Inguinal hernia repair (IHR) is a common ambulatory surgery procedure performed in Canada, after which many patients experience moderate to severe pain. Limited research has been found that examines interventions to reduce pain following ambulatory surgery, and none specifically for patients undergoing IHR. This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following this ambulatory surgery. Participants (N= 82) were randomized to either the intervention or usual care group pre-operatively in the pre-admission clinic. The HREI included a booklet about managing pain and face-to-face session to discuss its content, and two telephone support calls (before surgery and 24 hours after surgery). The primary outcome was WORST 24 hour pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain–related interference with activities, pain quality, analgesics taken, and adverse effects at post-operative days 2 and 7. At day 2, the intervention group reported significantly lower scores for all pain intensity outcomes, including WORST 24hr pain on movement (t (df) = 4.7 (73), p< 0.001), WORST 24 hr pain at rest (t (df) = 3.8 (73), p < 0.001), pain NOW at rest (t (df) = 3.3 (73), p = 0.001) and on movement (t (df) = 3.4 (73), p = 0.001). Also on day 2, pain-related interference scores for the intervention group were lower than the usual care group but not significantly different with the bonferroini correction (t (df) = 2.1 (73), p=0.04). The intervention group took significantly fewer opioids on day 2 (t (df) = 3.0 (73), p=0.004). Although there were no differences in any of the pain or interference outcomes on day 7, 36% (n=26) of the total sample reported moderate-severe pain at day 7. Constipation was the adverse effect identified most often, by both groups, on both days 2 and 7.This intervention was effective at post-operative day 2 but revisions need to be made to the intervention to assess for outcomes over a longer period of time.

Inguinal hernia repair (IHR) is a common ambulatory surgery procedure performed in Canada, after which many patients experience moderate to severe pain. Limited research has been found that examines interventions to reduce pain following ambulatory surgery, and none specifically for patients undergoing IHR. This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following this ambulatory surgery. Participants (N= 82) were randomized to either the intervention or usual care group pre-operatively in the pre-admission clinic. The HREI included a booklet about managing pain and face-to-face session to discuss its content, and two telephone support calls (before surgery and 24 hours after surgery). The primary outcome was WORST 24 hour pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain–related interference with activities, pain quality, analgesics taken, and adverse effects at post-operative days 2 and 7. At day 2, the intervention group reported significantly lower scores for all pain intensity outcomes, including WORST 24hr pain on movement (t (df) = 4.7 (73), p< 0.001), WORST 24 hr pain at rest (t (df) = 3.8 (73), p < 0.001), pain NOW at rest (t (df) = 3.3 (73), p = 0.001) and on movement (t (df) = 3.4 (73), p = 0.001). Also on day 2, pain-related interference scores for the intervention group were lower than the usual care group but not significantly different with the bonferroini correction (t (df) = 2.1 (73), p=0.04). The intervention group took significantly fewer opioids on day 2 (t (df) = 3.0 (73), p=0.004). Although there were no differences in any of the pain or interference outcomes on day 7, 36% (n=26) of the total sample reported moderate-severe pain at day 7. Constipation was the adverse effect identified most often, by both groups, on both days 2 and 7.This intervention was effective at post-operative day 2 but revisions need to be made to the intervention to assess for outcomes over a longer period of time.

Introduction - India is beginning to resemble the western worlds’ way of living and that leads to an increased risk of chronic diseases such as diabetes. Due to its very large population India has the world second largest number of people with diabetes; 61, 3 million people. Studies have shown that the awareness of diabetes is poor, especially in rural areas. Aim - To investigate nurses’ experience of applying professional competence in patient education with focus on diabetes type II in an Indian rural hospital. Method – Data was gathered through twelve qualitative interviews. The interviews were tape recorded, transcribed verbatim and then analyzed through content analysis. Result – Three main categories were identified; Acquired competence to meet the patients, Helping the patients manage their disease and Nurses’ ideas for quality improvements regarding diabetes care. Conclusion - This study identified different obstacles that could have a negative effect on the care and treatment of patients with diabetes type II. The nurses had many ideas for quality improvements which could raise the awareness of the disease among patients, improve clinical outcomes and the work environment for the nurses. The nurses are willing to get more education about the disease and implement quality improvements if the resources and equipment are provided by the hospital.

Dissatisfaction with medical information is a common problem among patients. There is also evidence that patients lack information that physicians believe they have given to the patient. The aims of this study were to 1) survey patients' subjective need for, and satisfaction with, the information that they received during their hospital stay 2) develop and evaluate systematic routines for giving information to the patients and also communication and collaboration between the medical and nursing staff concerning the satisfaction of the patients' need for information. The study was an intervention project and the research perspective was organizational psychology. Survey study. The patients experienced a considerable need for medical information, especially about the examination results and prognosis. The patients' need for information regarding prognosis was the least satisfied. Intervention 1. A general improvement of the information to the patients occurred when the systematic routines were established. The patients' subjective need for information was unchanged throughout two years. Their satisfaction with information, after an initial improvement, did not increase throughout these two years. There was low correlation between the patients' and their physicians' estimations concerning the patients' need for information on diagnosis, prognosis and examination results. Likewise, concerning the adequacy of that information. Intervention 2. Communication and collaboration between the medical and nursing staff included a system for assessment and solution of the patients' information problems. Problem-solving took place at a multidisciplinary team conference (MTC). Medical problems were better elucidated than the patients' psychological problems. After training of registered nurses (RN) as conference chairpersons, the patients need for information was better understood. The staff reported 42 information problems after training compared to two before. For half of the information problems decisions were discussed on steps to be taken in order to satisfy the patients' need for information. A year after the system for assessment and solution of information problems was established, the patients were more satisfied with information about examinations and their results and on information about medication (p&lt; 0.05). Further, new norms for the patients' need for information were established and a change was initiated. The results are discussed with regard to how and why patients' shall have information, by whom and to whom information shall be given, when and where information shall be given and which content it shall have. / <p>S. 1-56: sammanfattning, s. 57-137: 4 uppsatser</p> / digitalisering@umu

Background: Exclusively breastfeeding a child during the first six months of life reduces the risk of mortality by 14 times. 42 % of mothers in Indonesia breastfed their infant exclusively in 2012. It is the registered nurses´ responsibility to provide information about consequences of their decision to the patient. Aim: The aim of this study was to investigate how registered nurses describe how they provide patient education about breastfeeding to newly delivered mothers and how registered nurses experience their role as a patient educator. Method: It was an empirical, qualitative study based on a focus group interview with four registered nurses and two midwives. The interview was based on a semi-structural interview design. The focus group interview was transcribed and analyzed using a qualitative content analysis. Result: Three major themes were found in this study, “strategically using different techniques while educating”, ”patient and family centered care” and “the registered nurse as a significant source of knowledge”. The first theme describes how the registered nurses used different techniques to encourage the mothers to breastfeed. The second theme describes the importance to include the entire family in the education and to adjust the education depending on the patient. The third theme describes how the registered nurses saw themselves as significant sources of knowledge and that it was their responsibility to provide evidence-based knowledge. Discussion: All registered nurses and midwives described the importance of evaluating the education. Families had a great influence over the patient in the Indonesian culture, hence, it was crucial to involve them in the education. The registered nurses felt that they were in the right position to give crucial information and education about breastfeeding.

Effective treatment of heart disease and an aging population have led to increases in the incidence of heart failure. Treatment requires complex medication regimes and recognition of symptoms. Best practice guidelines published by the American, European and Canadian cardiac societies promote self-care behaviours and skill building. No concrete examples of education programmes for clients were found in the literature. The purpose of the study was to develop, pilot and evaluate an education series for clients with heart failure within a primary care setting. “LEARN twice”, a three part education series with related resource material, was developed in the context of inter-professional collaboration and drew upon theories of health education, and literacy. The concept of co-management was incorporated as the philosophical basis in the design. The pilot-test used an experimental design, and incorporated pre and post-testing with standardized instrumentation including the Dutch Heart Failure Knowledge Scale and the Minnesota Living with Heart Failure Questionnaire. To pilot the education series, participants attended three education classes highlighting the essential skills for self management of heart failure. A qualitative descriptive component included brief semi-structured interviews with participants and educators to provide feedback about both the process and content of the educational series. Limited participant numbers did not permit statistical testing, however potentially promising results were found in the quantitative data collected. Descriptive participant data indicated that the education series was meaningful, and helped iii understanding of symptoms. Instructors rated the content as good to excellent and anticipate the adoption of the education series as standard practice in the clinic. The pilot test of the education series has provided a foundation for future research endeavours, in particular the replication and completion of this study protocol. As clients with heart failure have the potential to be in regular contact with a primary care provider, subsequent studies could include a longitudinal component to examine whether rates of re-hospitalization are reduced for clients who attend an education series.

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Preoperative instruction has been documented to benefit patients. With recent health care changes, most patients are now admitted to the hospital on the day of surgery. The optimal time for preoperative instruction requires re-examination. This study evaluated differences in anxiety levels of patients who received structured preoperative instruction prior to hospital admission and patients who received unstructured preoperative instruction after admission on the day of surgery.Roy's Adaptation Model guided this study. The state scale of the State-Trait Anxiety Inventory (STAI) measured anxiety in a convenience sample (n=40) admitted for same-day surgery. Participants in one group received structured preoperative instruction 1-7 days prior to surgery. Participants in a second group received unstructured preoperative instruction on the day of surgery. All participants completed the STAI 1-7 days before surgeryand on the morning of surgery. Paired t-tests on difference scores showed no significant difference in anxiety between the groups. / School of Nursing

Patient education has become more important in decreasing patient anxiety about surgery. The purpose of this study was to examine the effects of two methods of teaching instruction on 2 groups of surgical patients (25 in each group): traditional (film and interview) and traditional plus nurse teaching-coaching on anxiety scores on two groups of surgical patients. Sister Callista Roy's Adaptation Model (1984) was the conceptual framework for this study.The research questions are a) "Are there significant differences between preoperative and postoperative scores on State Anxiety between two groups of surgical patients using two methods of preoperative instruction: traditional preoperative teaching and traditional preoperative teaching plus nurse teaching-coaching interventions" and b) "Are there significant differences in pre- and postanxiety scores of men and women?"State anxiety was measured by Form Y-1 of the State-Trait Anxiety Inventory by Speilberger, Gorsuch, & Lushene (1983). The nurse teaching-coaching intervention was performed in a 30 minute session that focused on content covered in the traditional preoperative teaching. Procedures for the protection of human subjects were followed.Findings of this study showed that no significant differences between pre- and post- anxiety scores for two groups of surgical patients, regardless of the method of instruction. There was, however, a significant difference between pre- and post- scores for two groups of surgical patients in regards to men and women. Women had greater levels of anxiety before surgery and greater decreases postoperatively than did men.Conclusions indicated that further research is needed to demonstrate the effectiveness of the nurse teaching-coaching intervention on decreasing anxiety levels of surgical patients. The nurse teaching-coaching intervention warrants strong consideration for further study and use in nursing practice in assisting in recovering from surgery. / School of Nursing

Seeking cancer information is key in coping with the feelings (e.g., fear, uncertainty) and other challenges (e.g., treatment decision-making) confronting individuals diagnosed with cancer. Despite recognition of a variation in why, when, how, and where individuals diagnosed with cancer seek information, few efforts have been made to systematically document patterns in information-seeking. Aim: To explore individuals' patterns of health information-seeking behaviors (HIS B) including the type, amount, and sources ofinforn1ation and the strategies used to process and/or manage cancer information. / La recherche d'information sur Ie cancer est d'une importance determinante pour les personnes atteintes de cette maladie dans Ie contexte OU elles ont gerer des emotions intenses (p. ex. : peur, incertitude) et font face plusieurs defis (p. ex. : processus de decision relatif au traitement). Des variations concernant la recherche d'information par les individus diagnostiques avec un cancer ont ete observees et reconnues notamment en termes des raisons qui motivent la recherche d'information et des moyens utilises pour obtenir l'infomlation desiree. Cependant, a ce jour, peu d'efforts ont ete deployes pour documenter de maniere systematique les differents types de comportements de recherche d'information.