<p>Konfusion är mycket vanligt förekommande hos äldre och skapar stort lidande, ger höga samhällskostnader och orsakar hög mortalitet. Syftet med studien var att belysa sjuksköterskans icke farmakologiska omvårdnadsåtgärder vid konfusion hos äldre patienter. Metoden var en litteraturstudie, vilken innefattade tio artiklar där relevanta omvårdnadsåtgärder framkom, dessa presenterades i resultatet under VIPS - modellens åtgärdssökord. Resultatet av studien visade att patienter med konfusion mindes och uppmärksammade vad som skedde med och runt omkring dem. Viktigt var att få information om sitt konfusionstillstånd för att förstå vad som hände och varför. Samspelet mellan sjuksköterska och patient var av stor vikt. Återorientering av patienten var vanligt och ansågs oftast ha positiv effekt. Att bekräfta patientens upplevelse, och att visa omtanke och förståelse var väl fungerande stöd. Kontinuitet av personal, att eliminera bakomliggande orsaker och att främja god sömn var av stor betydelse. Vanligt förekommande var tvångsåtgärder för att skydda patienten från att skada sig själv och andra. Musik och ljusterapi togs upp som omvårdnadsåtgärder. Även närstående hade en stor roll vid omvårdnaden av patienten med konfusion. Relativt lite forskning finns inom området konfusion, i synnerhet gällande omvårdnadsåtgärder i samband med konfusionstillståndet. Behov av ytterligare forskning föreligger inom området. //</p><p>Confusion is quite common among elderly and creates great suffering, high cost for social services and high mortality. The purpose of this study was to highlight the non-pharmacological actions in care provided by nurses to elderly with confusion. The method was a literature study, based on ten articles containing relevant care measures where the result is presented in the VIPS-model’s keywords. The result of the study showed that patients with confusion remembered and registered what was happening around them. It was important for the patient to obtain proper information regarding the state of confusion to understand what is happening. The teamwork between nurse and patient is of great importance. Re-orientation of patient was common and mostly considered to have a positive effect. Important support by the nurse is to confirm the patient’s perception by showing concern and understanding. Other key concepts where continuity of staff, eliminate underlying causes, facilitate good sleep. It was common with supervision and constrainer to protect the patients from harming themselves and others. Music and light therapy were mentioned as care measures. Relatives also played an important part in treating a patient with confusion. There is relatively little research regarding confusion especially with focus on suitable care actions. There is a need of further studies in this matter.</p>

Konfusion är mycket vanligt förekommande hos äldre och skapar stort lidande, ger höga samhällskostnader och orsakar hög mortalitet. Syftet med studien var att belysa sjuksköterskans icke farmakologiska omvårdnadsåtgärder vid konfusion hos äldre patienter. Metoden var en litteraturstudie, vilken innefattade tio artiklar där relevanta omvårdnadsåtgärder framkom, dessa presenterades i resultatet under VIPS - modellens åtgärdssökord. Resultatet av studien visade att patienter med konfusion mindes och uppmärksammade vad som skedde med och runt omkring dem. Viktigt var att få information om sitt konfusionstillstånd för att förstå vad som hände och varför. Samspelet mellan sjuksköterska och patient var av stor vikt. Återorientering av patienten var vanligt och ansågs oftast ha positiv effekt. Att bekräfta patientens upplevelse, och att visa omtanke och förståelse var väl fungerande stöd. Kontinuitet av personal, att eliminera bakomliggande orsaker och att främja god sömn var av stor betydelse. Vanligt förekommande var tvångsåtgärder för att skydda patienten från att skada sig själv och andra. Musik och ljusterapi togs upp som omvårdnadsåtgärder. Även närstående hade en stor roll vid omvårdnaden av patienten med konfusion. Relativt lite forskning finns inom området konfusion, i synnerhet gällande omvårdnadsåtgärder i samband med konfusionstillståndet. Behov av ytterligare forskning föreligger inom området. // Confusion is quite common among elderly and creates great suffering, high cost for social services and high mortality. The purpose of this study was to highlight the non-pharmacological actions in care provided by nurses to elderly with confusion. The method was a literature study, based on ten articles containing relevant care measures where the result is presented in the VIPS-model’s keywords. The result of the study showed that patients with confusion remembered and registered what was happening around them. It was important for the patient to obtain proper information regarding the state of confusion to understand what is happening. The teamwork between nurse and patient is of great importance. Re-orientation of patient was common and mostly considered to have a positive effect. Important support by the nurse is to confirm the patient’s perception by showing concern and understanding. Other key concepts where continuity of staff, eliminate underlying causes, facilitate good sleep. It was common with supervision and constrainer to protect the patients from harming themselves and others. Music and light therapy were mentioned as care measures. Relatives also played an important part in treating a patient with confusion. There is relatively little research regarding confusion especially with focus on suitable care actions. There is a need of further studies in this matter.

Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the quality of documentation of patient care in nurses' notes in a home health agency in central Texas. A retrospective audit of quality of nursing documentation using the Nurse and Midwifery Content Audit Tool (NMCAT) was done. A pre- and posttest design was used. A convenience sample of de-identified nurses' notes (80 pre- and 80 post) was selected from active patient records in the agency (n = 160). Descriptive and inferential statistics from the project showed that there was improved quality for the 15 criteria representing quality nursing documentation. After the educational intervention, documentation of patient's status if changed or unchanged improved to 80%, and patient's response to treatment improved (57% to 85%), entries were written as incidents occurred improved (53% to 64%). The nurse refers to the patient by name improved (0% to 66%). These findings were an indication of practice change, validating the need for periodic audits of nurses' notes in the agency in order to demonstrate compliance with quality standards. Based on the project findings, a retraining program is recommended to improve structured nursing documentation in a home health agency. This project is likely to contribute to social change as it enhanced the information communicated to other health care providers, coordination of care, and patient outcomes.

Bakgrund. Miljön på intensivvårdsavdelningen är fylld av olika stimuli i form av ljud och ljus. Sjuksköterskorna arbetar bedside och täta omvårdnadsåtgärder är nödvändiga för dessa kritiskt sjuka patienter. Denna miljö lämnar en liten möjlighet för sömn och vila. För att patienterna ska få möjlighet till vila under dagtid har vissa intensivvårdsavdelningar lagt in en period med mindre aktivitet, tysta timmen, också kallat patientvila. Målet med patientvilan är att erbjuda patienterna en timme med ostörd vila under dagtid. Syfte. Att undersöka patienternas möjlighet till vila under dagtid genom att observera antal utförda omvårdnadsåtgärder enligt VIPS sökordsmodell. Metod. En icke-deltagande strukturerad observationsstudie utfördes. Observationsprotokoll utformades med VIPS-sökordsmodell. Studien utfördes på två intensivvårdsavdelningar i Mellansverige, IVA 1 och IVA 2. Observationerna utfördes under åtta dagar. Observatörerna registrerade allt som skedde runt patienterna mellan klockan 12.00 – 13.00, då patientvilan ägde rum. Resultat. Totalt observerades 19 patientplatser på IVA 1 och IVA 2. Under de åtta tillfällen som observerades registrerades totalt 158 störningar, 101 av dessa störningar skedde på IVA 2 och 57 störningar skedde på IVA 1. Antalet störningsmoment per patient under patientvilan varierade från en till 18 stycken. På IVA 1 var de vanligaste störningsmomenten läkemedelshantering samt speciell omvårdnad. Miljö fick mest punktmarkeringar på IVA 2. Den enda åtgärden som inte förekom var träning. Totalt 152 störningsmoment utfördes av vårdpersonal. Slutsats. Patienterna blir störda under patientvilan med en mängd olika omvårdnadsåtgärder. Vissa åtgärder är nödvändiga och svåra att undvika, andra åtgärder hade kunnat prioriteras annorlunda. Klinisk betydelse. Att öka medvetenheten hos personalen angående betydelsen av sömn och vila för patienterna på intensivvårdsavdelning. / Background. The environment at the ICU (Intensive Care Unit) is filled with different stimuli of sound and light. Nurses work bedside for the critically ill patients, and frequent nursing interventions are required. This environment gives little possibility for sleep and rest. It is important to make sure that the patients will have the possibility to get sufficient amount of rest during the day. Some ICUs have addressed this by applying less activities during one hour per day, patient resting or quiet time. Purpose. To investigate patients' ability to rest during the day, by observing the number of performed nursing interventions according to the VIPS-model. Method. A non-participating structured observational study was performed. The observation protocol was designed with the VIPS-model. The study was conducted in two ICUs in central Sweden, ICU 1 and ICU 2. The observations were carried out during eight days. Observers registered everything that happened around the patients between the hour of 12:00 to 13:00, when the quiet time took place. Results. A total of 19 patients were observed on ICU 1 and ICU 2. A total of 158 interruptions were observed, 101 of these interruptions occurred in the ICU 2 and 57 interruptions occurred in the ICU 1. The number of interruptions during the quiet time varied from one to 18 distractions. The most common interruptions, for the ICU 1, were medication and special care. The environment was the most common distraction at the ICU 2. The only intervention that didn´t occur was training. A total of 152 distractions were performed by health professionals. Conclusions. The patients are disturbed during quiet time, with a variation of nursing interventions. Some interventions could have been prioritized differently, but other interventions were necessary and difficult to avoid. Relevance to clinical practice. To increase awareness among staff regarding the importance of sleep and rest for patients in ICU.

Bakgrund: Omvårdnadsepikrisen är den utskrivningsanteckning som sammanfattar viktiga händelser under en patients vårdtid rörande omvårdnadsfaktorer när vårdepisoden tagit slut. Termen omvårdnadsepikris ingår som ett så kallat huvudsökord i den svenska dokumentationsmodellen VIPS. Denna modell har tagits fram för att ge stöd åt de olika delarna av omvårdnadsprocessen. Neuropsykiatriska kliniken, avd 1 (NP) vid Universitetssjukhuset Malmö Allmänna Sjukhus (UMAS) genomför ett fortlöpande utvecklingsarbete gällande utformningen av omvårdnadsepikriser vari denna studie ingår som en del.Syfte: Att undersöka vilken betydelse omvårdnadsepikrisen utfärdad av NP har som underlag i det fortsatta omvårdnadsarbetet för sjuksköterskor verksamma inom hemsjukvård, särskilda boenden samt korttidsboenden. Metod: Kvalitativt och kvantitativt utformad enkätstudie baserad på ett strategiskt urval och presenterat med hjälp av en deskriptiv analysmetod. Totalt deltog 18 respondenter.Resultat: Sjuksköterskorna använder omvårdnadsepikrisen utfärdad av NP som ett underlag i den fortsatta omvårdnadsplaneringen. Detta motiverades bland annat med argumenten att det är viktigt att få bakgrundsinformation om patienten för att lättare kunna möta dess omvårdnadsbehov.Slutsats: De sjuksköterskorna som ingår i studien använder NP:s omvårdnadsepikriser som ett underlag för planering av det dagliga omvårdnadsarbetet. Att dessa sjuksköterskor tycker att NP:s omvårdnadsepikriser är till hjälp vid den fortsatta omvårdnadsplaneringen kan också utläsas. Eftersom studiens svar i princip bara behandlar åsikter om just NP:s omvårdnadsepikriser kan resultatet inte överföras såsom gällande för andra avdelningar inom slutenvården. Viss generalisering för undersökt poulation, det vill säga kommunala vårdboende som tar emot eller potentiellt kan ta emot patienter från NP, bör dock kunna göras. / Background: The note that summarizes important events regarding nursing factors during a patients care episode, after the episodes’ ending, is the nursing discharge note. The term nursing discharge note is a part of the Swedish nursing documentation model VIPS which is a model containg of different headwords, where of the nursing discharge note is one. The model has been developed to support the different parts of the so called nursing process. The Neuropsychiatric clinic, department 1 (NP) at the university hospital Universitetssjukhuset Malmö Allmänna Sjukhus (UMAS) is carrying out continuous work to develop their nursing discharge note where of this study can be seen as one part. Aim: To investigate what importance the nursing discharge note written by NP has as a base in the continuous daily care planning performed by nurses in homecare or at different kinds of livings for patients in municipal geriatric care. Methods: A qualitative and quantitative questionnaire study based on a strategic sample and presented with a descriptive method of analyzes. In total 18 informants participated.Results: The nurses participating in this study use the nursing discharge note written by NP as a base in their continuous daily care planning. The importance of knowing the background information about a person to easier meet his need as a patient was mentioned as one of the reasons.Conclusions: The nurses participating in this study use the nursing discharge note from NP as a base for their daily care planning. It can also be understood that these nurses find that the nursing discharge note from NP is helping them in their care planning. The results from this study cannot be used as a guideline for other departments within hospital care as it only focuses on NP’s nursing discharge note. Though, within the investigated population, a certain generalization could be possible to do.

Background Swedish nurses are required by law to document nursing care. Studies have proved scarce in nursing documentation with regard to written language, the nursing process and the nurse´s caring perspective. Educating nurses in using the VIPS model have improved nursing documentation. Few studies have included nursing documentation of psychiatric care. Aim The aim of this study was to describe nursing documentation within psychiatric care of inpatient settings. Method A quantitative, retrospective descriptive research design was applied. A total of 60 nursing journals from a psychiatric department of six wards were studied. Data was audited using the Cat-ch-Ing audit instrument that comprises 22 questions reflecting various issues relating to the VIPS model and the nursing process. Measurements of quantity and quality were evaluated for each question using a 4-point scale. Results The nursing documentation showed a better quantity and quality at the patients’ admission for care than the remaining documentation, long duration of hospital stay indicated better quantity of documented nursing diagnoses and nursing interventions, all of the wards showed a poorly quantitative documentation of status after admission for care as well as nursing care plans. Conclusion The nursing documentation within psychiatric care of inpatient settings of one department showed an inadequate documentation of nursing both quantitatively and qualitatively. The nursing care of the patient was neither described nor evaluated. Clinical implications The results suggest that strategies for improving nursing documentation will be needed in the future. In addition, further education in using the VIPS fully can be a means to enhance the nurses’ documentation.