Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

Scand J Caring Sci; 2011; 25; 185–193
Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study Aim: To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method: This is a retrospective epidemiologic cross‐sectional study based on a 1‐year data set of all the 1753 registered injury events from a well‐defined population. Result: The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65–74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed‐days for trauma in all ages (0–102 years). Conclusion: Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40–50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.     

Reality basis for teaching psychomotor skills in a tertiary nursing curriculum

This paper, written whilst the authors were working at Curtin University, Western Australia, describes a process of determining the psychomotor skills to be taught in an undergraduate nursing programme. It outlines how consultation with clinical agencies enhanced the planning of the skills component within the new nursing curriculum and details the outcomes in terms of faculty development and curriculum design.     

Nurse socialization: issues and problems

A comparative study was conducted of the professional socialization process of student nurses in three nurse education centres in South Wales. Patterns and problem areas can be identified of relevance to issues in role theory and with practical implications for the more effective implementation of Project 2000. Three cohorts of students were interviewed using a semi-structured interview schedule whilst in the introductory block and at the end of the first year. The teaching and ward staff directly involved in the socialization process were also interviewed so that their views could be compared with those of the students. There were differences between the types of ward in the opportunities they offered for role modelling. It was doubtful whether the three categories of students, teaching staff and ward staff were all employing a single conception of 'the good nurse'. The student has to find her own pathway through the divergent and often conflicting values and philosophies of the teaching staff and those in authority on the wards. It is recommended that a more unified approach be adopted to reduce the conflict which learners experience. In accordance with Project 2000, the teaching staff should act as practitioners and thereby be perceived as a professional role model with clinical credibility.     

Computer training in nurse education: a bird''s eye view across the UK

This paper is borne of the increasing interest and relevance of computers in nursing. It describes the method, and results obtained from a postal questionnaire survey distributed across the United Kingdom to gain information about the developments in computing in nursing education. The results indicate that considerable developments have been made, but that they are more piecemeal than co-ordinated. A selection of the results are presented and discussed, and one or two points concerning future proceedings are raised.     

Student nurse attitudes to teaching/learning methods

This article outlines the findings of a study which investigated the attitudes of 203 general and psychiatric student nurses from nine schools of nursing towards a defined number of teaching/learning methodologies. All students were at the end of their first year or the beginning of their second year of a 3-year first-level training. Data were collected using an instrument based on a semantic differential scale. The findings, when compared against certain variables, for example, gender, showed that there were very few significant differences in relation to the defined and tested methodologies. Students generally showed themselves to be a homogeneous group and the findings indicate that students were more positively predisposed towards student-centred teaching/learning methodologies.     

Patterns of elderly spousal caregiving in dementia care: an observational study

AIM: The aim of this study was to describe which caring activities eight spouses performed when caring for a partner with dementia, and in what way these activities were carried out. BACKGROUND: Family caregivers are recognized as being the primary source of care for the community's older people. The largest group is comprised of spouses, with wives as the predominant caregivers. This informal care seems to be more or less invisible and performed in silence within the family. Despite the wealth of studies, the essence of family caregiving is not well understood. METHODS: Data collection was conducted by observing the dyads in their homes. A qualitative approach inspired by grounded theory was chosen to discover qualities and describe patterns of spousal caregiving in dementia care. RESULTS: The analysis yielded four broad themes, which included nine categories. Findings from the study shed some light on the invisible aspects besides the traditional hands-on caregiving. CONCLUSION: The elderly carers were engaged in demanding and time-consuming care ranging from supervision to heavy physical responsibility. They were caring for as well as about their partners. The study also showed that spouses were successful in managing their situation in different ways. The results reported in this article are unique as they come from direct observations in family home settings where a spouse cared for a partner with dementia. Knowledge about family caregiving is valuable for nurses as there is an emphasis on collaboration between family caregivers and professionals.     

A description of clients nursed by community psychiatric nurses whilst attending English National Board Clinical Course No. 811: clarification of current role?

The English National Board Clinical Course No. 811 is a 36-week preparation for community psychiatric nurses (CPNs). Unlike health visiting or district nursing the course is not yet a mandatory prerequisite for practice and it has been estimated that, nationally, 23% of all CPNs have been awarded the certificate to date. There are currently 24 course centres in England, offering 420 places annually. The completion of a care study by the course student is a curriculum requirement. The present study aimed to establish the characteristics of clients chosen by course students for such work whilst attending the course in an attempt to obtain a 'proxy' measure of the current CPN role nationally. A stratified random sample of eight course centres was selected--four based in schools of nursing, and a further four located in establishments of higher education. Then within each course centre a stratified random sample of students was selected, who each completed a postal questionnaire. A 79% response was obtained. The results are described and discussed within the context of the CPN's developing role. The findings suggest that many CPNs conceptualize their role and function, to use Caplan's terminology, at the primary prevention level, and see their work as being located firmly in primary health care settings. The desirability of this orientation to CPN intervention is examined, acknowledging both mental health service developments and the wider educational implications.     

The psychometric properties of the Chinese Dialysis Quality of Life Scale for Hong Kong dialysis patients

AIMS: This paper describes the process by which the Chinese Dialysis Quality of Life Scale was developed, and the preliminary testing and psychometric evaluation of the scale in a sample of dialysis patients. BACKGROUND: Quality of life as a specific outcome variable has not been systematically and satisfactorily studied in Chinese dialysis patients in Hong Kong. A single global quality of life measure that is both reliable and valid for dialysis patients has yet to be developed. Without measurement tools, it is impossible to judge progress towards this goal. DESIGN: A list of key issues was first derived from an in-depth literature review, then verified by semi-structured interview on seven patients. The initial list of 87 items was then further refined through two rounds of content analysis. The remaining 50 items were finalized by pilot test on seven patients. Of the refined 40 items, face validity was assessed by a team including one professor and ten patients. The 40-item scale was further evaluated by stability, internal consistency and criterion validity with a convenience sample of 164 patients. The scale demonstrated high internal consistency and good test-retest reliability and criterion validity when used. CONCLUSIONS: The psychometric evaluations suggest that the instrument is worthy of further development. Continued validation of this scale on larger sample and Chinese population living outside Hong Kong has the potential to provide nurses with a valid assessment and treatment guide, and researchers with a valid measurement tool.     

Measuring the quality of nursing care: a consideration of different approaches

This paper argues that a preoccupation with cost-effectiveness threatens to swamp nurses' traditional concern with quality of care, and underlines the importance of clinical nurses becoming familiar with the complexities of quality measurement. Terminology widely used in the nursing literature is clarified and research studies that address the quality of nursing care are reviewed. It is suggested that whilst some of these have provided important theoretical insights into quality issues, the qualitative research methods employed have so far failed to provide a practical alternative to the more 'objective' measures of quality currently adopted by clinical nurses and their managers. Generic measures of quality are identified and categorized and it is suggested that most of these are in need of extensive validity testing in relation to the concepts of quality that they purport to measure. The measures of quality themselves may be less important than the content in and process by which they are applied. 'Top-down' and 'bottom-up' approaches to measurement are discussed in relation to the notion of facilitative leadership. The value of top-down approaches is questioned on the grounds that they may violate the integrity of the quality-assurance cycle and prevent clinical nurses from making the commitment that is necessary in order to assess and improve the quality of their nursing practice.