Abstract Type 2 Diabetes Mellitus (T2DM) is the seventh leading cause of death in the United States with a projected increase of 552 million people worldwide who will be affected with this illness by 2030. The need to address this issue is vital to prevent complications and reduce healthcare spending. The DNP project is aimed at planning and designing a nutritional education program tailored toward specific ethnic groups in order to increase knowledge in making healthy food choices. This project is intended to educate Registered Nurses (RNs) on nutrition so that they can offer dietary knowledge to T2DM patients. Additional patients can be reached by educating the RNs rather than patients being limited to consultations with a Certified Diabetes Educator or Registered Dietician. This project focused on whether healthy nutrition tailored toward the individual's own ethnic foods helps to stabilize glycemic values for patients with Type 2 diabetes. A toolkit was utilized to aid with the RNs' learning on healthy nutrition and its impact on the management of blood glucose. It addressed areas such as food groups and calories, grocery shopping, preparation methods, and portion control. The framework for design utilized the basic concepts associated with the systems theory with an intended goal to prevent further complications and improve patients' glycemic value through consuming nutritious foods. The logic model will be used to evaluate the impact of healthy nutrition on blood glucose through pre- and post-program tests of the RNs' nutritional knowledge on healthy eating. The continuation of this program will promote positive social change by helping patients to achieve a healthier lifestyle and reduce healthcare expenditures.

Background: “Nurses provide essential care to the millions of people who are hospitalized each year as a result of illness or injury” (Smith, 2012, p. 172). The Institute of Medicine reported approximately 44,000-98,000 patients die annually resulting from a medical error, and health care errors ranked among the top 10 for the leading causes of death in the United States (Smith, 2012). Problem: Nurse competence impacts safe and quality nursing, and several research studies investigated the measurement of nurse competence among nurses in various nursing settings (Flinkman et al., 2016). However, a review of the research revealed limited studies in the emergency department (ED) setting and in the United States (O’Leary, 2012). Method: This study implemented a quantitative nonexperimental research design using the combination of an instrumental case study and a cross-sectional survey for this study’s sample. An Internet-based SurveyMonkey questionnaire collected data on nurse competence from registered nurses (RNs) working in the ED at a San Francisco Bay Area hospital. Part I of the questionnaire integrated Meretoja, Isoaho, and Leino-Kilpi’s (2004) Nurse Competence Scale (NCS) consisting of 73 closed-ended clinical indicators divided into seven competence areas. Participants rated their level of competence and frequency of use for each clinical indicator. Part II of the questionnaire obtained background information about participants. A total of 21 out of 110 potential participants completed the survey. Results: The data analysis using Statistical Package for Social Sciences (SPSS) provided descriptive and nonparametric correlation statistics. Descriptive statistics described survey respondents. The least and most competent areas were ensuring quality and managing situations, respectively. The most frequent length of nursing experience was at least 60 months and the most frequent number of hours worked was at least 65 hours per 2-week period. Nonparametric correlation statistics, including Kendell’s tau-b and Spearman’s rho, identified significant relationships. A significant relationship existed between the frequency of using clinical skills and level of competence for four of the seven competence areas. A significant relationship existed between the background factor of experience, both as an RN and an ED RN, and level of competence for many clinical indicators. A significant relationship existed between the background factor of hours worked and level of competence for one clinical indicator. Conclusion: Despite the small sample size of 21 survey respondents, this study revealed findings consistent with the existing research on nurse competence. This study offers implications and recommendations for practice relative to nurse competence, nurse competence assessment, and transitions to new settings of nursing practice to support the nursing profession and safe and quality nursing.

No description available.

Bakgrund:Allt fler äldre människor i Sverige och Norge avlider idag på särskilda boenden, i stället för på sjukhus. Trots detta har den palliativa vården ingen etablerad grund inom denna vårdform. Målet med palliativ vård är att ge patienten ökad livskvalitet och minskat lidande, liksom att erbjuda de anhöriga stöd i processen. Detta kräver strukturerad vårdplanering och lämplig kompetens hos samtliga berörda yrkesgrupper som vårdar den boende. Syfte:Att undersöka sjuksköterskor och omvårdnadspersonals upplevelser av palliativ vård i livets slutskede inom särskilda boenden i Sverige och Norge.  Metod:Denna kvalitativa litteraturöversikt baseras på 11 kvalitativa originalartiklar av svenskt och norskt ursprung. Data från dessa artiklar har analyserats med tematisk innehållsanalys.  Resultat:Översikten visar på flera faktorer som ligger till hinder för att sjuksköterskor och omvårdnadspersonal ska kunna ge god palliativ vård till äldre på särskilda boenden. Den palliativa vården initieras för sent, ansvarsfördelningen är oklar och det saknas tydliga rutiner för hur vården ska utföras. Tre huvudteman återfinns i resultatet; organisation, relationer och döden. Slutsats:Så väl sjuksköterskor som omvårdnadspersonal beskriver flera kritiska brister inom äldreomsorgen och den palliativa vården för de äldre med komplex multisjuklighet. / Background:It is getting more common for elderlies in Sweden and Norway do die in nursing homes, rather than in the hospital. Despite this fact, the palliative care has no established basis in this line of care.  The main goal in palliative care is to help the patient to retain quality of life and to reduce suffering, as well as offering the relatives support in the process. That requires structured care planning and adequate competence in all professions involved in the patients care. Aim:To investigate registered nurses ´and nursing staff`s experiences of end-of life care in nursing homes in Sweden and Norway. Method:This literature review is based on 11 qualitative original articles of Swedish and Norwegian origin. The data from these articles were analysed with thematic content analysis. Results:The result shows several factors that prevent registered nurses and nursing staff to from providing good palliative care to the elderly in nursing homes. The palliative care is initiated too late, the division of responsibilities is ambiguous and the routines for palliative care are deficient. The result contains three main themes: organization, relations and death. Conclusion:Registered nurses as well as the nursing staff describe several critical deficiencies in the elderly care, and the palliative care for older patients with multimorbidity.

No description available.

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that affects women’s menstrual cycles, androgen (male hormones) levels, and cysts on the ovaries. This endocrine disorder has various symptoms, with insulin resistance as a hallmark symptom. Approximately 65-70% of women with PCOS have insulin resistance and hyperinsulinemia, whether or not they are overweight, obese, or lean (Marshall & Dunaif, 2012). Many women with PCOS struggle to lose weight because their excess weight is related to nutrition, lifestyle factors, and imbalanced hormones. Understanding PCOS as a metabolic disorder with nutritional implications led to investigating the potential benefit of having registered dietitian nutritionists (RDN) as part of the healthcare team of women with PCOS. We developed a survey based on the literature on PCOS, diet/nutrition interventions, and the role of RDNs in the healthcare team of PCOS women of childbearing age. Only childbearing-age women (18–44) diagnosed with PCOS were eligible to complete the survey. The survey was designed as a needs assessment to determine if women with PCOS are routinely referred to RDNs for support; whether or not such support is beneficial; and what gaps in knowledge or misconceptions about nutrition and PCOS exist among participants. Most importantly, it was designed to examine if women understand how nutrition relates to managing their PCOS symptoms and future disease risks. The data from this survey shows the need for RDNs on the healthcare team of women with PCOS and gives us an understanding of nutrition education interventions that could be developed for future studies. Understanding how RDNs play a role in symptom management could lead to a better quality of life for women with PCOS.

No description available.

No description available.

Bakgrund: Palliativ vård är en huvuddel av vårdkedjan som tillämpas till de döende patienter som kommit till livets slutskede. Palliativ vård innebär att vården syftar till att lindra lidandet istället för att vara behandlande och botande. Sjuksköterskor som vårdar dessa döende patienter har en centralt stödjande roll där syftet är att lindra och trösta patienter och deras anhöriga med målet att ge dessa patienter ett värdigt avslut på livet. Sjuksköterskor kan ha olika upplevelser och utmaningar under denna typ av arbete. Dessa upplevelser och utmaningar har undersökts i detta examensarbete i en vetenskaplig litteraturstudie. Syftet: Undersöka sjuksköterskors upplevelser av att vårda patienter vid palliativ vård. Metod: Systematisk litteratursammanställning av kvalitativa studier. Resultat: Denna litteraturstudie resulterade i en sammanställning av olika typer av utmaningar och känslor i arbetet med palliativ vård. Institutionella utmaningar som tidsbrist, kommunikationsbrist, informationsbrist och arbetsbelastningen bidrog till att sjuksköterskorna upplevde att de inte kunde utföra den palliativa vården på ett värdigt sätt. Det framkom även kunskapsbrist kring den palliativa vården som en viktig faktor till sjuksköterskornas osäkerhet kring utförandet av denna vårdform. Resultatet visade att det var utmanande för sjuksköterskorna att förmedla patientens önskan så som att påbörja palliativ vård när anhöriga och andra i vårdteamet såsom läkare hade andra uppfattningar. Slutsats: Grundutbildade sjuksköterskor behöver ytterligare kunskap kring palliativ vård under hela sitt professionella yrkesliv. Sjuksköterskor behöver även stöd från kollegor och arbetsgivare för att kunna hantera dessa svåra situationer. Bristande kommunikation har visat sig vara en stor del till att många utmaningar uppstått och förbättrad kommunikation visade sig även vara lösningen på många utmaningar. Den höga arbetsbelastningen bidrog till ohälsa för sjuksköterskorna och ett professionellt förhållningssätt var en tydlig förutsättning för deras goda hälsa samtidigt som stödet från högre instanser visat sig vara betydelsefullt. / Background: Palliative care is a central part of the care chain that is provided to the dying patients who have reached the end of life. Palliative care means that the care aims to alleviate the suffering instead of giving treatments and curative care. Nurses who care for these dying patients have a central supportive role where the purpose is to relieve and comfort patients and their relatives with the aim of giving these patients a dignified end of their life. Nurses might have different experiences and challenges during this type of work. These experiences and challenges have been examined in this degree project with the support of scientific literature studies. Aim: Examine nurses' experiences of caring for patients in palliative care. Method: A systematic literature revive of qualitative studies. Result: This literature study resulted in experiencing different types of challenges and emotions in the work with palliative care.  Institutional challenges such as lack of time, lack of communication, lack of information and the workload contributed to nurses feeling not being able to provide palliative care in a dignified manner. There was also a lack of knowledge about palliative care as an important factor of the nurses' uncertainty about the performance of this care. The results showed that it was challenging for the nurses to mediate the patient´s wishes, such as starting the palliative care, when relatives and other caregivers, such as doctors, had other aspects. Conclusion: Registered nurses need additional knowledge about palliative care during the entire professional life. Nurses also need support from colleagues and employers to be able to handle these difficult situations. Lack of communication has proven to be a source of many challenges and improved communication can be the solution to many challenges. The high workload contributed to health problems for the nurses and a professional approach was a clear prerequisite for their good health and the support from higher instances showed to be meaningful.

Aim:  The present study aimed to determine if foreign-born women from different countries of birth have a greater risk of GDM compared to Swedish-born women and to what extent income might mediate this relationship. Methods: This cross-sectional type study included 835279 women, of which 151,642 were foreign-born and 683637 were Swedish-born women who gave birth to their first singleton child in Sweden between 1997 to 2016. Register data from the Swedish Medical Birth Register, the Swedish Total Population Register, and the Longitudinal Integrated Database for Health Insurance and Labour Market Studies was used. Multiple Logistic Regression analysis and the Karlson-Holm-Breen methods were used to explore the relationship between GDM and country of birth and to estimate the proportion of the association explained by income. Results:  Foreign-born women demonstrated higher odds ratios for developing GDM than Swedish-born women. South East Asian women showed the highest risk of GDM (OR: 4.40, CI: 4.01-4.81) followed by Africa (OR: 3.42, CI: 3.07-3.81) and Middle East & North Africa (OR: 2.92, CI: 2.67-3.20) respectively. Income partially explained the risk of GDM differences between foreign-born and Swedish-born women, accounting for 26% of the association. However, the proportion explained by income varies from 8.9% to 23.0% by country of birth. Conclusions:  A disparity exists in the risk of GDM based on country of birth, and Foreign-born women are more likely to have GDM and need additional support, including prenatal care and treatment. Since income only partially explains this association, other factors that may explain the association need to be explored.