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Gustafsson, M., Lämås, K., Isaksson, U., Sandman, P.-O. & Lövheim, H. (2019). Constipation and laxative use among people living in nursing homes in 2007 and 2013. BMC Geriatrics, 19, Article ID 38.
Open this publication in new window or tab >>Constipation and laxative use among people living in nursing homes in 2007 and 2013
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2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 38Article in journal (Refereed) Published
Abstract [en]

Background: Constipation is a common condition among older people, particularly among people living in nursing homes, and the use of drugs such as opioids is one of many factors that contribute to its high prevalence. The aim of this study was to compare the prevalence of constipation and the use of laxatives between 2007 and 2013, to analyze constipation and laxative use among people who are prescribed opioids, and to identify factors associated with constipation. Methods: In 2007 and 2013, two surveys were performed in the county of Vasterbotten in Northern Sweden, comprising all those living in nursing homes. The Multi-Dimensional Dementia Assessment Scale was used to collect data regarding laxative, opioid and anticholinergic drug use, functioning in activities of daily living (ADL), cognition and symptoms of constipation. A comparison was made between 2820 people from 2007 and 1902 people from 2013. Results: The prevalence of symptoms of constipation among people living in nursing homes increased from 36% in 2007 to 40% in 2013. After controlling for age, sex, ADL, cognitive impairment and use of opioid and anticholinergic drugs, this difference was found to be statistically significant. When controlled for demographic changes, there was a statistically significant difference in the regular use of laxatives between the respective years, from 46% in 2007 to 59% in 2013. People prescribed opioids and anticholinergic drugs were at increased risk of constipation, while people with a higher ADL score were at decreased risk. Further, among people prescribed opioids and rated as constipated, 35% in 2007 and 20% in 2013 were not prescribed laxatives for regular use, a difference that was found to be statistically significant. Conclusions: The prevalence of symptoms of constipation increased between 2007 and 2013. Although there was a decrease between the years, there were still a number of people being prescribed with opioids and rated as constipated who were not treated with laxatives. This study therefore indicates that constipation remains a significant problem among people in nursing homes and also indicates that those prescribed opioids could benefit from an increased awareness of the risk of constipation and treatment, if required.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Constipation, Laxatives, Dementia, Nursing homes
National Category
Gerontology, specialising in Medical and Health Sciences Geriatrics
Identifiers
urn:nbn:se:umu:diva-162507 (URN)10.1186/s12877-019-1054-x (DOI)000458136800002 ()30736737 (PubMedID)
Available from: 2019-08-21 Created: 2019-08-21 Last updated: 2019-08-21Bibliographically approved
Fischer Grönlund, C., Söderberg, A., Dahlqvist, V., Andersson, L. & Isaksson, U. (2019). Development, validity and reliability testing the Swedish Ethical Climate Questionnaire. Nursing Ethics, 26(7-8), 2482-2493
Open this publication in new window or tab >>Development, validity and reliability testing the Swedish Ethical Climate Questionnaire
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2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 7-8, p. 2482-2493Article in journal (Refereed) Published
Abstract [en]

Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire.

Method: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed.

Ethical considerations: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results.

Findings: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach’s alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach’s alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach’s alpha was 0.82.

Discussion: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole.

Conclusion: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Ethical climate, Habermas, healthcare professionals, psychometric assessment
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-156992 (URN)10.1177/0969733018819122 (DOI)000486024000051 ()30665340 (PubMedID)2-s2.0-85060602906 (Scopus ID)
Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-10-10Bibliographically approved
Nordlander, M., Isaksson, U. & Hörnsten, Å. (2019). Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution. Sage Open Nursing, 5
Open this publication in new window or tab >>Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution
2019 (English)In: Sage Open Nursing, ISSN 2377-9608, Vol. 5Article in journal (Refereed) Published
Abstract [en]

The proportion of older people in the population increases and more and more continue living in their own homes. Appetite among the elderly people is important to their nutrition and health. The increased risk of unintended weight loss and malnutrition is linked to food distribution among home-living elderly people. The aim was to describe experiences and perceptions of what matters to appetite among home-living elderly people having food distribution. The design was qualitative where interview data were collected among 13 interviewees in 2017 to 2018. Data were analyzed using qualitative content analysis. The results are presented in three domains: the food, the meal situation, and the adaptation to meal service with categories and themes responding to each domain. The six themes related to appetite among the elderly people concerned the following: eating tasty, savory, and culturally adapted food; eating healthy and sustainable food; eating alone or together with others; eating in a pleasant meal environment; having choices to make about the meal; and last, accepting disabilities and increased dependency. One conclusion is that many aspects should be taken into consideration when promoting appetites of people who also get food distribution. It is highly individual and an understanding of which aspects are relevant must be considered; consequently, person-centered care is suggested to promote appetite.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
appetite, home-living elderly people, perceptions, food distribution, interviews, nursing
National Category
Nursing Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-156877 (URN)10.1177/2377960818817126 (DOI)000458647600001 ()
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-03-11Bibliographically approved
Öberg, U., Isaksson, U., Jutterström, L., Orre, C. & Hörnsten, Å. (2019). Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 8(4), Article ID e10250.
Open this publication in new window or tab >>Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial
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2019 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 4, article id e10250Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs.

OBJECTIVE: To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care.

METHODS: This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA1c) will be the primary outcome measure.

RESULTS: This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019.

CONCLUSIONS: This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10250.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
eHealth, internet, mobile apps, nurse specialists, primary health care, randomized controlled trial, self-management, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158655 (URN)10.2196/10250 (DOI)000466496800003 ()30958279 (PubMedID)
Funder
Swedish Diabetes Association
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-06-10Bibliographically approved
Sjöström, A. E., Hörnsten, Å., Hajdarevic, S., Emmoth, A. & Isaksson, U. (2019). Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study. JMIR Nursing, 2(1), Article ID e14194.
Open this publication in new window or tab >>Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study
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2019 (English)In: JMIR Nursing, ISSN 2562-7600, Vol. 2, no 1, article id e14194Article in journal (Refereed) Published
Abstract [en]

Background: Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients.

Objective: The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet.

Methods: This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines.

Results: The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information.

Conclusions: Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
eHealth, Internet, consumer health information, health literacy, patient-centered care, qualitative research, primary health care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-162733 (URN)10.2196/14194 (DOI)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-30Bibliographically approved
Norberg, C., Santamäki Fischer, R., Isaksson, U. & Lämås, K. (2019). Something wonderful and incomprehensible: Expressions and experiences of spirituality among very old people.
Open this publication in new window or tab >>Something wonderful and incomprehensible: Expressions and experiences of spirituality among very old people
2019 (English)In: Article in journal (Refereed) Epub ahead of print
Abstract [en]

This study aimed to illuminate very old people’s experiences and expressions of spirituality and is a part of the Umeå 85+/Gerontological Regional Database (GERDA). The participants (n = 12) had declared an interest in spirituality, were 86–99 years of age, and were interviewed in their own homes. The interviews were analyzed using qualitative content analysis. The findings revealed that spirituality was experienced as being in communion, transcending life’s circumstances, and living in a spiritual reality. Spirituality was expressed as an inner sense of communion with God and with other people, and as a spiritual reality. The participants expressed a desire to talk about spiritual experiences and personal beliefs but regarded spirituality as an uncommon topic. Nurses and other professionals need to be aware of spiritual needs and prepared to give spiritual care.

Keywords
Personal beliefs, spiritual needs, transcendence, Umeå 85+/GERDA, nursing, experiences
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-163507 (URN)10.1080/20440243.2019.1658265 (DOI)2-s2.0-85072014668 (Scopus ID)
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-10-03
Öberg, U., Hörnsten, Å. & Isaksson, U. (2019). The Self‐Management Assessment Scale: development and psychometric testing of a screening instrument for person‐centred guidance and self‐management support. Nursing Open, 6, 504-513
Open this publication in new window or tab >>The Self‐Management Assessment Scale: development and psychometric testing of a screening instrument for person‐centred guidance and self‐management support
2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, p. 504-513Article in journal (Refereed) Published
Abstract [en]

Aim: To develop and psychometrically test the Self‐Management Assessment Scale (SMASc), a screening instrument for person‐centred guidance and self‐management support of persons with type 2 diabetes (T2D).

Background: T2D is a common and globally increasing chronic condition. Improved self‐management is a vital and integral component of diabetes care to prevent complications from poorly managed diabetes. For diabetes nurses to better understand persons with diabetes experienced challenges and needs regarding self‐management and further for persons with T2D to take an active role in managing their condition, an instrument measuring this is needed.

Design: Instrument development and psychometric testing of the content and construct validity, factor structure and reliability.

Method: The SMASc was psychometric tested on a sample of participants (September 2017–November 2017) with a confirmed diagnosis of T2D (N = 104).

Results: Psychometric findings were satisfactory and supported the scale´s reliability. Cronbach's alpha, CVI and goodness‐of‐fit were acceptable.

Conclusion: Self‐Management Assessment Scale is a short validated screening instrument, which can indicate possible barriers for self‐management that ought to be approached during the conversation between the person with T2D and the primary healthcare nurses. Therefore, it is a promising instrument to be used to facilitate person‐centred guidance and to improve self‐management of people living with T2D.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
instrument development, nursing, person‐centred care, psychometric properties, self‐management support, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-155317 (URN)10.1002/nop2.233 (DOI)000461835600030 ()30918701 (PubMedID)
Funder
Swedish Diabetes Association
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-05-16Bibliographically approved
Skottheim, A., Lövheim, H., Isaksson, U., Sandman, P.-O. & Gustafsson, M. (2018). Insomnia symptoms among old people in nursing homes. International psychogeriatrics, 30, 77-85
Open this publication in new window or tab >>Insomnia symptoms among old people in nursing homes
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2018 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, p. 77-85Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Insomnia symptoms are common among old people, and hypnotics and sedative drugs are often prescribed in spite of small benefits. The aim of this study was to estimate the prevalence of insomnia symptoms and to analyze the association between insomnia symptoms, cognitive level, and prescription of hypnotics and sedatives among old people living in nursing homes.

METHODS: The study comprised 2,135 people living in nursing homes in the county of Västerbotten, Sweden. Data concerning hypnotic and sedative drugs, cognitive function, and prevalence of insomnia symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale (MDDAS).

RESULTS: The three most common insomnia symptoms were "sleeps for long periods during the day," "interrupted night-time sleep," and "wakes up early in the morning" with 57.8%, 56.4%, and 48.0%, respectively, of the residents exhibiting the symptoms at least once a week. Different insomnia symptoms showed different association patterns with sex and age. Most insomnia symptoms were more common among people with cognitive impairment compared to those with no cognitive impairment and seemed to reach their peak prevalence in people with moderate to severe cognitive impairment, subsequently decreasing with further cognitive decline. Of the study population, 24.0% were prescribed hypnotics and sedatives. Prescriptions were more common among those without cognitive impairment, and among those exhibiting the symptom "difficulty initiating sleep."

CONCLUSIONS: Insomnia symptoms and prescription of hypnotics and sedatives are common among old people living in nursing homes. Considering the risk of adverse effects, it is important to regularly re-evaluate the need for these drugs.

Place, publisher, year, edition, pages
New York: Cambridge University Press, 2018
Keywords
cognitive impairment, dementia, hypnotics and sedatives, insomnia symptoms, nursing homes
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:umu:diva-139893 (URN)10.1017/S1041610217001703 (DOI)000423081100009 ()28927479 (PubMedID)
Available from: 2017-09-26 Created: 2017-09-26 Last updated: 2018-06-09Bibliographically approved
Öberg, U., Isaksson, U., Jutterström, L., Orre, C.-J. & Hörnsten, Å. (2018). Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support. JMIR Diabetes, 3(1), Article ID e7.
Open this publication in new window or tab >>Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support
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2018 (English)In: JMIR Diabetes, ISSN 2371-4379, Vol. 3, no 1, article id e7Article in journal (Refereed) Published
Abstract [en]

Background: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services.

Objective: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care.

Methods: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.

Results: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty.

Conclusions: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.

Place, publisher, year, edition, pages
JMIR Publications, 2018
Keywords
eHealth, internet, type 2 diabetes, self-management, primary health care, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145997 (URN)10.2196/diabetes.9059 (DOI)30291075 (PubMedID)2-s2.0-85047781902 (Scopus ID)
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2019-05-16Bibliographically approved
Hemmingsson, E.-S., Gustavsson, M., Isaksson, U., Karlsson, S., Gustavsson, Y., Sandman, P.-O. & Lövheim, H. (2018). Prevalence of pain and pharmacological pain and treatment among old people in nursing homes in 2007 and 2013. European Journal of Clinical Pharmacology, 74(4), 483-488
Open this publication in new window or tab >>Prevalence of pain and pharmacological pain and treatment among old people in nursing homes in 2007 and 2013
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2018 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 4, p. 483-488Article in journal (Refereed) Published
Abstract [en]

Purpose: Many elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013.

Methods: Cross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best.

Results: The prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain.

Conclusions: There has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
pain, elderly, nursing home, analgesic drugs, dementia
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-144537 (URN)10.1007/s00228-017-2384-2 (DOI)000427468600011 ()29260276 (PubMedID)
Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-06-09Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-5191-4599

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