methods in nursing

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M E T H O D S I N N U R S I N G

Inventory as a Basis for SBU Alert Evaluations

Ania Willman, Anna Forsberg, Anna Strmberg

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M E T H O D S I N N U R S I N G

INVENTORY AS A BASIS FOR SBU ALERT

EVALUATIONS

PREFACE

This report was written with the assistance of Sara Carlsson RN from the Unit for Evidence-based Nursing, School of Health and Society, Malm University. We are very grateful for her

commitment, valuable input and practical assistance in compiling this report. We would also like

to thank Christel Bahtsevani, RN, doctoral student, School of Health and Society, Malm

University, for critically reviewing our text.

12 April 2003

Ania Willman Anna Forsberg Anna Strmberg

Malm Gteborg Linkping

The Swedish Society of Nursing, 2003

ISBN No: 91-85060-07-0

Cover picture: Roland Nilsson

English Translation: Gullvi Nilsson versttningar AB


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TABLE OF CONTENTS

TERMS OF REFERENCE OF THE WORKING GROUP AND DESIGN

OF THE REPORT...4

PROCEDURE..8

USE OF REFERENCES..9

RESULTS....10

Examples of value-based approaches in the care relationship.11

Examples of nursing methods for the provision of support

and treatment.11

Examples of methods for assessing suffering/well-being in

health, ill-health and disease...12

Examples of methods for preventing ill-health and/or treating

ill-health12

Examples of methods for evaluating planned individual care12

Examples of methods for the organisation of individual care.....13

DISCUSSION..13

Tables...16

List of appendices.33

References37

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TERMS OF REFERENCE OF THE WORKING GROUP

AND THE DESIGN OF THE REPORT

Today prioritisation influences the choice of care provided, something that is expected to

become increasingly common in the near future. The hope is that such setting of priorities will

take place more openly than previously as well as be increasingly based on scientific facts: facts

that can be evaluated with reference to ethical, social and other considerations, including financial

ones. The Swedish Council on Technology Assessment in Health Care (SBU) is a government

agency that evaluates the methods used in health care. The SBU analyses the cost and benefits of

various health care methods and compares the research findingswith Swedish healthcare

practice. The goal is to provide a better basis for decision-making forall those who determine

what care should be provided. This approach is sometimes called evidence-based care.

Evidence-based health care is a popular term, both in Sweden and abroad, and can be defined in

various ways. In these definitions, the common denominator is a willingness to use the best

available scientific evidence as a basis for care decisions. The evidence in question is the result of

scientific investigations in the field. The work of compiling this evidence is usually described as

evaluation research since it involves the systematic compilation, critical assessment, valuation and

interpretation of existing research results. Evidence-based health care can therefore best be

described as both an approach and a systematic process for the critical appraisal of research

results reported in scientific articles (Willman & Stoltz, 2002).

The 1990s have seen the emergence of systems for reportingnewmedical methods (known as

early warning systems) in a number of countries. In Sweden, the SBU was given the task of

building up a national system for the identification and early assessment of new methods, and

SBU Alert was established in 1997. The objective of Alert is to report methods that may be of

vital importance to health care. No areas of the health care sector are excluded. The most

important target groups for Alert are politicians, senior civil servants and other decision-makers.

All of the Alert reports are available on the SBU website to cater for interest from, for example,

the mass media, nursing staff and patients. Identification and prioritisation of new methods to be

examined are the responsibility of the Alert secretariat at the SBU. The secretariat is supported by

an Advisory Committee made up of individuals with broad experience in the area of health care

(Appendix 1). The Alert Advisory Committee determines which methods are to be studied.

When a method has been studied, a 6-8 page report is produced that describes the method and

its effects. Finally, the conclusions of the Alert Advisory Committee are published together with

an assessment of the existing body of knowledge. The publications are available from the SBU

Alert website at www.sbu.se. Since its inception, the Alert Advisory Committee has selected

about 80, mainly medical methods for study. The ambition of the Alert Advisory Committee to

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carry out more evaluations, particularly in the nursing field, has led to the appointment of a

working group by The Swedish Society of Nursing (SSF). The task of the group has been to map

methods used in nursing and to suggest suitable methods for evaluation.

The SSF is a professional society of the country's nurses. The SSF wishes to assist nurses in

providing the highest standards of care through an inspirational and influential role. The SSF

works on projects within prioritised areas considered strategic in nature due to health care

developments achieved in those areas. In order to develop a long-term strategy for research,

development and quality issues, the SSF has a Scientific Advisory Council, an Ethics Advisory

Council and a Quality Advisory Council.

The Scientific Advisory Council of The Swedish Society for Nursing monitors the field of

evidence-based nursing in collaboration with other bodies, including SBU Alert. The Scientific

Advisory Council and the Board of SSF have appointed Anna Forsberg, Gothenburg, Anna

Strmberg, Linkping, and Ania Willman, Malm, to a Working Group with the task of mapping

and proposing methods suitable for evaluation. Karin Axelsson, Lule, who is also a member of

SBU Alert, has functioned as an expert advisor. The SSF decision sets out the group's terms of

reference as follows:

- to design procedures for the study of 1) methods, 2) working practices and 3) theory-

based approaches to, for example, empowerment

- to propose methods, modes of working and theories as a basis for approaches in nursing

that could be evaluated within the framework of SBU Alert.

Evaluation research in health care has focused on health methods/technology. The English term

technology denotes technical methods or engineering, but is often translated into Swedish as

method. Brorsson & Wall (1984) state that the evaluation of health technology aims to illuminate

the extent to which the specific technology the method is safe and beneficial. For this to be

possible, the aims and outcome criteria of the method must be pre-defined. No methods in

health care have been excluded in advance; a broad definition is usually employed to determine

the methods eligible for inclusion. One example of a definition is that of the Health Technology

Assessment Group, an evaluation group set up in 1991, which defines health technology as "any

method used by those working in the health services to promote health, prevent and treat disease

and improve rehabilitation and long-term care." (Department of Health, Research for Health: a

Research Development Strategy for the NHS. London: Department of Health, 1991). Such a

broad definition means that all methods, from methods for counselling to methods for

organisation, can be the object of evaluation. In nursing contexts, it has been more common to

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use words such as intervention or mode of working to describe existing methods and less

common to use the word technology. This has been remarked upon by Bonair (1994) as follows:

"In nursing contexts, and in research into the clinical work of the nurse, it is less common to

speak of technology, while others, including Eriksson et al., in the bookVrdteknologiuse the

term health technology in the sense of "the theory of health care methods" or knowledge of the

practical provision of health care. The term technology as used by Eriksson et alin the evaluation

of health technology builds on a broad definition of technology; in other words, technology is

defined as knowledge applied to achieve set goals in a given situation." (Bonair, 1994, pp. 29-30).

In view of the fact that the terms: method, technology, and intervention are used

interchangeably in spite of the fact that they do not exactly correspond to each other, it is

important to define what they mean in order to avoid misunderstanding. Below, we show how a

number of terms with similar meanings are used in this work:

The term technologydenotes the science of engineering and is used in relation to

a) techniques, technical appliances and similar,

b) application of technical methods and ideas in a field other than engineering, for

example teaching methods the use of technical aids in teaching (www.ne.se).

The term methodologyrefers to the approaches used in various disciplines to

obtain knowledge or solve problems, cf. methodology (www.ne.se).

The term techniquedenotes all available methods or procedures for the use of

physical appliances in order to achieve a specific result (www.ne.se).

The term methodis defined as a planned procedure intended to achieve a

predetermined result (www.ne.se).

The term intervention is defined as an action (to achieve a specific purpose) orform of treatment (www.skolverket.se/skolnet/lexikon)..

The term nursing interventionis clarified in the following: "In a broad sense,

nursing interventions mean that the staff become involved in collaboration with

the patient, and where appropriate the patient's close relatives, formulate and

define physical, mental, social and spiritual health goals. Nursing interventions

span a wide area, from high-technology to moral support in existential crises."

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(The National Board of Health and Welfare Guidelines, 1993:17).1 Nursing

measures also include assessment, planning, implementation and evaluation of

results.

Against this background, the term "method" is defined as a planned procedureintended to

achieve a specific result. This means that a "method" can consist of several sub-components and

can therefore be understood as meaning both a "package" of methods and sub-components of

planned procedures, possible to evaluate individually.

To help establish an improved basis for decision-making in healthcare, the 1990s have seen the

growth of reporting systems for newmedical methods ("early warning systems") in several

countries. In Sweden, SBU Alert was formed in 1997 with the aim of identifying and carrying out

early assessment of new methods. SBU Alert defines the expression "new method" as a method

that is not common but may have a major impact on the health care system in a broad sense. The

SBU Alert criteria for selecting a method suitable for examinationare as follows:

- the method must have been tested on patients in a standard health care or research

setting

- results published in a scientific journal or presented at a conference

- the method should have the potential to play an important role within the health services

- the method should have the potential to lead to significant advances in the medical field

- the method is relevant to common health problems/many patients

- the method influences the structure of health care provision

- the method is controversial or has ethical implications

- the method has substantial economic impact.

This report describes the working group's method of working and the results obtained. The

nursing methods identified are shown in table form accompanied by an explanatory text. The

results shown in the tables are those of the authors, in the sense that the range of journals

searched reflects the fields of interest of the working group. We wish to emphasize that each

individual method must be further examined in order to ascertain whether or not the effects of

the method are supported by scientific evidence. No such review of each individual method has

been carried out within the framework of this remit. In this report, we propose methods that

should be capable of evaluation. Finally, the working group will submit a proposal to the SSF

1 If, for example, "injection technique" is used as an umbrella term for various methods for the administration ofinjections (subcutaneous, intramuscular) involving knowledge of the properties of materials, asepsis etc, the term"nursing method" in this context describes a planned procedure to give the correct patient the correct dosage in thecorrect way. When the injection technique and the injection method are adapted to an individual patient, it is describedas a nursing intervention in the sense used in The National Board of Health and Welfare Guidelines.

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Board for discussion and decision concerning nursing methods, nursing practice and theories

that the Board may wish to propose for further evaluation within the framework of SBU Alert.

PROCEDURE

The working group has met on three occasions and has operated on the basis of the following

strategy:

1. Description of the work methods of the Alert Advisory Committee and criteria for the

assessment of methods.

2. Definition of method.

3. Screening of nursing methods on the basis of the established definition.

4. Selection of methods on the basis of the assessment protocol of the Alert AdvisoryCommittee.

5. Selection of methods in consultation with the relevant experts in the respective field.

6. Final proposal to the SSF Board on possible methods for evaluation.

In addition to this strategy, there have been discussions about methods that are not compatible

with the Alert Advisory Committee's current methods of evaluation and about possible ways of

assessing these. The results contain various examples of theoretical approaches (Table 1). We do

not equate theoretical approaches with "methods", in the sense in which it is used in this work.An approach is a basic view that becomes clear and apparent in dialogue. Dialogue presumes a

mutual exchange. This mutual exchange means that even if an action is planned, it is not planned

in the sense that permits pre-determined endpoints, such as effects and goals. In our view,

theoretical approach implies basic research, which we understand/consider as a systematic and

methodological search for new knowledge and new ideas without any pre-determined benefit

(Lehtinen et al., 2002). The fact that we do not define a theoretical approach as a method does

not mean that we believe it cannot be evaluated. Since instruction in a theoretical approach has

the aim of achieving certain results, it should be possible to test the effects of a changedapproach in scientific studies. In such a study, it is of great importance to choose the "correct"

measure of effect.

Screening of nursing methods has been performed to identify on methods for patient care. We

have focused on Swedish material and have taken a broad approach to each field. The selection

of journals was influenced by a wish to find new publications about nursing methods, but also by

the fields of interest of the working group. The disadvantage of this approach may be that only

some areas of nursing and nursing duties are illuminated. The advantage of the approach is that

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the reviewers have in-depth knowledge of the fields examined and could thereby identify the

methods and nursing practicedescribed. The screening phase identified methods for patient care,

documentation and clinical supervision. In the report, we have chosen to focus on methods for

patient care.

Manual searches have been carried out in the following journals for the years 2000-2002.

- Circulation

- European Heart Journal

- Heart

- Heart and Lung

- International Journal of Nursing Studies

- Journal of Advanced Nursing

- Journal of Clinical Nursing

- Patient Education and Counselling

- Scandinavian Journal of Caring Sciences

- Theoria, Journal of Nursing Theory

Appendix 2 provides an overview of the objective, target group and contentof each journal. All

journals included have peer-reviewed articles and are indexed in the MedLine and/or CINAHL

databases. Searches have also been carried out on reference lists contained in these articles

pertaining to methods deemed relevant. Literature searches were also carried out in the form of a

review of all SBU and SSF reports referring to nursing (SBU, 1994; SBU & SSF, 1998 a;b; 1999,

a;b), the VIPSbook (Ehnfors et al., 2001), Kvalitetsindikatorer inom omvrdnad [Quality Indicators in

Nursing](2001), and the two SSF reports Omvrdnad som akademiskt mne(2001) and (2002)

[Nursing as a Scientific Subject].

USE OF REFERENCES

Stated references describe the method or the approach that we have chosen to report. The aim

was to identify as many methods and modes of nursing practice as possible in the available

journals and reports in the short time allocated for the task. The intention was not to cover entire

fields or to identify the main reference. The report only gives examples of references that deal

with the stated method. The reference is not necessarily the source of this method. We have not

carried out a systematic search of databases. The assumption is that those who choose to

examine any of the examples we have given will themselves carry out a systematic search to

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examine the scientific basis. We have not investigated whether each method is an example of

methods used by nurses or purely a nursing method (nurses can use medical methods as well).

We have listed and referred to methods and theoretical approaches that can be described as

nursing methods and/or that are used by nurses. This report makes no attempt to be

comprehensive with respect to references or methods.

RESULTS

The results of the mapping of nursing methods carried out by the working group are presented in

six separate sections. Table 1 differs from the rest in that it describes theoretical approaches,

which we have not classified as methods. Tables 2a-d give examples of methods that can be

individually adapted. Table 3 describes methods for the organisation of the nurses duties and

care of the individual:

Examples of value-based approaches in the care relationship (Table 1)

Examples of nursing methods for the provision of support and treatment (Table 2a)

Examples of methods for assessing suffering/well-being in health, ill-health and disease

(Table 2b)

Examples of methods for preventing ill-health and/or treating ill-health (Table 2c)

Examples of methods for treating and evaluating planned individual care (Table 2d)

Examples of methods for the organisation of individual care (Table 3)

No significance is attached to the order in which the methods are presented. Some boxes in the

tables are empty, the reason being the working groups lack of time to ascertain whether or not

the method was implemented and if so, its outcome. An empty box in the table should not be

interpreted as meaning that the value of the method in question is negligible compared to the

other methods presented in each table.

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EXAMPLES OF VALUE-BASED APPROACHES IN

THE CARE RELATIONSHIP

The examples of theoretical approaches given in Table 1 include confirmation during feeding as

well as the "SAUC" model. The ability to give and receive confirmation is intimately linked tohuman existence and well-being. All care work involves encounters, and it is in the encounter, the

dialogue, that the attitudes of an individual and his/her outlook on humanity become clear. The

confirming dialogue can be used to gain an understanding of the patient's situation and to design

the nursing care to meet the needs of that individual. In the Handbook for Swedish healthcare

(www.infomedica.se/handboken), the SAUC method is described as a method that outlines the

correct attitude towards and confirmation of patients.

The value-based approaches that emphasise nursing actions such aspresence, active listening, being

involvedand present as a witnesshave their roots in current nursing theories. Several modern nursing

theories are based on a humanitarian view and focus on the encounter between the nurse (carer)

and the patient/family. They also give concrete advice and directions on how the relationship can

be established, developed and concluded without loss of autonomy, integrity and self-esteem. An

evaluation of value-based approaches could deepen and clarify the present knowledge about "the

human being in focus" and "care needs time" contained in, for example, the Handbook for

Swedish healthcare. Reporting in this table is very limited since we only refer to the references

that we have encountered in our review, and we recommend that the section "value-basedapproaches in the care relationship" be studied in more depth by means of a new literature

review.

EXAMPLES OF NURSING METHODS FOR THE PROVISION OF

SUPPORT AND TREATMENT

The examples in Table 2a represent nursing methods that aim to strengthen the patient's ability

to deal with changes in his or her new health situation. The methods consist of individually

designed support, therapy of various kinds as well as education and information, with or without

IT support. Examples are also given of nurse-led clinics in various specialist fields. Since there are

a number of methods in Table 2a that can be deemed new or at the start oftheir dissemination

curve, we recommend that an in-depth study be done in this field.

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EXAMPLES OF METHODS FOR ASSESSING SUFFERING/WELL-

BEING IN HEALTH, ILL-HEALTH AND DISEASE

The examples in Table 2b illustrate the wide-ranging work of the nurse in assessing suffering and

well-being in health, ill-health and disease. Traditionally nurses have worked to assess the state of

the patient's health using more or less systematic methods. The methods given here involve tools

for assessing a large number of symptoms and clinical conditions such as pain, constipation, oral

status, consciousness, incontinence, ADL capacity and the risk of pressure ulcers. Several of the

tools are well established, but just as many are at the start of their dissemination curve.

EXAMPLES OF METHODS FOR PREVENTING ILL-HEALTH

AND/OR TREATING ILL-HEALTH

Table 2c shows methods of a preventive nature. In our view it is important to evaluate these

methods since the outcome of well-designed prevention can be decisive for the health status and

rehabilitation capacity of large groups of patients. The table provides examples of methods to

prevent pressure ulcers, hip fractures due to falls, and constipation. The methods represent

nursing interventions undertaken in close co-operation with the patient with the aim of creating a

significant improvement in patient well-being.

EXAMPLES OF METHODS FOR EVALUATING PLANNED

INDIVIDUAL CARE

In spite of the fact that the nursing profession in general lacks a tradition of evaluating the effects

of treatment measures, there is, in research, great use of tools to measure quality of life in various

types of ill health, disease and treatment. The use of evaluation tools in clinical work is not

systematic, nor have the effects of measurements on planned individual care been evaluated.

Assessment of the effect of treatment measuresused in the planned care of the individual can

therefore be seen as a "new" method that requires evaluation. Against this background, we have

chosen to show, in Table 2d, examples of tools for evaluating how patient quality of life is

affected. We are aware that these methods in some cases touch on the quality assurance field and

that tools used for research often cannot be implemented in day-to-day work without adaptation.

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EXAMPLES OF METHODS FOR THE ORGANISATION OF

INDIVIDUAL CARE

This section touches on the field of organisational theory and models that we do not define as

nursing methods. On the other hand, we wish to show examples where a planned approach to

organizing direct patient care can have consequences for the individual patient. A documentation

model that is frequently used and that influences the care of the individual patient is that of

Standard Care Plans. These care plans have not yet been adequately evaluated. The examples

presented in Table 3 illustrate the need for outcomes research when many patients, nurses and

employers are involved, which is difficult to evaluate using traditional measurements.

DISCUSSION

While working on this task, we have become aware of the considerable difficulties involved in

mapping nursing methods suitable for evaluation by Alert. It is not easy to identify specific

nursing interventionsin the research literature. Nurses make wide-ranging assessments within the

parameters of their clinical work, but seldom carry out evaluations and lack a tradition of

comparing different methods. We have also identified a large number of methods that are

compatible with the working group's definition "planned approach for achieving a given result in

health care" and that might be suitable for evaluation using current Alert methods. Table 1provides examples of methods or approaches that are unsuitable for evaluation using Alerts

current methods. There is a need here for alternative approaches to evaluation. Since the working

group had very little time in which to complete the task, we have not been able to presentany

proposal pertaining to alternative evaluation approaches in this report. The working group has,

however, identified several difficulties in the evaluation of nursing methods using current Alert

methods:

- Several nursing methods are presented and evaluated in descriptive studies. In

comparison with the medical literature, the nursing literature does not contain very manyRCTs (Randomised Controlled Trials), a study design that is used to demonstrate the

effect of a certain intervention. This lack of RCTs means that the method cannot be

evaluated using Alert's current approach. The lack of RCTs can be due to many factors.

One is that in nursing research there has been, and to an extent still is, scepticism about

whether the design of RCT studies is suitable for conducting research into nursing

issues. Another reason is that some nursing methods are not deemed suitable for

evaluation in randomised studies. Instead, evaluation using qualitative methods has been

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preferred. We wish to emphasize that it is possible to use both qualitative and

quantitative methods within the framework of an RCT design.

- The evaluations reported in the literature sometimes lack a clear connection between

intervention and the selection of outcome variable. It is not always clear whether the

intervention has the potential to influence the selected outcome variable, for example

quality of life. There is often a lack of studies that demonstrate the link between

intervention and outcome.

- In the evaluation of nursing methods, hard end points, such as survival, health care

consumption, progress of condition or similar are seldom used.

- Many nursing methods are evaluated qualitatively and there are today shortcomings in

the evaluation and assessment of qualitative studies.

- A very large number of patients are affected every day by various nursing methods, but

research within nursing has a relatively short history, and the number of nursingresearchers is small in relation to the extent of the clinical work and the number of

methods available. There is therefore a lack of studies evaluating nursing methods.

Dissemination of new methods is sometimes slow because of the lack of communication

of new research results between researchers and clinically active nurses. This is a

situation that can be both positive and negative. Negative if it is a good method that can

help many patients, and positive if it is the case that we need more evaluation studies to

be able to pass judgment on the outcome of the method.

Actions are needed at several levels to deal with these difficulties. The Swedish Society of

Nursing, with its Scientific Advisory Council, can and should work in various contexts to ensure

that future nursing research focusesto a greater extent on studies of nursing methods, their

effects and their applications. A progressive research policy that encourages a diversity of

research approaches and methods could foster a new tradition in which nursing care becomes a

natural field for research, development and training. The importance of a planned approach to

nursing should be given greater emphasis in clinical training. Studies of the effects of nursing

methods could be carried out as master degree projects at universities. Collaboration with bothSBU and Alert is expected to continue to reinforce the view that evaluation of the effects of

nursing methods is of great importance for the dissemination of research results, as well as of

both new and established methods, to clinically active nurses.

In the course of the work we have discussed organisational models that have a major impact on

the patient and the continuity of individual care. One such model is known as the "laundry-room

model" and involves staff drawing up their schedules on the basis of individual considerations.

We have, for obvious reasons, not discussed this working practice here since it is not a nursing

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15

method. On the other hand, we do see the modes of working as such as a widespread system in

Sweden that has not been satisfactorily evaluated in terms of the consequences for the continuity

of patient care. Perhaps an evaluation of this type could be initiated by the SSF.

Finally, the working group proposes the following nursing methods for evaluation within Alert:

Music in the care of people with dementia

Change of peripheral vein cannula (PVC) every 24 hours

Nurse-led clinics

Hip protectors to prevent injuries resulting from falls in geriatric care

Patient education with the help of computer support and/or interactive systems

Individual adaptation of external stimuli in neonatal care related to the level of maturity.

Our proposal to evaluate the use of music in the care of people with dementia is based on the

fact that it is a method at the start of its dissemination curve and is supported by scientific

evidence. The importance of changing peripheral venal cannula every 24 hours is well described

in the scientific literature but it has not received much attention in health care. Focusing on and

examining the method in an Alert Report would improve dissemination. Our proposal about

nurse-led clinics is based on our identification of evaluation studies of this type of clinic. Our

view is that knowledge should be gathered, not about the clinics in general, but rather restricted

to certain types of clinic that exist in the Swedish health services. Examples of these are nurse-led

clinics for patients with diabetes or heart failure. The same applies to our recommendation toevaluate methods for patient education. We do not believe it is possible to evaluate patient

education as a single method, since many approaches are reported in the literature. Our proposal

is that the evaluation should be limited to certain patient groups and that methods of informing

and educating them, covering both oral and written instruction, be evaluated. Above all, we

recommend the rapid evaluation of computer-assisted teaching. This can be regarded as a new

method and a method that can be evaluated using Alert's current procedure. Hip protectors to

prevent injuries due to falls in geriatric care is also a method that is compatible with Alert's

current model. Finally, the fact that individual adaptation of external stimuli related to maturitylevel has been evaluated in a Cochrane report increases the potential for evaluation within Alert.

Since the method can be regarded as "new" in Sweden, Alert, with the support of the Cochrane

report, could issue recommendations for possible Swedish implementation.


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Table

1Examplesofvalue-basedappr

oachesinthecarerelationship.

16

Value-basedapproach

Result

Implementation

Refere

nce

SAUCmodel

S

ecurityandsafetyforthepatient,

s

upportforthepatient'sself-

d

eterminationandintegrity.

TheModelforconfirmingnursingis

aimedatsupportingtheindividual's

self-esteem/self-determination.

Individual-specificnursing.

GustafssonB(2000).

GustafssonB&Prn

I(1994).

GustafssonB&Ande

rssonL(2001a).

GustafssonB&Ande

rssonL(2001b).

Presence:presentasawitness,

activelistening,advice,guidance,

humour,socialsupport

E

nhancedqualityoflife.

Consciousapproachtotheindividual

withillhealth/diseaseandhis/her

family.

Educationofclosere

latives.

Workshopforrelatives.

GardnerD.L

(1985).

SodergrenKM(1985

).

SwansonK(1991).

Transculturalnursingtheory

C

ulture-congruentnursing

Systematicapplicationoftheory

throughculturalsupport.

Show

interestin,andassess,

thepatient's

situation.

LeiningerM(1991).

LeiningerM&McFarlandMR(2002).

Confirmationfromcarerduring

feeding

R

einforcesthepatient'sfeelingof

r

eceivinghelpandtheexperience

that

t

heabilitytoswallowisimproved.

Continuityinfeeding

.

Samecarerand

Confirmation.

GustafssonB(1992).

TheSymtomManagementModel

I

ndividualpaintreatment.

Anexplanationmodelthatta

kesinto

accountthateachindividual

hasa

uniqueexperienceoflong-te

rmpain.

Larsonetal.(1994).

DoddMetal.(2001).

TheMiddleRangeTheoryof

UnpleasantSymptoms

I



kesinto


hasa


rmpain.

LenzERetal.(1997).

Evolu

tionofthetheMidRange

Theo

ryofComfort

I



kesinto


hasa


rmpain.

KolcabaK(2001).

Contd.onpage17


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Table

1Examplesofvalue-basedappr

oachesinthecarerelationship.

17

Value-basedapproach

Result

Implementation

Refere

nce

Barr

ettspowertheoryand

measurementinstrument,the

Powe

rasKnowingParticipationin

Chan

geTool

Value-basedapproachbase

don

Rogers'SUHB(ScienceofU

nitary

HumanBeing)nursingtheory.

Objectiveisthattheindividu

alcan

assistinchanginghis/herow

nhealth

pattern.

BarrettEAM(2000).

Value-basedtoolsformapping

andinventorybasedonSUHB

(Scie

nceofUnitaryHuman

Bein

gs)

Holis

ticAssessmentofChronicPain

Clien

t

GaronM(1991).

HumanEnergyFieldAssessment

Form

WrightSM(1989).

WrightSM(1991)

FamilyAssessmentTool

WhallAL(1981).

AnAssessmentGuidelinetoWork

withFamilies

Johnston(1986).

ASA-scale,

(theAppraisalofSelf

care

Agency-scale

EversGCM(1989).

SderhamnOetal.(1996a).

SderhamnOetal.(1996b).


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Table

2aExamplesofnursingmethodsfortheprovisionofsupportandtreatment.

18

Method

Result

Implementation

Reference

Informationandeducationto

variouspatientgroups

P

romotehealth,

increase

u

nderstandingandmotivation.

P

reventill-health.

Oralandwritteninformation.

Guidance,advice,

instructionand

demonstration.

Specialprog

rammes

forpeoplewithdiabetes,asthma,

colostomies,

heartfailure,m

yocardial

infarction,

incontinence,pain

,

overweight,smokingandalcohol

dependency,multiplesclero

sis,

epilepsyandParkinson'sdis

ease.

DevineEC,

CookTD

(1986).

Hjelm-KarlssonK(1988).

Kvalitetsindikatorerinomomvrdnad,

(2001).Kapitel2Ek

A-C,

Nordstrm

G&LindgrenM.


(2001).Kapitel5WredlingR.


(2001).Kapitel6BjrvellH&

EngstrmB.

Meth

odofmappingtheneedfor

partic

ipationinpatientswithbreast

cancer

M

appingthetypeofparticipationthat

a

womandiagnosedwithbreast

c

ancerwants.

Simplesortingofcardswith

various

participationalternatives.

Beaveretal.(1996).

"P-LI-SS-T"(Permission,

Limited

Information,

SpecificSuggestions,

Inten

siveTherapy)

Modeldescribingfourcouns

elling

levelsintheencounterwithpeople

withsexualproblems.

RanchM(1995).

Psychosocialsupportwhen

diagn

osedwithcancer

T

hepatientbegantointegratebod

y,

s

oulandspiritandhadasmoother

t

ransitionphase.

Thenurseidentifiedstressfactors,

supportsystems,ordinarycoping

strategiesandthepatient'sknowledge

ofthedisease.

KumasakaLM,

DunganJM(1993).

PerkinsPJ(1993).

Psychosocialsupportinheart

disea

se

Trainingofmotivationtopar

ticipatein

cardiacrehabilitation.

JairathN(1994).

Cogn

itiveOrientationTreatment

withthehelpofamanual

R

educeddegreeofdepression,

r

educedfeelingofhopelessness,

increasedself-esteem.

10people,

2hours/weekfor

14

weeks.

Nomedication.

Two

nurses

areresponsible.

GordonVC,

GordonE

M(1987).

GordonVCetal(1988).

Educ

ationalprogrammewith

cognitiveorientation

R

educeddegreeofdepression,

r

educedfeelingofhopelessness,

r

educedanxiety,

increasedself-

e

steem.

9-10people,

90min/weekfo

r12

weeks.

Nomedication.

Two

nurses

areincharge.

MaynardC(1993).

Contd.onpage19


19/47

Table


19

Metod

Resultat

Genomfrande

Refere

ns

Individually-adaptedsupportand

advic

ewithcognitiveorientation

E

ffectonpost-partumdepressionand

t

hemother-childrelationship.

Healthvisitorintheformofanurse,

outpatientcareonehour/we

ekfor8

weeks,

focusonsolvingpractical

problems.

SeeleySetal.(1996)

.

Psychotherapyingroups

R

educeddegreeofmanodepressive

c

ondition.

Twice/weekfor20weeks,nursewith

traininginpsychotherapy.

Simultaneousmedication.

PollackLE(1993).

Cogn

itivebehaviouraltherapyin

groups

R

educeddegreeofdepression

10people,

45minutes/session,

twice/

weekfor24weeks.

AbrahamILetal.(1991).

BeckAT(1967).

Visua

limagingtherapyingroups

R

educeddegreeofdepression.

10people,

45minutes/session,

twice/

weekfor24weeks.


BeckA(1967).

Train

ingingroups

R


10people,

45minutes/session,

twice/

weekfor24weeks.


BeckAT(1967).

Copingtherapyingroups

R


8people,

1hour/weekfor9

weeks.

DhooperSSetal.(19

93).

Psychosocialactivities(social

thera

pisttookpartinthedesign)

R


1-2h/day,5days/weekfora

totalof8

weeks.

Simultaneousmedic

ationinall

exceptoneparticipant.

RosenJetal.(1997).

Individualcognitivetherapy

R


Twice/weekfor8weeks.

CampbellJM(1992).

Reminiscencetherapy

R


Twiceduringthefirstweek,

then

once/weekfortenweeks.

YoussefF(1990).

Cogn

itivetherapyingroups

R


6-7people1h/session,

twice/weekfor

10weeks.

ZerhausenJDetal.(1995).

Contd

.onpage20


20/47

Table


20

Method

Result

Implementation

Referen

ce

Musicinthetreatmentofpeople

withdementia

C

almingthepatients,

improving

m

emoryfunction,

foodintakeetc.

Forexample,playingpleasa

ntmusic

atmealtimes.

RagneskogH(2001).

Relaxationandmusic,separately

andincombination

R

educedpost-operativepain.

Randomisedstudycomparin

gthe

effectsofthreenon-pharmacological

treatmentsforpain:relaxatio

n,music

andthesetwoincombination.

GoodMetal.(2001).

Informationandpatientparticipation

inendotrachealsuction

R

educedstress,reducedanxiety,

m

aximisedresultofsuction.

Quasi-experimentalrandomised

single-blindstudywiththeaimof

comparinghowICUnurseshandle

endotrachealsuctionbefore

andafter

aresearch-basedtraining

programme.

DayT,

WainwrightSP

,Wilson-Barnett

J(2001).

Computer-basedpatienteducation,

patientswithcancer

E

ffectivetrainingstrategyforpatients

w

ithcancer,providingknowledge

a

boutthedisease,choicesof

treatmentetc.

Randomisedstudiescomparing

computer-basededucationw

ith

traditionaleducation.

Measu

rementof

knowledgebeforeandafter

education.

Alsopre-andpost-

measurementofonegroup.

LewisD(1999).

Computer-basedpatienteducation

forpatientswithasthma

R

educedconsumptionofhealthca

re.

Increasedknowledgeandself-care

by

m

eansofcomputereducation

c

omparedtonoeducationatall.



ithno

educationatall.

Comparisonofhealthcare

consumption.

LewisD(1999.)

Computer-basedpatienteducation

forpatientswithheartfailure

C

omputer-basedpatienteducation

r

esultedinincreasedpatient

k

nowledgeofheartfailure,andold

er

p

eoplewithoutcomputerskillshad

no

d

ifficultyusingthecomputer.



ith

traditionalnurseledteaching

.

Measurementofknowledge

before

andaftertheinterventionand

observationofuser-friendliness.

Strmbergetal.(2002

).

BjrckLinneA,

LiedholmH&

IsraelssonB(1999).

Contd.onpage21


21/47

Table


21

Method

Result

Implementation

Referen

ce

Computer-basedpatienteducation,

patientswithdiabetes

C

omputer-basedpatienteducation

is

a

neffectivestrategyforeducating

p

atientswithdiabetestoincreasethe

p

atientsknowledgeaboutdisease

a

ndself-care.

EffectsonHbA1Cvary.



ith

traditionalnurseledteaching

.

Measurementofknowledge

and

metabolicbalancebeforean

dafter

theintervention.

LewisD(1999).

Struc

turedfollow-upatnurse-led

primarycareclinicsinsecondary

preve

ntionofheartdisease

N

urse-ledclinicsinprimaryhealth

c

areeffectivelyincreasedseconda

ry

p

reventionofcardiovasculardisease.

M

ostpatientsadoptedatleastone

p

reventivemeasure,suchasASA,

B

Preduction,

diet,physicalactivity

a

ndreducedlipids.

Thenumberof

e

ventsfellbyuptoathird.


g

patientswhoreceivedstructured

follow-upandadvicefroma

nurse

withacontrolgroupwhodid

not

receivestructuredfollow-up.

CampbellNCetal.(1998).

Follow-upatnurse-ledasthma

clinic

s

Increasedself-careandreductionin

thenumberofasthmasymptoms.The

c

linicwascost-effective.

Studywithmeasurementpre

and

post-interventioninnurse-ledasthma

clinicinprimaryhealthcare.

The

resultwascomparedtohealthcentres

withoutasthmaclinics.

LindbergMetal.(200

2).

Follow-upatnurse-ledheartfailure

clinic

s

F

ollow-upofpatientsafterdischarge

fromhospitalreducesthenumberof

r

e-admissions,

improvesself-care

as

w

ellasreducesmortality.


patientswhowerefollowedupby

nursesinthehomeorinanoutpatient

clinicwithacontrolgroupwh

odidnot

receiveanystructuredfollow

-up.

GradyKLetal.(2000).

Follow-upatnurse-ledcancer

clinic

s

LoftusLA,

WestonV(2001).

Nurse-ledpsychosocialintervention

inthe

homebymeansofadvice

over

thetelephoneandhomevisits

follow

ingmyocardialinfarction

T

heinterventionasawholehadno

e

ffect,butsub-studiesshowedthat

s

ometypesofemotionalsupport

r

educedworry.


g

individualisedfollow-uporien

ted

towardspsychosocialneeds

after

myocardialinfarctionwithco

ntrol

group.

Cossetteetal.(2002).

Contd.onpage22


22/47

Table


22

Method

Result

Implementation

Referen

ce

ITba

sedsupportforelderlyfamily

carers

EUprojectonITsupporttoelderly

familycarers.

Magnussonetal.(200

2).

Manu

alpressuretoreduce

intram

uscularinjectionpain

R

educedpainifmanualpressureis

a

ppliedbeforeintramuscularinject

ion.

Comparativestudyonwheth

er

manualpressurebeforeintramuscular

injectionreducespost-injectionpain.

Chungetal.(2002).

Phys

icaltrainingforpatientswith

heartfailure

P

hysicaltrainingforpatientswith

c

hronicheartfailureincreases

p

hysicalperformance,oxygenupta

ke

a

ndqualityoflife.


varioustypesofphysicaltraining

(bothcentralandperipheral

training)

withacontrolgroupthatdid

not

participateintraining.

EurHeartJ(2001).

Individually-designedtraining

programmesforseriouseating

problems

T

hepatientregainstheabilitytoea

t

o

rallyandexperiencesabetter

h

ealth-relatedqualityoflife.

Cost-

e

ffective.

JacobssonCetal.(20

00).


23/47

Table

2bExamplesofmethodsforassessingsuffering/well-beinginhealth,

ill-healthanddisease.

23

Method/Tool

Result

Implementation

Reference

PainA

ssessment

VAS

VisualAnalogueScale

S

ystematicassessmentofpain.

Thepatientratestheintensityofthe

painona10cmscale.

Gaston-JohanssonF

(1985).

BrattbergG(1989).

NRS

NumericalScale

S



painbymeansofthetool.


(2001).Kapitel9Ca

rlesonB.

VDS

VerbalScale

S





(2001).Kapitel9Ca

rlesonB.

BPI-S

FBreifPainInventoryShort

Form

S





(2001)Kapitel9CarlesonB

Struc

turedquestionnaireforpain

history

S





(2001).Kapitel9Ca

rlesonB.

McGillPainQuestionnaire

M

ultidimensionalassessmentof

p

atient'spain.

Tooltoassesthepatient'so

verall

experienceofpain.

McGuireD(1988).

Pain-O-Meter(POM)

S

ystematicassessmentand

e

valuationofacuteandlong-term

p

ain.

Thepatientassesseshis/he

rown

painviaaplasticsliderulec

ontaining

aVASscale,andaffectivea

nd

sensoryterms.

Gaston-JohanssonF

(1996).

HawthornJ&RedmondK(1999).

ObjectivePainDiscomfortScale

M

easureofpresenceanddegreeof

e

xcitation.

WalkerSMetal.(1997).

Assessmentofeatingand

swallo

wingproblems

SSA

TheStandardized

SwallowingAssessmenttool

S

creeningfordysphagia.

Stepwiseimplementationof

thewater

swallowingtestonconsciouspatients

inasittingposition.

Carriedoutby

nurses.

PerryL(2001b).

EllulJ,etal.(2001).

Obse

rvation/assessmentofthe

abilitytoswallowvariousfoodstuffs

S


PerryL(2001a).

Contd.o

npage24


24/47

Table



24

Method/Tool

Result

Implementation

Reference

Assessmentofeatingand

swallo

wingproblemscontd

Clinicalscreeningtools

"Anytwo"

BDSTTheBurkeDysphagia

ScreeningTest

TheTimedTest

BSATheBedsideSwallowing

Assessment

S


PerryL(2001a).

Scree

ningofdysphagia

I

dentificationofobstaclestooptimal

n

utritionalintakeintheformof

insufficientenergy,fatigueandability

t

oconcentrate.

Thepatientsaremonitoredforthree

months.

WestergrenA,etal.(1999).

Meth

odfordiagnosingeating

problems

T

estingofindividualprogrammesto

t

raintheabilitytoeat.

Observationofspecialtestm

eals,

togetherwithdialogues.

JacobssonC,etal.(2

000a).

JacobssonC,etal.(1

996).

Standardisedassessmentofeating

bymeansofguide

Mappingtheabilitytoeatwithout

assistance,aidsandcompe

nsatory

strategies.

WestergrenA,etal.(2001).

Mode

lforassessmentofeating

AxelssonK.

(1988).

Axelssonetal.(1988).

Axelssonetal.(1989).

Assessmentofpressureulcers

Norto

nScale

P

ressuresoreprevention.

Assessmentofriskofpressureulcers,

involvingfivefactors:physic

al

condition,mentalcondition,

activity,

mobilityandincontinence.

NortonD,etal.(1979)

.

ModifiedNortonScale

P


NortonScalewithadditiono

f

nutritionalandfluidstatusas

predictorsofpressureulcers.

EkAC(1985).

Eketal.(1988).

EkAC&BjurulfP(19

87).

GunningbergL,etal.

(1999;2001).

Contd.

onpage25


25/47

Table



25

Method/Tool

Result

Implementation

Reference

Assessmentofpressureulcers

contd.

Asse

ssmentScaleRBT(Risk

Asse

ssmentPressureUlcers)

P


Identifypatientsatriskofde

veloping

pressureulcers.


(2001).Kapitel2Ek

A-C,etal.

Assessmentofriskofinjuriesdue

tofalls

Asse

ssmentofriskofinjuriesdueto

falls

P

reventionofinjuriescausedbyfa

lls

Assessmentoffrequencyof

factors

thatcangiverisetoinjuries

causedby

falls.

UdnG(1985).

Tool

foridentifyingpatientsathigh

risko

finjuriesduetofalls

P

reventionofinjuriescausedbyfa

lls

Screening.


(2001).Kapitel3Ud

nG.

Assessmentofulcers

Meth

od/toolfortheassessmentof

ulcers

I

ndividually-adaptedsoretreatmen

t.

Planningforpreventionand

treatment

ofpressureulcers.


(2001).Kapitel2Ek

A-C,etal.

Srbedmningsmallfrbensr

I

ndividually-adaptedsoretreatmen

t.

Assessmentoflegulcersus

inga

giventemplate.

LindholmCetal.(199

3).

Other

Tool

toassesstheneedforpatient

education

I

ndividually-adaptededucation.

Assesslevelofknowledgea

ndability

tousethatknowledge.



EngstrmB.

Neon

atalInfantPainScale(NIPS)P

ainreliefofnewbornsadaptedto

a

geandtheindividual.

Assessmentofpostoperativepainin

newborns,

includingassessmentof

facialexpression,

breathing

patterns,

legandarmtonus,

degreeo

f

wakefulnessandmovementinfingers

andhands.

Jrnvik-KarlssonA&

KosinskyE

(1995).

Contd.onpage26


26/47

Table



26

Method/Instrument

Result

Implementation

Reference

Contd.

Other

TheGlasgowComaScale(GCS)

E

arlydiscoveryofchangesin

p

atients'degreeofconsciousness.

Systematicassessmentofd

egreeof

consciousness.

JonesC(1979).

FraserM.C

(1988).

Tool

forthegradingof

throm

bophlebitis

I

ndividually-adaptedtreatmentof

t

hrombophlebitis.

Ascalefrom0-4thatgrades

the

degreeofcomplicationandtypesof

symptoms.

LundgrenA,etal.(19

93).

IdvallE&LundgrenA

(1996).

Naus

eadiary

I

mprovedself-monitoring.

Thepatientsthemselveskeepadiary

oftheirexperiencesofnauseaduring

cytostatictreatment.

RegionalOncological

Centre,

Uppsala

(1990).

VAS

registrationofnausea

I

mprovedself-monitoring.

Self-assessmentofnausea

during

cytostatictreatment.

JennsK(1994).

Asse

ssmentoforalcavity

O

verallassessmentoforalcavity

s

tatus.

Thetoolcomprisesassessm

entof

voice,

throat,lips,

tongue,m

ucous

membranes,gums,

teethetc.

EilersJ,etal.(1988).

SubjectiveglobalassessmentscaleE

arlydiscoveryofmalnutrition.

Subjectiveassessmentofnutritional

status.

Detsky,etal.(1987).

Incon

tinenceMonitoringRecord

I

ndividually-adaptedtreatment.

Assessmentofincontinency

problems

inelderlypeoplewhoaredis

oriented

orhavecommunicationprob

lems.

OuslanderJG,etal.(1986).

Scale

forconstipationassessmentI

ndividually-adaptedconstipation

p

revention.

Assessmentofconstipation

during

courseofmedication.

McMillanSC&William

sFA(1989).

Mass

ageastreatmentfor

constipation

N

oconstipation.

Emly,etal.(1998).

Treatmentmeasuresfor

constipation

N

oconstipation.

Systematicliteraturereview,

describingsevenRCTsthat

have

examinedconstipationtreatment

methods.

Wiesel,etal.(2002).

Contd.onpage27


27/47

Table



27

Method/Tool

Result

Implementation

Reference

Contd.

Other

Tool

forassessmentofself-care

ability

IndirectlymeasuredviaHIin

dex

(generalwell-being).



EngstrmB.

KatzADLindex

I

ndividuallyadaptedADLtraining.

Assessmentofindependenc

eor

dependencyonhelpbasedon

activitiesofdailyliving.

Hulter-

sbergK(1986).

Barth

elsADLindex

I

ndividuallyadaptedADLtraining.

AssessmentofADLabilityw

iththe

helpofatool.

MahoneyFI&BartehlDW(

1965).

MiniMentalStateExam

A

measureofdegreeofcognitive

d

ysfunction.

RagneskogH(2001).


28/47

Table

2cExamplesofmethodsforpreventingill-healthand/ortreatingill-health.

28

Method/Tool

Result

Implementation

Reference

Usespecialmattresse.g.water,air

orfoammattress

P

reventionofpressureulcersor

p

romotionofhealingofpressure

u

lcers.

CullumN,etal.(1995).

Seclu

sionasacareenvironment

measure

GlenS&JownallyS(

1995).

Individualadaptationofexternal

stimu

liinneonatalcarebasedon

matu

ritylevel

R

educestressinprematurebabies.

Adaptationofsound,

lightan

dthe

immediateenvironmentinchild's

incubator.

AlsH(1986).

SymningtonA&PinelliJ(2002).

Dieta

rysupplementsfortheelderlyF

unctionalconditionispreserveda

nd

m

ortalitydecreased.

Individualsystematicadministrationof

dietarysupplement.

UnossonM(1993).

Oralcare

I

mprovednutritionalintake.

Interventionprogrammeincluding

screeningoforalcavity,con

sultation

withdentist,oralcaretechniquesand

patienttraining.

Grahametal.(1993).

Nordenrametal.(199

4).

Bathing

T

reatmentofdryskin.

AnderssonHardyM(1992.)

Touc

hingskin/massage

I

nfluenceonreleaseofhormonesand

p

ositiveeffectsonanxiety,pain,

g

eneralhealthandhealing.

Also

a

imedtoreducemusculartension

and

s

tressinjuries.

WeinrichS&WeinrichM(1990).

ConellMeehanT(1992).

FerellTorryA&Glick

O(1993).

Relaxationtraining

T

ohelppatientsbettercopewith

s

tressthroughincreasedself-control.

Scandrett-HibdonS&

UeckerS

(1992).

SnyderM(1994).

Contd.o

npage29


29/47

Table


29

Method/Tool

Result

Implementatio

n

Reference

Methods

fortreatmentofulcers:

Compression

Cleaningwithwaterat

body-temperature

Vacuumtherapy

Honeyandmaggottherapy

Intensificationoffactors

promotinghealinginthear

ea

aroundthesore.

Speedinguphealingby

increasingthetemperature

in

thesoreto38degrees.

Treatmentofinfectedulcers.

Compressionofleg

sore

oedema

Cleaningofulcersw

ithwater

atbodytemperature

Vacuumtherapyn

egative

pressureinthesore

through

theapplicationofa

polyurethanespong

e

connectedtoasuctiondevice

Applicationofhoney

to

infectedulcers

Applicationofflyma

ggotsof

theLucilia

familyto

necrotic

ulcers.

AlvarezOM,etal.(1

983).

BriggsM&NelsonE

(2001).

BanwellP(1999).

CooperRA,etal.(1

999).

ThomasS,etal.(1998).

Metho

dfortheuseofmattresses

witha

preventivefunction

P

reventionofpressureulcers.

CullumN,

DeeksJ,SheldonTA,

Song

F,

FletcherAW(

2002).(Cochrane

Review)

Metho

dforprovidinganadequate

amountofnutritionalfood

P

reventionofpressureulcers.


(2001).Kapitel2EkA-C,etal.

Hipprotection

P

reventionofhipfracturesinfalls.

Individually-adaptedhipprotectorsin

cottonpants.


(2001).Kapitel3U

dnG.

Hipprotection

P

reventionofhipfracturesinfalls.

LauritzenJB,

PetersenMM,

LundB

(1993).

Metho

dforpre-operativeinstructions

Effectsonfearandanxiety

Postoperativebreathing

function

Useofanalgesics

Useoftranquillisingdrugs

Timeinrecoveryroom

Numberofin-patientdays

Post-operativecomplications

Earlierdischarge

SBU(1994).Rapportnr.123,

Kapitel3

BonairA.

Contd.on

page30


30/47

Table


30

Meth

od/Tool

R

esult

Implementation

Reference

Metho

dof"guidedimagery"

N

on-pharmacologicaltreatmentof

p

ain.

BulechekGM&McC

loskeyJC(1992).

Metho

dsforpreventingcontractures

SBU(1994).Rapportnr.123.

Toilettrainingmethods


Monito

ringmethods


Lotion

E

liminationofheadlice.

PlastowLetal.(2001).

Combingincombinationwithhair

shamp

oo

E

liminationofheadlice.

PlastowLetal.(2001).

Tapw

ater

Sterile

saltsolution

C

leansore.

Bowlorshower.Evaluationof

municipalnursingorganisation.

SelimP,etal.(2001).

Massa

ge

P


BussIC,etal.(1997

).

Compressionbandage

Improvedhealingofulcers.

NelsonEA,etal.(2001).

Individ

ualprogrammetotraineating

ability

T

hepatientsfeltitwaseasiertoea

t.

B

eforethetreatment,nooneate.A

fter

treatment,6patientsateand4

p

atientshadtheirtuberemoved.

Systematicfocuson,andtra

iningof,

functionsrequiredforeating

and

discussionswiththepatient.

JacobssonC,etal.(

1997).


31/47

Table

2d.Examplesofmethodsforevaluatingplannedindividualc

are

31

Method/Tool

Result

Implementation

Reference

Toolsandmethodsforevaluating

preve

ntionandtreatmentofpatients

withhighriskoffallinjuries

S

afecareenvironment.


(2001).Kapitel3Ud

nG.

Tool

forsystematicevaluationof

patientsatisfactionwithtreatment.

TreatmentSatisfactionDTSQand

DTSQc

H

igherqualityinthecareofpatients

w

ithdiabetes.



Meth

ods/toolsforevaluatingpatient

self-c

areandcopingabilityand

comp

liance(concordance)

Assessmentbasedonself-r

ated

copingstrategies,self-careabilityand

compliance.



EORTCQLQ-C30(questionnaire)

M

easureofqualityoflife.

Patientswithcancer.

MaughanK&ClarkC

(2001).

Lasry

SexualFunctioningscaledataM

easureofeffectsofcanceron

s

exualfunctioning.

Originallydevelopedforpatientswith

breastcancer.

MaughanK&ClarkC

(2001).

CQO

LC(CaregiverQualityofLife

Index

-CancerScale)

M

easureofqualityoflifeincaregiv

ers

w

hoarecaringforacloserelative

w

ithcancerinthehome.

Questionnaire(five-pointLik

ertscale),

10minuteduration.

WeitznerMAetal.(1

999).

WeitznerMA&McMillanSC(1999).

SF-36(MedicalOutcomesStudy

ShortForm)

M

easureofhealthandhealth-relat

ed

q

ualityoflife.

Thepatientrateshis/herperceived

healthandvariousfunctioningby

completingaquestionnaire.

Ware&Sherbourne(1992)

Bowling(1997).

NHP-NottinghamHealthProfile

M


ed

q

ualityoflife.




HuntSMetal.(1980)

HuntSM,

McKennaS

P,

WilliamsJ

(1981).

SIP-

SicknessImpactProfile

M


ed

q

ualityoflife.




BergnerM,

BobittRA,

CarterWB,

GilsonBS(1981).


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Table

3

Examplesofmethodsforthe

organisationofindividualcare.

32

Method

Results

Implementation

Reference

Primarynursing

Enhancedqualityofnursin

g

Increasedpatientsatisfaction

Shorterin-patienttimes

Increasedcost-effectivene

ss.

Eachpatientislistedwitha

specific

nursewhoisresponsibleforthe

patient'soverallcareduring

hospitalisationincludingany

readmission.

ReedSE(1988).

GiovanettiP(1986).

JohnsonT&TahanH

(1997).

Grou

pcare

T

hegroupisdeemedtoprovidebetter

c

arethanasinglecarer

Alimitednumberofcarerstendingthe

patient.

SegerstenK(1996).

NursingCaseManagement

Acontrolledbalancebetween

costandquality.

Aresult-basedcareprocess.

Oneandthesamenursepla

ns,

organises,co-ordinates,

imp

lements,

documentsandevaluatesth

ecare.

Thisalsoincludesoverall

responsibilityforgoalattainm

ent

withintheframeworkofa

predeterminedcareperioda

ndthe

planneduseofresources.

ZanderK(1988a).

ZanderK(1988b).

Individualcareplanning

Writtendirectivesfornurses.

Facilitatescontinuityofcare

forthepatient.

Aidstheprioritisingofnurs

ing

interventions.

Documentedindividualplansforeach

patient.

CarpenitoLJ(2000).

Standardcareplans

Increasedcarequality.

Moretimeforpatientcare,

Increasedexchangeofskills,

Facilitatestheintroduction

of

newemployeesandstude

nts.

Preparationofgeneralcare

plans

basedonamedicaldiagnos

is,

treatmentornursingaspects.

RyanKA(1989).

HellgrenA&EdlundK

(1996).

EdlundK&Forsberg

A(1999).


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LIST OF APPENDICES

APPENDIX 1. LIST OF MEMBERS OF T HE ALERT ADVISORY COMMITTEE IN THE

YEAR 2002

APPENDIX 2.DESCRIPTION OF SCIENTIFIC JOURNALS EXAMINED WHEN

MAPPING NURSING METHODS


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34

APPENDIX 1. LIST OF MEMBERS OF THE ALERT ADV ISORY COMMITTEE IN THE

YEAR 2002

Thomas Ihre, Chair, MD, PhD, General Surgery, Chair of the Swedish Society of Medicine, Member of

the Board of SBU

Karin Axelsson, RNT, DMSc, Lule University of Technology

Marianne Boijsen Carlsson, MD, PhD, Consulting radiologist, Sahlgrenska University Hospital

Professor Mona Britton, MD, PhD, Internal medicine, SBU

Sussanne Brjesson, University Lecturer, Nursing Research, Health University, Linkping

Professor Jane Carlsson, RTP, PhD, Physiotherapy, Gothenburg University

Professor Bjrn-Erik Erlandson, PhD, Health technology, Uppsala University Hospital

Professor Jan-Erik Johanson, MD, PhD, Urology, rebro Regional Hospital

Professor Dick Killander, MD, PhD, Oncology, Lund University Hospital

Gran Maathz, MPolSc, Purchaser Network for County Councils and Regions

Professor Felix Mitelman, MD, PhD, Clinical genetics, Lund University Hospital

Professor Lars G Nilsson, PhD, Pharmacist, NEPI

Per Nilsson, MD, PhD, Internal medicine, Medical Products Agency

Cecilia Ryding, General Medicine Specialist, Kvartersakuten Surbrunnsgatan, Stockholm


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35

APPENDIX 2. DESCRIPTION OF THE JOURNA LS EXAMINED WHEN MAPPING

NURSING METHODS

Circulation is a medical journal in the field of cardiovascular disease containing some basic research aswell as basic and clinical research. Contains mainly RCT studies.

European Heart Journal is a medical journal in the cardiovascular field that contains some basic

research but also clinical research. Mainly contains RCT studies.

Heart is a medical journal in the cardiac field that contains both descriptive studies and RCT studies of

clinical problems.

Heart and Lung is a US journal aimed at contributing to the development of research and practice in

nursing and closely related disciplines in the heart and lung field.

International Journal of Nursing Studies contains both descriptive studies and RCT studies in all fields

of nursing research. It has the aim of contributing to the development of research and practice in nursing

and related disciplines. Contains articles on the subjects of nursing theories, research that is close to the

patient, training and care organisation.

Journal of Advanced Nursing contains both descriptive and RCT studies in all fields of nursing

research. Contains articles on the subjects of nursing theories, research that is close to the patient, training

and care organisation.

Journal of Clinical Nursing has the aim of spreading clinical knowledge and experience between nurses,

midwives and public health workers in various cultures and health care systems. The journal publishes

articles on evidence-based care, clinically relevant research and literature reviews. Includes mainly

descriptive articles, but also RCT studies.

Patient Education and Counselling is a multidisciplinary journal that publishes work in the fields of

patient education and health promotion measures. The journal aims to describe and illuminate models for

education, support and advice in health care and contains both descriptive and RCT studies.

Scandinavian Journal of Caring Sciences has the aim of disseminating research in the health field to

nurses, occupational therapists, physiotherapists, physicians and social workers. The journal contains

research articles on care, organisation and training.


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36

Theoria, Journal of Nursing Theory, focuses on theory development, theoretical understanding of

nursing practice, and implementation of theory and theoretical understanding in clinical practice.


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37

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