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Family Health Conversations (FamHC) increase health and well-being, but knowledge about their cost-effectiveness, and how to best calculate this, is lacking. In this feasibility study we evaluated the cost-effectiveness of using FamHC with families in which a middle-aged family member had suffered stroke. Seven families participated in a FamHC intervention and seven families received ordinary care. Health-related quality of life (HRQoL) was estimated with SF-6D and EQ-5D over a six-month period. The costeffectiveness of the intervention was calculated. Families receiving FamHC intervention had significantly increased HRQoL at follow up. Cost per quality adjusted life year differed depending on the instrument and analysis method used in the calculation. However, all calculations showed that FamHC were cost-effective. We conclude that FamHC significantly increase HRQoL and suggest that they are cost-effective. Both instruments seemed to be able to capture changes. Considering the participants’ experience of answering the two instruments, we advocate the use of EQ-5D.

Introduction: Constipation is relatively common, especially among women, but little is known about the experience of livingwith constipation. Aim: To explore the experiences of middle-aged women living with constipation.

Design: A qualitative,descriptive design.

Method: Six women in middle age (50-64 years) with constipation were interviewed in 2005-2007 about their experiences ofliving with constipation. The interviews were transcribed and the data were analyzed with qualitative content analysis.

Result: The women described being constipated as being alone in an excruciating condition where life alternated betweenfeeling tormented and feeling released, and this condition evoked feelings of stress and anxiety. Difficulties in discussingconstipation and a lack of support meant that they were alone in their struggle and they felt humiliated when seeking healthcareservices. Life was seen as an endless struggle between being mastered by the bowel and mastering the bowel.

Conclusion: Even though data has been collected more than five years ago, the experiences described by the women are deemedto be highly valid for today. It is essential that fundamental needs like elimination are satisfied, but constipation problems seemsto be neglected in the healthcare system. It is important, therefore, that patients’ complaints are taken seriously.

Priorities and allocation are complex tasks in health care. Unspoken and also often unconscious priorities frequently occur. Research concerning how registered nurses (RN) priorities are limited. The aim of this study was to illuminate the meanings of RNs' lived experiences of priorities in surgery care. Narrative interviews were conducted with 10 RNs working in a department of surgery. The RNs interviewed had all worked for more than 5 years as RNs. A phenomenological-hermeneutic interpretation of the interviews was conducted. The findings revealed 3 themes: making a conscious allocation and priorities of care, doing unreflected good, and being qualified to determine. The RNs did not often comprehend their actions as prioritizing. They more often comprehended their nursing tasks as obvious and did not consider this as priorities. But in situations of ethical difficulty, the RNs reflected upon their priority and actions.

Aim. This study aims to illuminate participants experiences of receiving abdominal massage for constipation. Background. Abdominal massage has been found to decrease the severity of constipation and abdominal pain, but little is known about how patients experience receiving abdominal massage. Design. The present study is a qualitative descriptive study, based on individual interviews. Method. Nine adults receiving abdominal massage for constipation were invited to participate. Semi-structured interviews were conducted in Sweden between 2005-2007. The interviews were transcribed and subjected to qualitative content analysis. Results. Four themes were formulated: 'being on one's guard', 'becoming embraced by safe hands', 'being touched physically and emotionally' and 'feeling vulnerable'. The participants reported that they were on guard, i. e. they were sceptical about whether or not abdominal massage was effective and suitable. However, as the massage sessions continued, they found the massage pleasant and began to feel embraced and in safe hands. They described how the abdominal massage made them feel as 'being touched physically and emotionally' and their bowel habits were improved. Along with the improvements, their agony was gone and they felt relieved. However, they considered their new condition fragile and they felt vulnerable to relapse. Conclusions. Abdominal massage was experienced as pleasurable, and after treatment, the participants felt more comfortable with their bowel function. Participants described abdominal massage as affecting the whole person. Relevance to clinical practice. Abdominal massage has been shown to be an effective intervention for constipation. A crucial aspect is that nurses need to be sensitive and respect the intimacy associated with the abdomen.

In an academic programme, completion of a postgraduate degree project could be a significant means of promoting student learning in evidence- and experience-based practice. In specialist nursing education, which through the European Bologna process would be raised to the master's level, there is no tradition of including a postgraduate degree project. The aim was to develop a didactic model for specialist nursing students' postgraduate degree projects within the second cycle of higher education (master's level) and with a specific focus on nurturing shared involvement between universities and healthcare settings. This study embodies a participatory action research and theory-generating design founded on empirically practical try-outs. The 3-year project included five Swedish universities and related healthcare settings. A series of activities was performed and a number of data sources secured. Constant comparative analysis was applied. A didactic model is proposed for postgraduate degree projects in specialist nursing education aimed at nurturing shared involvement between universities and healthcare settings. The focus of the model is student learning in order to prepare the students for participation as specialist nurses in clinical knowledge development. The model is developed for the specialist nursing education, but it is general and could be applicable to various education programmes.

AIM: This paper is a report of a study conducted to evaluate change in health-related quality of life for people with constipation receiving abdominal massage and to estimate the cost-effectiveness of two alternative scenarios developed from the original trial.

BACKGROUND: Constipation is a common problem and is associated with decrease in quality of life. Abdominal massage appears to decrease the severity of gastrointestinal symptoms, but its impact on health-related quality of life has not been assessed.

METHODS: A randomized controlled trial including 60 participants was conducted in Sweden between 2005 and 2007. The control group continued using laxatives as before and the intervention group received additional abdominal massage. Health-related quality of life was assessed using the EQ-5D and analyzed with linear regression. Two scenarios were outlined to conduct a cost utility analysis. In the self-massage scenario patients learned to give self-massage, and in the professional massage scenario patients in hospital received abdominal massage from an Enrolled Nurse.

RESULTS: Linear regression analysis showed that health-related quality of life was statistically significantly increased after 8 weeks of abdominal massage. About 40% were estimated to receive good effect. For 'self-massage', the cost per quality adjusted life year was euro75,000 for the first 16 weeks. For every additional week of abdominal massage, the average dropped and eventually approached euro8300. For 'professional massage', the cost per quality adjusted life year was euro60,000 and eventually dropped to euro28,000.

CONCLUSION: Abdominal massage may be cost-effective in the long-term and it is relevant to consider it when managing constipation. A crucial aspect will be to identify those who will benefit.

OBJECTIVES: To evaluate effects of touch massage (TM) on stress responses in healthy volunteers.

METHODS: A crossover design including twenty-two (mean age=28.2) healthy volunteers (11 male and 11 female) cardiac autonomic tone was measured by heart rate (HR) and heart rate variability (HRV). Stress hormone levels (cortisol) were followed in saliva. We also measured blood glucose and serum insulin. Extracellular (ECV) levels of glucose, lactate, pyruvate and glycerol were followed using the microdialysis technique (MD). TM was performed on hands and feet for 80min, during control, participants rested in the same setting. Data were collected before, during, and after TM and at rest. Saliva cortisol, serum glucose, and serum insulin were collected before, immediately following, and 1h after intervention or control, respectively.

RESULTS: After 5min TM, HR decreased significantly, indicating a reduced stress response. Total HRV and all HRV components decreased during intervention. Saliva cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control situation. Only minor changes were observed in ECV levels of glucose (a decrease) and lactate (an increase). No significant alterations were observed in glycerol or pyruvate levels throughout the study. There were no significant differences between groups in ECV concentrations of analyzed substances.

CONCLUSIONS: In healthy volunteers, TM decreased sympathetic nervous activity, leading to decreased overall autonomic activity where parasympathetic nervous activity also decreased, thereby maintaining the autonomic balance.

Background: The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing.

Aim: The aim of this paper was to investigate how studies of nursing practices apply economic evaluations.

Methods: A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews, and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form.

Results: The search identified 115 studies published between1984 and august 2007. Studies were found in the following nursing practices: provision of support and treatment (n=17); assessing suffering/wellbeing (n=1); preventing or treating ill health (n=53); and organization of individual care (n=44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and there were a large variability in cost considered in the analysis. In 82 studies, the authors reported cost-effective intervention.

Conclusions: Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.

Background. Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed.

Objective. This study investigates the effects of abdominal massage on gastrointestinal functions and laxative intake in people who have constipation.

Design. Randomized controlled trial.

Participants and method. A sample of 60 people with constipation was included and randomised in two groups. The intervention group received abdominal massage in addition to an earlier prescribed laxative and the control group received only laxatives according to earlier prescriptions. Gastrointestinal function was assessed with Gastrointestinal Symptoms Rating Scale (GSRS) on three occasions; at baseline, week 4 and week 8. The statistical methods included linear regression, Wilcoxon sign rank test, and Mann-Whitney U-test.

Result. Abdominal massage significantly decreased severity of gastrointestinal symptoms assessed with GSRS according to total score (p=.003), constipation syndrome (p=.013), and abdominal pain syndrome (p=.019). The intervention group also had significant increase of bowel movements compared to the control group (p=.016). There was no significant difference in the change of the amount of laxative intake after 8 weeks.

Conclusions. Abdominal massage decreased severity of gastrointestinal symptoms, especially constipation and abdominal pain syndrome, and increased bowel movements. The massage did not lead to decrease in laxative intake, a result that indicates that abdominal massage could be a complement to laxatives rather than a substitute.

The aim of this article is to discuss challenges in the development of Specialist Nursing Educations as a result of the 2007 Swedish Higher EducationReform: the implementation of the so-called Bologna process. Certain challenges follow this reform, particularly since the specialist nursingprogrammes will be part of the second cycle of the higher education system, and it will be possible to combine the professional degree witha masters degree (one year). Possible strategies in four areas related to the Specialist Nursing Education are discussed: integration of researchbasedknowledge, experienced-based knowledge, improvement knowledge, and strategies for collaboration between university institutions andclinics. Specific didactical issues are raised.