AIMS AND OBJECTIVES: To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission.

BACKGROUND: Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients.

DESIGN: A mixed-methods convergent design.

METHODS: Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research.

RESULTS: Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients.

CONCLUSIONS: These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety.

RELEVANCE FOR CLINICAL PRACTICE: The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

BACKGROUND: Nurses’ working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees’ behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions.

OBJECTIVE: To investigate the relationship between nurses assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress.

METHODS: A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed.

RESULTS: The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254–0.268. Significant differences in self-efficacy were found in the grouped working conditions.

CONCLUSIONS: This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.

Since individual and societal expectations regarding the possibility of an extended working life after the expected retirement age are increasing, research on sustainable working life combined with healthy ageing is needed. This study explores the incentives behind and experiences of an extended working life after the expected retirement age of 65 among Swedish people. The inductive qualitative content analyses are based on 18 individual semi-structured interviews among persons 67–90 years old with varying characteristics and varying experiences of extended working lives. The analyses revealed that working contributed to (1) sustained internal resources, i.e., cognitive function, physical ability and increased vigor; (2) sustained external resources, i.e., social enrichment, better daily routines and economic benefits; (3) added meaningfulness to life, i.e., being needed, capability and satisfaction with working tasks. Meanwhile, having flexible working conditions enabled a satisfying balance between work and leisure. Altogether, these different aspects of overall health and working life were interpreted as contributing to increased feelings of vitality, the innermost dimension of health. Conclusions: regardless of biological age, our results indicate that being able to remain active in working life can be beneficial to vitality and could make these results valuable for both health-care personnel and employers.

BACKGROUND:In most Western countries, senior workers have increased their participation in the workforce. However, at the same time, early retirement also increases. The reasons behind this early exit from the workforce are still unclear.

OBJECTIVE:This qualitative study aims to explore the antecedents of and experiences with a voluntary exit from working life before the expected retirement age of 65 in Sweden.

METHODS:Data consist of semi-structured interviews with 18 participants who exited working life between the ages of 61–63. In Sweden, these ages are considered as an early exit from working life since, for many years, the expected retirement age has been 65. Qualitative content analysis with an abductive approach was utilized.

RESULTS:The analysis revealed four sub-themes: 1) Health benefits with an early exit from working life (with the categories: own health status, the possibility for recovery time, and avoidance of strain); 2) Having economic conditions that enable an early exit from working life (with the categories: offers from the employer and financial compromises); 3) Social benefits with an early exit from working life (with the categories: enabling more time with my social network and avoidance of unsatisfying social work environment); 4) Self-fulfillment activities during the senior years (with the categories: enabling time for activities beyond work and avoidance of decreased job satisfaction.

CONCLUSION:This variety of antecedents of and experiences with a voluntary early exit from working life before the expected retirement age highlights that the ongoing increased statutory retirement age also increases the risk for extended inequalities among the aging population.

Background. A crucial factor for social sustainability is equal health and social justice. With an aging population andincreased expectations on senior workers to prolong their working life, research focusing on sustainable working life incombination with healthy aging is needed.

Purpose. To explore factors related to and experiences of prolonging working life after the expected retirement age of65 among Swedish people.Methods. Cross-sectional and longitudinal data were used to assess associations with participation in working life atages 66 and 72. Additionally, qualitative data, based on 18 individual semi-structured interviews with workers 67–90years were used to gain an extended understanding of incentives for prolonged working life.

Findings. Male gender and profession were associated with participating in working life at age 72, additionally, fewerdiagnosed diseases and a light level of physical activity at work at 66. Senior workers described that workingcontributed to sustained internal and external resources, added meaningfulness to life and flexible working conditionsenabled a satisfying balance between work and leisure. Altogether, these different aspects of working life wereinterpreted as contributing to increased feelings of vitality, the innermost dimension of health.

Conclusion. Regardless of biological age, being able to remain active in working life can be beneficial to vitality.Actions to provide flexible working conditions, especially for disadvantaged senior workers, may facilitate working lifeafter the expected retirement age with extended equality.

There is a lack of research exploring emotional commitment to work in relation to eating attitudes. Since eating disorders are associated with adverse psychological and social consequences, work engagement could be affected. The purpose was to compare work engagement among women with and without disturbed eating (DE).

A cross-sectional survey using the Utrecht Work Engagement Scale and the Eating Disorder Examination Questionnaire in a general population cohort of 26-36-year-old women (n=847). Threshold for DE was 1 SD above general population mean. Independent t-test was used to compare work engagement. Ethical approval (reg no:2014/401)

The level of work engagement was lower (p=0.02) among women with DE (mean 3.69 +-1.43) than women without DE (mean 4.06 +-1.18). The score for dedication was also lower (p=0.02) within the DE group (mean 3.74+-1.57 vs 4.22 +-1.26). However, vigour and absorption were not different.

The work engagement in the cohort was within the average range although women with DE had significantly lower emotional commitment to work. As work engagement is linked to business success, workplace growth and sustainability it seems important to explore tailored strategies to improve work engagement among women with DE.

AIMS AND OBJECTIVES: The aim was to examine significant factors for work attractiveness and how these differ from the current work situation among operating department nurses. A second objective was to examine the associations between age, gender, length of employment, work engagement, work ability, self-rated health indicators and attractiveness of the current work situation.

BACKGROUND: The attractiveness of work is rarely taken into account in research on nurse retention. To expand this knowledge, it is relevant to examine factors that make work attractive and their associations with related concepts.

DESIGN: Correlational, cross-sectional survey using a convenience sample.

METHODS: Questionnaires were answered by 147 nurses in four operating departments in Sweden. Correlation and regression analyses were conducted.

RESULTS: The nurses rated the significance of all factors of work attractiveness higher than they rated those factors in their current work situation; salary, organisation and physical work environment had the largest differences. The most significant attractive factors were relationships, leadership and status. A statistically significant positive correlation between work engagement and attractive work was found. In the multiple regression model, the independent variables work engagement and older age significantly predicted work attractiveness.

CONCLUSIONS: Several factors should be considered in the effort to increase work attractiveness in operating departments and thereby to encourage nurse retention. Positive aspects of work seem to unite work engagement and attractive work, while work ability and self-rated health indicators are other important dimensions in nurse retention.

RELEVANCE TO CLINICAL PRACTICE: The great discrepancies between the significance of attractive factors and the current work situation in salary, organisation and physical work environment suggest ways in which work attractiveness may be increased. To discover exactly what needs to be improved may require a deeper look into the construct of the examined factors.

Background

Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes.

Objectives

To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management.

Design

Cross-sectional audit. Participants Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. Measurements The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management.

Results

The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres.

Conclusions

These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation.

Basic trained nurses experience to start working on a children’s ward

The aim of the study was to describe nurses trained to a basic level experience of starting work on a children's ward. A qualitative study has been conducted with a purposively drawn sample of informants. Semi-structured interviews were conducted with eight basic trained nurses. Data were analyzed using qualitative content analysis. The results showed that respondents felt that the pediatrics course is not preparing for the professional work with children. Most felt that it was through real situations in the workplace that they gained necessary knowledge. Furthermore, it was found that only a few were satisfied with the induction. Spending time with many different supervisors was an important factor for experiencing dissatisfaction with the induction. Good support was received from employees; however the support of the organization was poor. Conclusion: Today's undergraduate education in nursing does not include enough pediatrics to prepare students for professional work with children and adolescents. Actions at individual and workplace levels are needed to increase knowledge of the basic trained nurse. Continuity and support during the induction is important for newly employed nurses to feel competent in their work.

The field of nursing has consistently upheld a strong sense of ethical awareness, which can be assumed to be reflected in the performance of nursing research. Adhering to sound research principles involves prioritizing research integrity. This entails being clear and open in detailing the methods used, allowing others to have confidence in both the methods and the resulting outcomes. This methodological review aimed to provide an overview of how statistical software programs have been reported in nursing studies. We screened articles published in the year 2023 in the five top-ranking and the five bottom-ranking nursing journals and found 311 that were eligible for this review; that is, quantitative/mixed-methods/meta-analyses. The most commonly used statistical software programs in these articles was IBM SPSS Statistics, followed by R. However, one out of 10 studies did not report the software used. Among those that reported the software, the software version was not always reported. Our findings suggest that there is insufficient reporting on the statistical software used for analysing quantitative data in nursing journal publications. From a perspective of maintaining research integrity, this presents an issue, as it jeopardizes transparency, sincerity, and, consequently, the ability to replicate methods and have confidence in the results.

OBJECTIVE

Depressive symptoms are commonly noted in patients on hemodialysis treatment. The objective of the present study was to evaluate the psychological care of patients receiving in-center hemodialysis treatment. Thus the aim was to describe the occurrence of depressive symptoms and prescription of antidepressive agents, as well as to assess the agreement between present symptoms and ongoing pharmacological treatment in clinical practice.

METHODS

The occurrence of self-reported depressive symptoms and documented ongoing pharmacological treatment was assessed in a cross-sectional survey including 141 hemodialysis patients. Agreement between depressive symptoms and prescription of antidepressants was analyzed.

RESULTS

Thirty-five percent of the participants suffered from self-reported depressive symptoms, and there was poor agreement between depressive symptoms and prescription of an antidepressant agent.

DISCUSSION

Depressive symptomatology is a significant problem in hemodialysis patients. It is therefore important to use systematic approaches to screen patients for depression, diagnose clinical depression, plan for treatment strategies, and follow up depression treatment outcomes.

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective.

The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate.

The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings.

Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake.

In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload.

This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

Excessive fluid overload is common in hemodialysis patients. Understanding fluid intake behavior in relation to used cognitive coping style would serve the fluid restriction consultation. The aim of this study was to explore whether hemodialysis patients' fluid intake behavior differs as a function of used coping style. Secondary analysis of data from 51 hemodialysis patients regarding cognitive coping style (assessed by the Threatening Medical Situations Inventory) and fluid intake behavior were used. The participants' mean age was 62.9 years (range 27-84), they had received dialysis treatment for 3.9 years on average (range 0-22), 63% were male and they had gained 3.6% (±1.3) of their dry body weight during the interdialytic period. There was a significant difference in fluid intake behavior between coping groups (F = 3.899, d.f. 2, P = 0.027). The difference (P = 0.028) was isolated between patients with cognitive blunting style and patients with neutral coping style. Identification of hemodialysis patients using cognitive avoidance strategies can be advantageous in renal care. Fluid advice provided may have to be adjusted to the used coping style, especially for patients with a blunting coping style. However, the findings need to be confirmed, and the effect of individualized counseling needs to be evaluated in forthcoming studies.

Background:The concept of dry weight is central to fluid control in patients on haemodialysis (HD). Few studies have explored the concept from the patient perspective. Thus, the aim of the present study was to explore how patients on HD perceive the concept of dry weight and how they act in relation to it.

Methods:A purposive sample of 10 HD patients was interviewed once during a dialysis session in May–June 2009. The narratives were analysed using manifest qualitative content analysis.

Findings: The findings indicated that the concept was regarded as either an aid to securing treatment-related health, as indicating the fluid surplus volume or as a reminder of the daily fluid allotment. Some informants, however, did not report any specific perception. Plans for dealing with the perceptions were expressed in terms of using self-care strategies to control fluid balance, transferring responsibility to the HD team, and managing the physical consequences or social and psychological concerns.

Conclusion: Four ways in which HD patients perceived the dry weight concept were demonstrated. It is important that HD patients understand the significance of dry weight, both for their own wellbeing and for treatment adequacy. Prevalent misunderstandings about the dry weight concept have to be addressed by the dialysis team in order to prevent further suffering. By acknowledging the patient’s perspective of the dry weight concept, the dialysis team could help the patient to successfully develop self-care strategies for dealing with the consequences of chronic renal failure.

Self-efficacy is a temporary and influenceable characteristic, related to situations and tasks, mediating health-promoting behaviours. This study aimed to evaluate psychometric properties of a Portuguese version of the Fluid Intake Appraisal Inventory, and to describe self-efficacy in relation to limited fluid intake amongst Portuguese haemodialysis patients. Respondents were recruited from three dialysis units, and 113 of 155 eligible patients gave their informed consent. The translated scale was distributed and collected by the head nurses. Interdialytic weight gain was calculated as percentage of dry weight. Satisfactory psychometric properties were estimated in the Portuguese context. The participants' self-efficacy in relation to low fluid intake was asymmetrically distributed; the majority had moderately to high self-efficacy while some patients had very low self-efficacy to limited fluid intake. There was a significant difference in self-efficacy to fluid restrictions; patients with a weight gain of 3.5% or less presented higher self-efficacy scores than did patients exceeding the cutoff point.

Objective The aim of this study was to explore obstacles to adherence to phosphate binding medication and to describe the measures taken by dialysis patients to overcome these obstacles. Setting A Swedish renal unit. Method Ten patients undergoing dialysis were interviewed. The interviews were semi-structured and were analysed according to qualitative content analysis. Main outcome measure Statements about barriers and the ways to overcome these. Results Non user-friendly drug compound, feeling of discomfort, forgetfulness, polypharmacy and patient ignorance were identified as obstacles to adherence to phosphate binding medication. Measures taken by the patients to handle obstacles were identified as using a dispensing aid, consuming extra water and exercising routines. Conclusion Dialysis patients identify obstacles that impede patient adherence to prescribed phosphate binding medication. The patients overcame most obstacles by self-management but not always in concordance with treatment requirements. Our findings imply that the ways the patient conquer each barrier need to be considered when strategies for self-management are promoted.

Objectives. Extensive drug utilization, and non-concordance between the patient and the caregiver about prescriptions andactual medicine intake, are associated with the risk of non-adherence to medication as well as medication-related illness. Toachieve reliable estimates of drug use, it is important to consider the patient’s self-reported drug utilization as well as toconsult his/her medical record. The present multicentre study was conducted with the aim of examining the self-reporteddrug consumption of dialysis patients and its congruence with medical records.

Material and methods. Consumption ofpharmaceutical agents was recorded by 204 patients undergoing haemo- or peritoneal dialysis at 10 Swedish clinics. Drugrecord discrepancies were identified by comparing the self-reported use of prescribed medicines with the subsequentlyobtained medication lists.

Results. The median drug intake was 11 prescribed medicines and by including on-demand drugsthis increased to 12. Discrepancies between the self-reported use of prescribed drugs and the medical record were prevalentin 80.4% of cases, with a median of three discrepancies per patient.

Conclusions. Dialysis patients have an extensive need formedication but there is an undesirable deviation between consumption and prescription. A single medication list, accessiblefor the patient and for all prescribers, is a possible solution to achieve concordance but other measures, such as analysis ofthe reasons for discrepancy and tailored measures, would also benefit concordant medicine-taking.

Nursing quality indicators are widely used to demonstrate nurses' contributions to health care. Some studies in nephrology settings have addressed nursing quality, but indicators reflecting the nursing process quality in haemodialysis are lacking. This paper argues for considering ultrafiltration rate as a nursing-sensitive quality indicator in haemodialysis. Strategies and qualifications for considering ultrafiltration rate as a nursing quality indicator are established and discussed. It is argued that the indicator is associated with nursing practice, linked to both morbidity and mortality, and is within the scope of the nurse's responsibility. It is also argued that the indicator could be influenced by other factors than nursing care. Thus, further studies are needed to investigate the association between ultrafiltration rate and patient safety. The introduction of the ultrafiltration rate as a duty specific quality indicator is a coveted measure of nursing care quality in haemodialysis settings.

The aim of this study was to describe essential competencies relevant for professional renal nursing in Sweden. A Delphi study with four rounds was conducted from November 2008 to April 2009. A national sample of renal nurses was used to achieve consensus about the core competencies required. The 43 competencies were reviewed for face validity by external experts representing general nursing, renal nursing, stakeholders and nephrologists. The core competencies were categorised in nine areas according to their structure; nursing and medical science, information and teaching, examinations and therapies, promoting health and preventing ill health, palliative care, safety and quality, care environment, research and development and management and cooperation in the patient care pathway. Altogether these categories represent a national description of competence in renal nursing.

Excessive interdialytic weight gain (IWG) and ultrafiltration rates (UFR) above 10 mL/h/kg body weight imply higher morbidity and mortality. This study aimed to estimate the prevalence of high fluid consumers, describe UFR patterns, and describe patient characteristics associated with IWG and UFR. The Swedish Dialysis DataBase and The Swedish Renal Registry of Active Treatment of Uremia were used as data sources. Data were analyzed from patients aged ≥18 on regular treatment with hemodialysis (HD) and registered during 2002 to 2006. Interdialytic weight gain and dialytic UFR were examined in annual cohorts and the records were based on 9693 HD sessions in 4498 patients. Differences in proportions were analyzed with the chi-square test and differences in means were tested using the ANOVA or the t test. About 30% of the patients had IWG that exceed 3.5% of dry body weight and 5% had IWG ≥5.7%. The volume removed during HD was >10 mL/h/kg for 15% to 23% of the patients, and this rate increased during the first dialytic year. Patient characteristics associated with fluid overload were younger age, lower body mass index, longer dialytic vintage, and high blood pressure. By studying IWG and dialytic UFR as quality indicators, it is shown that there is a potential for continuing improvement in the care of patients in HD settings, i.e., to enhanced adherence to fluid restriction or alternatively to extend the frequency of dialysis for all patients, e.g., by providing daily treatment.

BACKGROUND: To understand healthcare personnel's infection prevention behaviour has long been viewed as a key factor in preventing healthcare-associated infections. Suboptimal hand hygiene compliance and handling of materials, equipment and surfaces present the main risks for potential organism transmission. Further exploration is needed regarding the role of context-specific conditions and the infection prevention behaviours of healthcare personnel. Such knowledge could enable the development of new intervention strategies for modifying behaviour.

AIM: To describe risk behaviours for organism transmission in daily care activities over time.

METHODS: Unstructured observations of healthcare personnel carrying out patient related activities were performed on 12 occasions over a period of 18 months.

FINDINGS: Risk behaviours for organism transmission occur frequently in daily care activities and the results shows that the occurrence is somewhat stable over time. Interruptions in care activities contribute to an increased risk for organism transmission that could lead to subsequent healthcare-associated infection.

CONCLUSION: Interventions aimed at reducing the risks of healthcare-associated infections need to focus on strategies that address: hand hygiene compliance; the handling of materials, equipment, work clothes and surfaces; as well as the effects of interruptions in care activities if they are to alter healthcare personnel's infection prevention behaviour sufficiently.

Aim.  To describe and perform a tailored treatment programme based on a behavioural medicine approach to enhance haemodialysis patients’ self-management of fluid restriction.

Background.  Haemodialysis patients are required to manage dietary restrictions within a framework of adequate nutrition. Adherence to limited fluid allotment is important but difficult to accomplish. Pragmatic and effective ways of helping patients with fluid management are lacking.

Methods.  Cognitive-behavioural techniques were used in four quasi-experimental case studies. Central features in the programme were individual analysis of dietetic knowledge and fluid intake, setting goals, self-monitoring and prevention of relapse. Fluid overload was continuously assessed. Data were collected from September 2009–March 2010.

Findings.  Acceptability and feasibility of the intervention was satisfactory. A clear reduction of fluid overload was shown. Some problems related to treatment fidelity were identified.

Conclusions.  The behavioural medicine approach resulted in a clear reduction of fluid overload in each of the four cases included.

Relevance to clinical practice.  This approach could be used as a method for tailoring interventions targeted to fluid intake behaviour in a heterogeneous group of HD patients with excessive fluid overload. Such treatment should take account of individual cognitive-behavioural patterns and include self-efficacy to low fluid intake. The efficacy of the tailored approach in regular practice has to be further tested in controlled trials.

Objective: Self-efficacy is an important determinant of health behaviour and reflects a person's belief about their capability to complete a given task. The relationship between self-efficacy and fluid adherence has been investigated, although limited attention has been given to measurement issues. The purpose of this study was to develop a measure of situation-specific self-efficacy for constructive fluid intake behaviour in haemodialysis patients, the Fluid Intake Appraisal Inventory (FIAI). Methods: Items were generated from an analysis of empirical studies available in the literature and exposed to an interpretability critique before haemodialysis patients confirmed sufficiency of each item. In a multi-centre study, data from 144 haemodialysis patients were collected regarding general self-efficacy, situation-specific self-efficacy, and estimated fluid consumption. Internal consistency, criterion-related validity, and structural validity were tested. Results: The FIAI was found to have high internal consistency (Cronbach alpha 0.96) and the theoretical assumptions for criterion-related validity and known-group validity were supported. Structural validity was not confirmed, however, because the theoretically hypothesized four-factor model was not the prime structure. Conclusion: The FIAI was revealed to have satisfactory psychometric properties. The scale may be used in research or in clinical settings to study the mediating effects of self-efficacy or to modify haemodialysis patients' fluid-intake behaviour. Although this first validity study is promising, further validation focusing on reliability and cultural validity is needed.

AIMS: To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain varies between patients in groups with different cognitive profiles.

BACKGROUND: Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control, and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions.

DESIGN: Explorative cross-sectional multicentre survey.

METHODS: The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One-way analysis of variance (anova) or Pearson's chi-square test was used for comparing subgroups.

RESULTS: Three distinct subgroups were found and subsequently labelled: (1) low self-efficacy, (2) distraction and depressive symptoms and (3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output or in receiving any fluid intake advice.

CONCLUSIONS: Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE: Based on this study, we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient's fluid control, is introduced.

It has been emphasized that future studies aimed at improving adherence to infection prevention guidelines should focus on beliefs in, e.g., self-efficacy. Reliable situation specific measures are needed to measure the phenomenon of self-efficacy, but there seems to be few valid scales available that are suitable for measuring one’s belief in self-efficacy regarding infection prevention measures. The purpose of the study was to develop a unidimensional appraisal scale to capture nurses’ beliefs in their abilities to practice medical asepsis in care situations. When creating the items, evidence-based guidelines for preventing healthcare-associated infections were used together with Bandura’s guide for constructing self-efficacy scales. Face validity, content validity, and concurrent validity were tested in various samples of the target population. Furthermore, dimensionality was evaluated on data collected from 525 registered nurses and licensed practical nurses recruited from the medical, surgical, and orthopaedic wards of 22 Swedish hospitals. The Infection Prevention Appraisal Scale (IPAS) consists of 14 items. Face and content validity were endorsed by target population representatives. The exploratory factor analysis suggested unidimensionality, and the internal consistency was good (Cronbach’s alpha 0.83). The total scale score correlated with the General Self-Efficacy Scale, as expected, and supported concurrent validity. The Infection Prevention Appraisal Scale demonstrates sound psychometric properties supporting a unidimensional measure of self-efficacy to medical asepsis in care situations.

Healthcare workers may lack knowledge about antibiotic-resistant bacteria and thereby increase the spread of such organisms. The aim of the present study was to describe the relationship between self-rated knowledge and actual knowledge about methicillin-resistant Staphylococcus aureus (MRSA) among 326 Swedish haemodialysis nurses. Data were collected through a postal questionnaire. The findings suggest that ongoing education about MRSA should be provided to haemodialysis nurses, but also that standardised evaluation of adequate knowledge, skills and competencies' regarding safe practices is warranted. Future research should focus on effective mechanisms to ensure that haemodialysis nurses provide safe MRSA care.

BACKGROUND: Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations.

OBJECTIVE: The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections.

DESIGN & SETTING: Unstructured nonparticipant observations were performed at three medical wards.

PARTICIPANTS & METHODS: Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities.

RESULTS: The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was.

CONCLUSION: The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission.

There is a need for validated assessment tools for measuring attitudes towards patients with multidrug- resistant bacteria. Such an assessment tool was developed and psychometrically evaluated in the present study. A literature review and discussions with experts and key informants were used to develop the questionnaire. To ensure item adequacy and interpretability, face validity and pre-tests were performed. Item validity, content validity and internal consistency reliability were evaluated in a non-random sample of 329 hemodialysis nurses. The psychometric properties were satisfactory, indicating good item validity. The content validity revealed three appropriate factors with good internal consistency reliability. The haemodialysis nurses’ knowledge about multidrug-resistant bacteria was not suf. cient, and their intentional behaviour was unsatisfactory with respect to infection control precautions. The multidrug-resistant bacteria Attitude Questionnaire would be a valuable tool, in nursing practice and nursing education, in promoting quality improvements in patient safety with regard to healthcare associated infections.

Background

The wearing of gloves is included in the standard principles for preventing healthcare associated infections. A continued wearing of gloves may, however, result in the transmission of organisms instead of preventing infections. Few studies have explored how common it is for surfaces to be touched by potentially contaminated gloves.

Methods

Secondary analysis of field notes from 48 hours of unstructured observations of healthcare personnel's actions during patient care. The new focus was on to what extent healthcare personnel wore gloves that should have been removed or changed, what surfaces were touched by contaminated gloves and what patient-related activities were involved.

Results

A continued wearing of gloves occurred in about half of the observed episodes of patient care. On average, 3.3 surfaces were touched by contaminated gloves. The surfaces most frequently touched were ‘unused single-use items’, ‘equipment controls/switches/regulators/flush buttons’ and ‘bed linen’. This occurred mostly while helping patients with ‘personal hygiene’, when performing ‘test taking’ or during procedures involving the operation of medical or other ‘equipment’.

Conclusion

The continued wearing of gloves during patient-related activities carries the risk of organism transmission, as the gloves touch many surfaces. The most critical moments seem to be when the use of gloves is considered essential. A better understanding of the motivators of improper glove-use behaviour is needed to develop interventions that rectify the improper use of gloves.

Aim: To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method: Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results: The mind-set to help one another and do one’s best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion: Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.

Purpose

Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager’s job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers’ perceptions of, prerequisites for and experiences from the implementation of changes in their manager’s work conditions.

Design/methodology/approach

A grounded theory–based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis.

Findings

Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers’ descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process.

Originality/value

This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.

Background

Management of hydration status in dialysis patients is a great challenge to nephrologists, and new tools to understand the hydration status (HS) are needed. The aim of this study was to investigate the usefulness of brain natriuretic peptide (BNP), analyzed bedside, as a marker of overhydration (OH) in hemodialysis (HD) patients.

Methods

We investigated the distribution of BNP, measured by Alere Triage® BNP Test, and analyzed the correlation between BNP and HS, defined by bioimpedance spectroscopy (BIS) in 64 HD patients. We assumed there would be a difference in HS between patients with high levels of BNP (h-BNP) and low levels of BNP (l-BNP) and choose an arbitrary cut off of 500 ng/ml, and then differences between the groups were tested for significance. HS, blood pressure (BP) and heart rate was measured, and BNP analyzed, before one mid-week dialysis session. Blood samples were also drawn for analysis of NT-proBNP and inflammatory markers. Demographic data, comorbidities, lab values and nutritional status were collected from medical records.

Results

A positive correlation was found between BNP and OH (r = 0.4), although many severely overhydrated patients had normal or just slightly elevated BNP. BNP levels were above 500 in 38 % (n=24) of the participants. The level of OH before dialysis was higher in the h-BNP group than in the l-BNP group. There was no difference in BP before or after dialysis, but patients in the h-BNP group were older, had lower muscle strength and lower Hemoglobin and Albumin levels compared to the l-BNP group.

Conclusion

A normal BNP does not rule out OH as defined by BIS in HD patients, on the other hand euvolemia was rare in patients with elevated BNP. This suggests that BNP might serve as a marker of OH in a subgroup of old and frail patients. In a further study we aim to investigate if the relationship between BNP, when elevated, and OH is reproducible at an individual level.

Aims and Objectives: To translate and evaluate the psychometric properties of a Danish version of the Fluid Intake Appraisal Inventory (Da-FIAI) regarding reliability and validity.

Background: Patients on haemodialysis are advised to restrict their fluid intake, which often requires patients to change their way of life and health behaviour.

Design: Cross-sectional study.; Methods: The FIAI was translated to Danish by two sets of target translations and two sets of back-translations (n = 4). One hundred and ninety-five patients on haemodialysis needing ultrafiltration completed the questionnaire for the evaluation study of the Da-FIAI, and psychometric properties were evaluated.

Results: Criterion validity was supported, and the Da-FIAI had an excellent internal consistency; known-groups validity and the factor structure could not be confirmed in the Danish sample.

Conclusions: We have shown that the Da-FIAI is useful in a Danish haemodialysis population to score the patient's ability to avoid drinking in specific situations.

Relevance to Clinical Practice: Using the Da-FIAI in the continuing nurse-patient communication, nurses have a validated instrument to evaluate patients' self-efficacy in fluid intake management and systematically identify and advise patients who need additional support.

Background

The mental health of university students is a global concern, with high rates of depression and anxiety that need to be addressed.AimWe aimed to compare the mental health of Portuguese, Swedish and German university students in the health and social sciences following the Covid-19 pandemic and to analyze the factors associated with depressive and anxious symptoms in each country.

Methods

A cross-sectional study with a sample of students from Portugal, Germany and Sweden was conducted. Data from online questionnaires, including a sociodemographic and clinical questionnaire, the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7) and the MHI-5 (Mental Health Inventory) was collected from October to December 2022.

Results

The sample was composed of 1670 university students. The prevalence of mild to severe depressive symptoms was 72.7 % in Germany, 62.9 % in Sweden, and 60.3 % in Portugal and the prevalence of mild to severe anxiety symptoms was 78.6 % in Portugal, 73.7 % in Germany, and 66.9 % in Sweden. Being a female student, having a previous mental health disorder diagnosis, and poor academic performance were associated with higher severity of depression and anxiety symptoms in all three countries. Country-specific factors associated with more depressive and/or anxiety symptoms were younger age, smoking, low socioeconomic level and living away from home. Swedish students who do not consume alcohol had more anxiety symptoms and German students who do not consume alcohol had more depressive symptoms.

Conclusion

The high prevalence of depressive and anxiety symptoms among students in the three countries highlights the need to address modifiable factors that contribute to this mental health burden. Our results, which are in line with international trends, underline the need for policy reforms that target the main determinants of mental health, in particular by improving socio-economic conditions. Addressing these factors could play a crucial role in improving mental health outcomes in this population.

BACKGROUND: Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals' perceived barriers and facilitators for use of bioimpedance in clinical practice.

METHODS: Qualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants' perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process.

RESULTS: Several barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants.

CONCLUSIONS: Determinants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation's attractiveness, advantages in practice, and collaboration. Motivation, team processes and organizational capacities appeared as both barriers and facilitators.

BACKGROUND: About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination.

METHODS: The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter-rater agreement analysis between nurses assessing typical patient cases.

RESULTS: The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self-reported confidence.

CONCLUSION: RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

Overhydration is an independent predictor of mortality in hemodialysis (HD) patients. More than 30% of HD patients are overhydrated, motivating the development of new methods for assessing hydration status. This study surveyed clinical praxis and local guidelines for dry weight (DW) assessment in Swedish and Danish HD units, and examined if differences in routines and utilization of bioimpedance spectroscopy (BIS) and other assistive technology affected frequency of DW adjustments and blood pressure (BP) levels. Cross-sectional information on praxis, guidelines and routines, plus treatment-related data from 99 stratified patients were collected. Qualitative data were analyzed with content analysis and interpreted in convergence with statistical analysis of quantitative data in a mixed-methods design. Local guidelines concerning DW existed in 54% of the units. A BIS device was present in 52%, but only half of those units used it regularly, and no correlations to frequency of DW adjustments or BP were found. HD nurses were authorized to adjust DW in 60% of the units; in these units, the frequency of DW adjustments was 1.6 times higher and systolic BP pre-HD 8 mmHg lower. There is a wide variation in routines for DW determination, and there are indications that authorization of HD nurses to adjust DW may improve DW assessment. BIS is sparsely used; its implementation may have been delayed by uncertainty over how to manage the device and interpret measurements. Hence, better methods and guidelines for assessing DW and using BIS need to be developed.

BACKGROUND: Fluid overload is associated with mortality in haemodialysis patients, and 30% of patients remain fluid-overloaded after dialysis. The aim of this study was to evaluate if implementation of Recova^®, a decision aid combining clinical assessment with bioimpedance spectroscopy, facilitates individualization of target weight determination and thereby contributes to improved fluid status in maintenance haemodialysis patients.

METHODS: The impact of the implementation was measured as the proportion of participants at an adequate target weight at the end of the study, assessed as change in symptoms, hydration status, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Nurses were instructed to use Recova every 2 weeks, and the process of the intervention was measured as frequencies of fluid status assessments, bioimpedance measurements, and target weight adjustments.

RESULTS: Forty-nine patients at two haemodialysis units were enrolled. In participants with fluid overload (n = 10), both overhydration and fluid overload symptom score decreased. In fluid-depleted participants (n = 20), target weight adjustment frequency and the estimated target weight increased. The post-dialytic negative overhydration was reduced, but NT-proBNP increased.

CONCLUSIONS: Implementation of Recova in haemodialysis care increased the monthly frequencies of bioimpedance measurements and target weight adjustments, and it contributed to symptom reduction.

TRIAL REGISTRATION: The Uppsala County Council Registry of Clinical Trials: FoU 2019-0001-15.

INTRODUCTION: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.

METHODS: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.

FINDINGS: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (r_s = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).

DISCUSSION: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.