Older patients comprise a large portion of patients in the acute care setting. Registered Nurses (RNs) are the main care providers in the hospital setting. RNs caring for older hospitalized patients are affected by many factors including workload pressures, issues related to the acute care environment and attitudes toward older patients. However, a literature review identified a limited number of studies exploring the RNs experience of caring for older patients in the acute care setting. This study explored the RNs experience of caring for older patients (age 65 and older) on an orthopedic unit in an acute care hospital. Saturation was reached with a purposive sample of nine RNs working on the orthopedic unit, including eight females and 1 male. Participants were interviewed using broad open-ended questions, followed by questions more specific to emerging themes. All interviews were audio-taped and transcribed verbatim. Data were analyzed using Glasers (1992) grounded theory approach. Participants described the basic social problem as dealing with the complexity of older patients. The basic social process identified was the concept of looking beyond. Looking beyond was described as looking at the big picture to find what lies outside the scope of the ordinary. Three sub-processes of looking beyond were identified as connecting, searching, and knowing. Connecting was described as getting to know patients as a person by taking time, respecting and understanding the individual. Searching was described as digging deeper, searching for the unknown by looking for clues and mining everywhere for information. Knowing was described as intuitively knowing what is going to happen and what the older patient needs by pulling it all together and knowing what to expect. These dynamic sub-processes provided the RN with the relationship and information required to look beyond to manage the older patients complexity. The results of this study have implications for nursing practice, education and research. These findings may provide RNs with a process to manage the complex care of a large portion of our population.

Bakgrund: Depression ses som en del av ett bipolärt syndrom med depressiva och maniska eller hypomana sjukdomsepisoder eller som ett unipolärt syndrom endast med depressionsepisoder. Fysisk aktivitet definieras som kroppens rörelse skapad av skelettmuskulaturens sammandragning. Den leder till att kroppen gör sig av med energi och har kopplats till att minska depressionsrisken, öka välbefinnandet och bryta isoleringen. Att motivera äldre med depressionssjukdom till fysisk aktivitet är inte helt okomplicerat. Sjuksköterskan har en viktig roll i att integrera fysisk aktivitet i omvårdnaden för denna patientgrupp. Det ingår i sjuksköterskeprofessionen att se till att patienten får det stöd som behövs för att främja dennes återhämtning. Syfte: Syftet med denna studie är att beskriva sjuksköterskors uppfattningar av fysisk aktivitet som en del av omvårdnaden av äldre patienter med depressionssjukdom och som vårdas inom psykiatrisk vård. Metod: Det har genomförts sex semistrukturerade intervjuer med sjuksköterskor verksamma på en avdelning med inriktning på att vårda äldre personer med psykiska sjukdomar. Induktiv kvalitativ innehållsanalys inspirerad utifrån Graneheim och Lundman (2012) har tillämpats för att analysera intervjuerna. Resultat: Två kategorier resulterade utifrån analysen: stöd riktat på att främja fysisk aktivitet och inverkan på hälsan. Tre subkategorier ingår i kategorin ”stöd riktat på att främja fysisk aktivitet”: praktiskt, emotionellt och socialt stöd. Subkategorierna ”fysisk inverkan”, ”psykisk inverkan” och ”social inverkan” innefattar kategorin ”inverkan på hälsan”. Diskussion: Resultatet har diskuterats i relation till Barkers tidvattenmodell (2005) med betoning på hans tre begrepp (självdomänen, andradomänen och världendomänen). Psykiatrisjuksköterskan har möjlighet att främja fysisk aktivitet hos denna patientgrupp genom att erbjuda praktiskt, emotionellt och socialt stöd till dem. / Background: Depression is seen as part of bipolar disorder when the individ suffers from both depressive and manic or hypomanic episodes or as a unipolar syndrome only with depressive episodes. Physical activity is defined as a body movement resulted from the muscles´ activity. It leads to increased energy consumtion. It has been linked to reducing the risk of depression, of isolation and to improving the feeling of well-being. It is not an easy task to motivate elderly to practise physical activity. The nurse has an important role in implementing physical activity in this patientgroup´s care. The psychiatric nurse´s responsiblity is to ensure that patients are offered the support that can help to their recovery. Aim: The purpose of this study is to describe the nurses´ perceptions of physical activity as part of the care of the elderly depressed patients who are treated within psychiatric care. Method: Six semi - structured interviews were done with nurses working on a ward specialized on taking care of elderly suffering from mental illnesses. Inductive content analysis inspired from Granheim och Lundman (2012) has been used to analyse the interviews. Results: Two categories resulted from the analysis: "support based on promoting physical activity" and "health impact". Three subcategories (practical, emotional and social support) are included in the category "support based on promoting physical activity". Subcategories "physical impact", "psychological impact" and "social impact" belong to the category "health impact". Discussions: The results were discussed in relation to Barker´s tidal model (2005) with emphasis on three of his concepts (self-domain, others´ domain and the world domain). The psychiatric nurse has the opportunity to promote physical activity for these patients by offering them practical, emotional and social support.

Tyrimas atskleidė, kad gydytojų požiūris į vyresnio amžiaus asmenis- stereotipizuotas, gydytojai senyvo amžiaus asmenims priskiria daugiau neigiamų nei teigiamų stereotipų. Bendrosios praktikos gydytojai vadovaujasi nuostatomis, kurios sudaro prielaidą diskriminuoti vyresnio amžiaus pacientus dėl per didelių jų lūkesčių sveikatai; dauguma gydytojų sutapatina senėjimo procesą su liga. Gydytojai, aptarnaujantys daugiau pacientų, turi mažiau diskriminuojantį ir humaniškesnį požiūrį į senyvo amžiaus pacientus.Senyvo amžiaus žmonių diskriminacijos apraiškų pirminėje sveikatos priežiūroje pasitaiko. / The empirical research led to revelation of the attitude of Lithuanian doctors towards older patients: a) the attitude of doctors towards older adults can be categorized as stereotypical; people attribute more negative stereotypes to older adults than positive ones; b) because of their expectations for health common practice doctors and therapists follow the norms which lead to discrimination of older patients; majority of doctors compare aging process with a disease; c) doctors who service many patients have less discriminatory and more humanistic attitude towards older patients.

Syfte: Att undersöka hur nöjda patienter 75 år och äldre är med vården som bedrivs på akutmottagningen på Akademiska sjukhuset i Uppsala avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Metod: Deskriptiv tvärsnittstudie. 38 patienter 75 år och äldre som besökt Akademiska sjukhusets akutmottagning svarade på en enkät avseende hur nöjda de var med sitt besök. Resultat: Patienter 75 år och äldre var i stort mycket nöjda över vården som bedrivs på Akademiska sjukhusets akutmottagning. Patienterna var minst nöjda över väntetiden som ibland ansågs vara för lång i relation till deras besvär. Ingen skillnad gick att utläsa mellan hur nöjda män och kvinnor var med vården avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Någon skillnad gick inte heller att utläsa mellan hur nöjda patienterna var med vården och vilken typ av besvär; medicinskt, kirurgiskt eller ortopediskt som patienten hade sökt för. Slutsats: Studien visar att de patienter 75 år och äldre som besvarade enkäten i stort är mycket nöjda med vården som bedrivs på Akademiska sjukhusets akutmottagning avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Resultaten går inte att generalisera och mer forskning krävs på området. / Aim: To investigate the satisfaction levels of patients aged 75 years and older for care received at the emergency department of Akademiska hospital in Uppsala with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication and pain relief. Method: Descriptive cross section study. 38 patients aged 75 years and older who visited Akademiska’s emergency department answered by completing a form regarding how satisfied they were with their visit. Results: Patients aged 75 and older were generally very satisfied with the care offered by Akademiska’s emergency department. Patients were least satisfied with waiting times, which were sometimes felt to be too long in relation to their symptoms. No significant difference was recorded between the satisfaction levels between men and women for the care offered with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication or pain relief. Neither were any significant differences recorded between the types of symptoms - medical, surgical or orthopaedic - that the patients were seeking treatment for. Conclusion: The study shows that patients aged 75 and over who answered the form were generally very satisfied with the care offered by Akademiska hospital’s emergency department with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication and pain relief. These results cannot be generalized and more research is required in this area.

Home health clinicians are uniquely qualified to fully evaluate patient falls risk and carry out clinical interventions to reduce risk. The objectives of this article are to give home health providers an update on the risk factors for falling, review the current guideline recommendations for prevention of falls, and provide a stepwise approach to evaluate patients and apply the clinical literature to decrease falls in older patients living at home. Many falls may be prevented with patient screening, assessment of risk, and modification of risk factors. Since the risk of falling is an interaction between three groupings of patient-specific factors, namely, environmental factors, diseases/disorders, and medication use, a multifactorial fall risk assessment can help identify the factors to consider modifying in an individual patient.

Aim: The overall aim is to examine how a patient perspective, grounded in caring science, can be preserved and developed in the context of hospital care. Methods: The first study examines attitudes towards caring science in a clinical practice. Data were collected through focus group interviews with seven nurses, three head nurses and four senior preceptors. An interpretive approach guided the study. The results called for collaboration between clinical praxis and the academy, according to how caring science can be preserved and developed. Study II–III functioned in accordance with this goal and were conducted in collaboration with a hospital ward for people over seventyfive years of age. In an attempt to develop care the patients were invited to attend a team meeting. The data in these studies were collected using interviews and observations. Fifteen patients (study II) and nine nurses (study III) who had experienced patient participation in a team meeting participated. In these studies, a reflective lifeworld approach guided the research process. Study IV is presented as a general structure and philosophical examination in the light of Heidegger and Merleau-Ponty’s philosophies. Main Findings: To preserve and develop a patient perspective is strongly connected to existential issues, such as lived time, intersubjectivity and a meaningful existence. For the patients, vulnerability is exposed and increased when the need for hospital care arises. The team meeting is experienced as an emotional situation where existential dimensions need to be recognized. The nurses desire to develop caring is challenged by organizational and economic demands. Time presents both a possibility for an encounter as well as a threat to excellent care. Conclusions: There is a need to challenge narrow processes in modern health care that value the staffs’ work and the patients’ vulnerability in quantifiable measures of efficiency. The challenge is to take into account something that is invaluable - human existence. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Linnéuniversitetet försvaras vid offentlig disputation, 15 september 2014, klockan 10.30 i sal Myrdal, Hus K, Växjö</p>

Bakgrund: Smärta är ett flerdimensionellt fenomen och ett vanligt problem inom äldrevården. Smärtbehandling finns att tillgå, trots detta är smärta underbehandlat hos äldre patienter. Syftet: Syftet med studien är att belysa hur sjuksköterskor bedömer fysisk smärta i omvårdnad av äldre patienter. Metod: Litteraturöversikt med kvalitativ ansats har använts. Datamaterialet bestod av fem kvantitativa och fyra kvalitativa vetenskapliga artiklar. Resultat: Det framkom tre huvudkategorier: smärtbedömningsprocesser, smärtbedömningsmetoder och smärtbedömningsredskap. Ur huvudkategorierna urskildes sex underkategorier: smärtidentifiering, smärtbedömningssvårigheter, kommunikation med patienterna för att bedöma smärta, smärtobservation, smärtbedömningsinstrument och dokumentation. Slutsatser: För att göra en smärtbedömning behövs en god relation till patienten, närstående och övrig personal där kommunikation har central roll. Sjuksköterskan måste tro på patientens egen skattning och smärtupplevelse. / Background: Pain is a multidimensional phenomena and a common problem in care of elderly patients. There are several pain treatment methods available however pain is often not fully treated. Aim: The aim of this study is to illustrate how nurses assess physical pain in care of elderly patients. Method:  A literature review based on a qualitative approach has been used. The study consists of an analysis of five quantitative and four qualitative research articles.  Results: Three main categories were found: the process of pain assessment, the methods of pain assessment and the tools of pain assessment. Those categories were further divided into six subcategories: pain identification, pain assessment difficulties, patient communication to assess pain, pain observations, pain assessment instruments and documentation. Conclusions: Pain assessment requires a good relation to the patient as well as relatives and other staff. Communication takes a central part of the pain assessment. A nurse must believe in the patient's own estimation and pain perception.

Bakgrund: Antalet äldre patienter som söker vård till akutmottagningen har ökat med åren. De flesta sökande av dessa äldre patienter är multisjuka, vilket innebär att de äldre patienterna har minst två sjukdomar. Sjuksköterskor upplever stress och frustration i sitt arbete på akutmottagningen på grund av tidsbrist och brist i kompetenser samt erfarenhet. Syfte: Att beskriva äldre multisjuka patienters upplevelser av att bli vårdade på akutmottagningen. Metod: En systematisk litteraturstudie med beskrivande syntes baserad på 10 kvalitativa vetenskapliga artiklar. Resultat: Resultatdelen presenteras utifrån två teman med sina respektive subteman. Första temat är ”Positiva upplevelser”, som inkluderar två subteman” Att uppleva tillfredsställelse och bli sedd och respekterad” och ” Att uppleva trygghet och tillit”. Andra tema är ”Negativa upplevelser” som inkluderar två subteman ”Att uppleva sig övergiven” och ”Att uppleva brist på trygghet och tillit”. Slutsats: Äldre multisjuka patienter har en stark önskan om att uppleva trygghet och sjuksköterskans närvaro. Att sjukvårdspersonalen är professionella och säkra i sin yrkesroll leder till att äldre patienter känner sig trygga, sedda och respekterade. När sjukvårdspersonalen inte har tillräckliga kunskaper och erfarenheter om de äldre patienternas hälsotillstånd leder det till att de äldre patienterna upplevde sig övergivna, otrygga samt en minskad tillit till sjukvårdspersonalen. / Background: The number of older patients who require and seek the emergency department is increasing every year. Most of them have multiple diseases, which means that the older patients have at least two diseases. The nurses encounter a lot of stress and frustration while working at the emergency department because there is always shortage of time but also because they might have a lack in their knowledge, certain competence skills or experience. Aim: To describe the experiences of older patients with multiple diseases to be cared at the emergency department. Method: A systematic literature study with descriptive synthesis based on 10 qualitative scientific articles. Results: The result is presented based on two themes with two subthemes, respectively. The first theme is "Positive Experiences", which includes two subthemes "Experiencing satisfaction, being seen and respected" and "Experiencing security and trust". The second theme is "Negative Experiences", which includes two subthemes "Experiencing abandonment" and "Experiencing lack of security and trust". Conclusion: Older patients with multiple diseases have a strong desire for staff presence and safety. The fact that healthcare personnel are professional and safe in their occupational role leads to older patients feeling safe, seen and respected. When healthcare personnel do not have sufficient knowledge and experience about the older patients’ health condition, older patients experience abandonment, insecurity and reduced confidence in healthcare personnel.

Le concept d’Hôpital Promoteur de Santé (HPS) a pris beaucoup d’importance depuis son élaboration vers la fin des années quatre-vingt. Dans le contexte de la dernière réforme, le réseau montréalais des HPS et CSSS a été créé. Le Centre Universitaire de Santé McGill (CUSM) fait partie de ce réseau depuis 2007. Cette étude vise la création d’un milieu hospitalier promoteur de la santé pour les patients et s’adresse à l’expérience d’un repas pour les personnes âgées nécessitant une diète purée. Une étude de cas qualitative a été utilisée pour explorer la perception de patients vis-à-vis les aspects relatifs à leur cabaret, l’assistance qu’ils recevaient et le contexte social de leur repas. Les impressions des professionnels de la santé quant à l’expérience des patients ont aussi été obtenues. Les résultats indiquent que l’identification difficile des aliments en purée, la saveur, l’apparence et la variété sont tous des éléments qui affectent négativement leur expérience repas. Des sentiments d’impuissance ont aussi été rapportés par les patients et les professionnels de la santé. Le contexte social du repas a été souligné comme étant un aspect à cibler pour améliorer l’expérience des patients. Un programme utilisant des purées formées pourrait contrecarrer les effets négatifs de la prescription d’une diète purée. Des changements dans les pratiques infirmières, à savoir la création d’une ambiance sociale agréable au moment des repas, semble être une option peu couteuse qui pourrait améliorer l’expérience repas des patients et diminuer les sentiments d’impuissance relevés par les professionnels de la santé à l’égard de cet aspect de soin. / The Health Promoting Hospital (HPH) concept has gained much momentum since its development in Europe in the late nineteen eighties. The Montreal network of HPH was created in 2005, within the context of the last reform. The McGill University Health Center (MUHC) is a part of this network since 2007. This study focuses on the creation of a health promoting hospital setting for patients and addresses the mealtime experience of older hospitalized patients requiring a puree diet. A qualitative case study design was used to explore patients’ perceptions of aspects of their puree meal tray, assistance provided by staff and the social context in which the meal was taken. Health professionals’ view of the patients’ experience were also obtained. Results indicate that the difficult identification of food items, flavour, appearance and variety were all important factors negatively affecting the mealtime experience. Feelings of loss of control were also reported by patients and staff. The social context in which the meal was taken was highlighted as an area which could be targeted to improve mealtimes. A program using formed puree food items could help lessen the negative impact of the prescription of a puree diet. Changes in nursing practices regarding the creation of a pleasant social atmosphere were identified as an inexpensive option to improve the mealtime experience for patients and decrease feelings of lack of control for staff in this aspect of care.

År 2030 beräknas var fjärde person i Sverige att vara 65 år eller äldre. Akutsjukvården är i dagsläget dåligt anpassad för att tillgodose de sköra äldres specifika behov. För att tillmötesgå de ökande behoven krävs nytänkande i omhändertagandet. Detta ställer stora krav på sjukvårdens kunskap om åldrandet och dess sjukdomar. Sjuksköterskan har en nyckelroll vid omhändertagandet av sköra äldre patienter genom att bedöma vårdbehov, utföra omvårdnadsåtgärder samt bidra till en trygg och säker vårdmiljö. Syftet med denna studie var att identifiera förbättringsområden i omhändertagandet av den sköra äldre patienten på akutmottagningen. Denna studie genomfördes med kvalitativ metod med induktiv ansats och fokusgruppsintervjuer. För att analysera datamaterialet har en kvalitativ innehållsanalys använts. I resultatet framkom en huvudkategori; ”För att tillmötesgå de ökade sköra äldres omvårdnadsbehov krävs av dagens akutvårdspersonal ökad förståelse och kunskap. Detta uppnås lämpligast på välbemannade akutmottagningar med god struktur”. Följande tre kategorier stöttar upp huvudkategorin; ”Tid och prioritering”, ”Förståelse och kunskap” samt ”Struktur”. Slutsatsen är att det finns förbättringsområden på akutmottagningen vid omhändertagandet av de sköra äldre patienterna. Studien visar behov av erfaren och intresserad personal som arbetar på personaltäta och strukturerade akutmottagningar där det finns möjlighet till fortbildning. / In 2030, every fourth person in Sweden is estimated to be 65 or older. Emergency care is currently poorly adapted to meet the specific needs of frail older people. In order to meet the increasing needs, new thinking is needed in the care. This places great demands on the healthcare knowledge about aging and its diseases. The nurse has a key role in the care of frail older patients by assessing care needs, performing nursing and contributing to a safe and secure caring environment. The aim of this study is to identify areas of improvement in the care of the frail older patient at the emergency department. This study was carried out with a qualitative method with inductive approach and focus group interviews. To analyze the data material, a qualitative content analysis has been used. In the result, a main category emerged; “To meet the increased frail older nursing needs, todays emergency care staff require increased understanding and knowledge. This is best achieved on well-manned emergency departments with a good structure”. The following three generic categories support the main category; “Time and priority”, “Understanding and knowledge” and “Structure”. The conclusion is that there are areas of improvement in the emergency department when handling the frail older patients. The study shows needs of experienced and interested staff who work on staff-tight and structured emergency department where there is the possibility of continuing education.