step to verify the presence or absence of depression in the participants. RESULTS: Two patterns were identified. One pattern revealed that informants without depression experienced a 'confident perception of recovery', which included perceptions of meaningfulness. Another pattern revealed that depressed informants experienced a 'pessimistic perception of recovery', which included perceptions of hopelessness. Expectations regarding care after departure from the neurointensive care unit were not met. CONCLUSIONS: Individuals suffering from depression after aneurysmal SAH have a pessimistic view of their recovery in contrast to those without depression. These findings highlight the importance of better recognition and treatment of depression in the aftermath of SAH. RELEVANCE TO CLINICAL PRACTICE: These findings highlight the importance of better recognition and treatment of depression after aneurysmal SAH, where nurses play an active role. Nurses should seek to take actions to better meet patient's needs after departure from neurointensive care units.

Quality of life varies with gender and age among adults treated for unilateral cleft lip and palate.

OBJECTIVE: To evaluate health-related quality of life among adults treated for unilateral cleft lip and palate and to investigate whether patients were affected differently depending on gender and age. DESIGN: Cross-sectional population study with long-term follow-up. PATIENTS/SETTINGS: All unilateral cleft lip and palate patients born 1960-1987 and treated at Uppsala University Hospital were invited (n = 109). Response rate was 79% (n = 86). Mean follow-up time was 35 years. Norm data matched for age and gender were used for comparison (n = 1385). MAIN OUTCOME MEASURES: Health-related quality of life measured with the SF-36 questionnaire. High values indicate good level of health-related quality of life. RESULTS: The total patient group had lower values in the Mental Health subscale compared with norm data (p = .005). Values in all other subscales did not differ from norm data. Women had a higher positive difference than men in the subscale emotional role function compared with the matched norm population (p < .001). The younger age group (20 to 32 years old) consistently had a larger negative difference to matched norm data compared with the older age group (33 to 47 years old) in the subscales social function (p = .009), physical role function (p < .001), and emotional role function (p < .001). CONCLUSIONS: Unilateral cleft lip and palate affected health-related quality of life differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients on several subscales. However, except for the mental health subscale, health-related quality of life was similar among unilateral cleft lip and palate patients and norm data.

Barriers to change hindering quality improvement: the reality of emergency care.

PURPOSE: The aim of this study was to investigate physicians' and nurses' perspectives and prerequisites for quality improvement in the emergency department based on results from a previous patient survey. METHOD: The study used an explorative design with a qualitative approach and was conducted at the main emergency department of a Swedish university hospital. Interviews were conducted with 5 focus groups. In total, the groups comprised 22 respondents. RESULTS: The respondents suggested goals and quality improvements, such as more patient-centered care, reduced waiting times, and better pain management. However, barriers to quality improvement also were identified and represented 3 themes: the patient is looked upon as an object or a problem; the physicians and nurses belong to different organizational cultures; and the hospital's organization hinders the optimal flow of patients and improvements to quality. DISCUSSION: When assigning priority to the topic areas, most of the focus groups ranked "information, respect, and empathy" as most important to improve. Adequate information, proper care, and treatment within a reasonable time in the emergency department were cited as the goals for patient care, but the health care professionals perceived barriers to change in the hospital culture and organization. To ensure quality care and patient safety, these barriers should be addressed by leaders on all levels in the organization, including the hospital board. Health care professionals' perspectives of quality of care are valuable and should be included in quality improvement work.

Nursing student's expectations for their future profession and motivating factors - A longitudinal descriptive study from Sweden.

BACKGROUND: The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored. OBJECTIVE: To describe students' motives to become registered nurses and their expectations regarding their future profession. DESIGN: A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education. PARTICIPANTS AND SETTING: A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden. METHODS: A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis. RESULTS: An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education. CONCLUSION: The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

Evaluation of OLD@HOME virtual health record staff opinions of the system and satisfaction with work.

The aim of the present research was to study outcomes of use of the OLD@HOME Virtual Health Record with regard to staff opinions about information, communication technology, and satisfaction with work. A quasi-experimental design was used. Staff opinions about the information and communication technology were assessed using a study-specific questionnaire at the test site (n =22) and at other settings in the municipality (n =172). Staff (n =22) job satisfaction, perceived quality of care, and psychosomatic health were assessed using the Satisfaction with Work Questionnaires before and after a 5-month period of testing the technology in an intervention and a comparison group. Staff opinions about the information and communication technology were significantly more positive at the test site compared to other settings in the municipality. For the total scale of quality of care and the factor documentation, there were significant differences in change scores between intervention and comparison groups, with improvements for the comparison group. For job satisfaction and psychosomatic health, there were no differences in change scores between the groups. Participatory design enhances staff opinions about information and communication technology. However, a 5-month test period showed no benefits regarding staff satisfaction with work when compared to a comparison group. On the contrary, the comparison group improved in documentation, and for the intervention group, there was a trend toward deterioration, which may be due to their knowing how to document, but not having time when using both paper-based and electronic systems.

Staff members' perceptions of a ICT support package in dementia care during the process of implementation.

AIM: The aim of the present study was to describe staff members' perceptions of an information and communication technology (ICT) support package during the process of implementation. BACKGROUND: ICT in dementia care will likely increase in the future. The diffusion of new innovations can be better understood through diffusion research. METHODS: Fourteen staff members in dementia care were interviewed, in groups, once before the new ICT, twice during its implementation and once after. Data were analysed using qualitative content analyses. The ICT included monitors/alarms: passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, and communication technology: Internet communication and additional computers. RESULTS: The results showed two themes 'Moving from fear of losing control to perceived increase in control and security' and 'Struggling with insufficient/deficient systems'. CONCLUSIONS: Staff perceptions of ICT were diverse and changed during the implementation. Benefits were more pronounced than disadvantages, and improvements were described both in care and in staff job situation. IMPLICATIONS FOR NURSING MANAGEMENT: Functioning and use of ICT may relate to design as well as by application and the surrounding structure, and the whole system: the organizational structure, the employers and the new product needs to be taken into consideration when implementing new technology.