Does Antenatal Fear of Childbirth Predict Postnatal Fear of Childbirth? A Study of Japanese Women

The study aimed to determine whether antenatal fear of childbirth (expectation) could predict postnatal fear of childbirth (experience) by taking account of other antenatal psychological variables (anxiety and depression) as well as birth outcomes in Japanese women. A longitudinal observational study was conducted at a clinic in Tokyo, Japan, in 2011. Self-report questionnaires were distributed to 240 Japanese women at 37 gestational weeks (Time 1) and on the second day after delivery (Time 2). Regression analyses by means of structural equation modelling were conducted in both the primiparous and the multiparous group. The models exhibited good fit (chisquare value/degree of freedom = 1.10 - 1.62, comparative fit index = 0.92 - 0.99 and root mean square error of approximation = 0.03 - 0.07). Antenatal fear of childbirth was the most predictive variable of postnatal fear of childbirth in both the primiparous (β = 0.58, p = 0.002) and the multiparous group (β = 0.62, p < 0.001). In conclusion, antenatal fear of childbirth was a significant predictor of postnatal fear of childbirth when other antenatal psychological variables and birth outcomes were taken into account. Pregnant women who are strongly afraid of childbirth need special attention before and after delivery.

Shared Decision-Making after Implementation of the Chronic Care Model (CCM)—An Evaluative Approach

Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.

The Relationship among Caregiver Burden, Demographic Variables, and the Clinical Characteristics of Patients with Parkinson’s Disease—A Systematic Review of Studies Using Various Caregiver Burden Instruments

Caring for a person with Parkinson’s disease (PD) extends far beyond the ordinary exchange of assistance among people in a close relationship. Caregivers must learn to cope with the patient’s increasing disability and loss of independence. The aim of this systematic review was to critically assess and summarize the evidence of the influence of the demographic and clinical characteristics of patients with PD on caregiver burden by means of a caregiver burden instrument. In order to identify articles, electronic databases and reference lists were searched using the search word “Parkinson’s disease” in combination with “caregiver” or “carer” and with “burden” or “distress” or “stress” or “strain”. Thirty one articles were deemed eligible for inclusion. The methodological quality of the studies was evaluated. No studies were excluded due to low quality. The results revealed similar associations among caregiver burden, demographic variables and patient characteristics, across different caregiver burden instruments and various clinical scales. Higher PD stage and functional disability are the non-motor characteristics that contribute the most to caregiver burden. However, when comparing the impact of patient motor and non-motor symptoms, several studies found that mental symptoms had a stronger impact on caregiver burden than motor symptoms. No association was observed between caregiver burden and patient and caregiver demographics with the exception of the sub-scale analysis of caregiver burden in various age groups. Interpreting the results of studies that employ a range of different clinical assessment scales and burden instruments makes it challenging to provide a valid summary of caregiver burden in PD. The most commonly used analysis methods contribute little information about burden variation across caregiver groups or which areas are the most burdensome for caregivers. There is a need for a more uniform use of recommended instruments and for longitudinal studies.

Implementation Strategies for Improving the Care of Depressed Elderly Persons—Summary of an International Workshop

The aim of the study was to identify the most important research priorities as well as future strategies for promoting and implementing evidence-based care of depressed elderly persons. An interdisciplinary workshop was organized using a focus group format and the transcript of the discussion was interpreted by means of the qualitative content analysis. The most important research priorities for improving the care of depressed elderly persons, implementation levels, theoretical approaches as well as possible outcomes were analysed on individual consumer, healthcare system, and policy level. A wide range of theories and methods are necessary to identify and explain implementation processes and results. Qualitative and quantitative methodologies in combination with knowledge synthesis were discussed. In addition, the need to summarize the literature in terms of specific issues was emphasized. In conclusion, the implementation strategies for improving the care of depressed elderly persons should be addressed on three levels: individual consumer, healthcare system and policy. Although some aspects of the implementation model may need to be enhanced, the fact that it includes conditions on individual level, i.e. self-management support, is of importance. The expansion and maintenance of evidence-based care generate potential for change in mental healthcare, thus improving outcomes for individual elderly patients. Areas that require further research are organization, cost and leadership. The use of mixed methods could strengthen future studies. Implementation researchers need a broad repertoire in order to plan and perform evidence-based research. To improve practice, implementation strategies should be developed in clinical and community guidelines.

Evaluation Nursing Students’ Views of Improved Competence Development after Clinical Supervision: An Educative Approach to the WHO Patient Safety Model

Bachelor of Science Nursing (BSN) students’ education comprises both theories and practical aspects. Access to resources is required for the development of a professional identity, which includes gaining technical knowledge and receiving feedback, guidance as well as social and emotional support from clinical supervisors. The aim of this study was to evaluate BSN students’ views of professional development after clinical supervision (CS) during their undergraduate education. An additional aim was to illuminate how competence development was related to the WHO Patient Safety Educational Model. A cross-sectional study was conducted, in which CS was measured as part of a survey completed by a sample of nursing students after their clinical placement at two time-points, namely 2012 and 2013. Statistical descriptive and inferential analyses were used and differences in the responses between Time 1 and Time 2 compared. The benefit of CS for nursing students’ competence development revealed a positive significant relationship between students’ Interpersonal skills and the factor Improved care/skills. There were differences in terms of variables related to the Importance value of CS and Professional skills. The results can be used to inform undergraduate nursing education leaders, teachers and practice partners on individual, group and organisational level in order to enhance patient safety and highlight the importance of CS for BSN students’ professional development.

Psychometric Evaluation of the Japanese Wijma Delivery Expectancy/Experience Questionnaire Version B

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely accepted approach to measuring fear of childbirth and is available in two versions: antenatal (version A) and postnatal (version B). The aim of this study was to develop the Japanese W-DEQ version B and confirm its validity and reliability among Japanese women. A self-administered questionnaire incorporating the translated Japanese W-DEQ (JW-DEQ) version B and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) was distributed to Japanese mothers at two days postpartum. Of the 246 women recruited, 231 who completed the questionnaire at two days postpartum were analyzed. An exploratory factor analysis of the JW-DEQ version B revealed four factors: fear, lack of positive anticipation, isolation and riskiness. The JW-DEQ version B exhibited a positive correlation with the HADS anxiety subscale (r = 0.34, p α value derived from the total 33 items was 0.95. This study provides evidence of the factorial, concurrent validity and the internal consistency of the JW-DEQ version B. However, a further study involving participants from different demographic groups will be required.

Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

Mapping Psychosocial Risk and Protective Factors in Suicidal Older Persons—A Systematic Review

Social disconnectedness in combination with depression, somatic disease, stigma, social exclusion and functional impairment has been described as a major risk factor for suicide in old age. However, protective factors have not been focused on in the same way. The aim was to identify psychosocial risk and protective factors in suicidal older persons. A systematic review was performed in Academic Search Premier (34), Ovid Medline (0), PsycInfo (0), PubMed (66), CINAHL (3) and ProQuest (1078) for the period May - September, 2014. Results: Twelve studies were included in the final analysis. Psychosocial risk factors were categorized under four themes: Being a burden to others increases depression and hopelessness, the struggle due to poor social integration, the strain of physical illness and old age and Negative aspects of religious activity. A total of four protective factors emerged: a sense of belonging, maintaining social dignity, satisfaction with relationships and feeling useful and positive aspects of religious activity. In conclusion, the context of a suicidal older person in a home healthcare service may create a “vulnerable psychosocial state” in which she/he is confronted by stressful psychosocial life events including physical illness and social network changes. The fact that protective factors are solely related to social factors needs to be taken into account in future prevention studies.

Understanding and Improving Quality of Care in the Context of Depressed Elderly Persons Living in Norway

Effective leadership plays an important role in safe patient care. The aim of this paper was to understand and improve the implementation outcomes identified by empirical studies based on Proctors et al.’s key concepts, acceptability appropriateness, feasibility and fidelity, and to propose recommendations for further research. Methods: An interdisciplinary approach using mixed methods. Results: A total of twenty papers based on data from this interdisciplinary study have been published. Overall, our published empirical studies revealed that the CCM intervention had positive results due to staff members’ engagement to improve care, their awareness of the need for collaboration and willingness to assume responsibility for patient care. From the perspective of the depressed elderly persons the results of the research project indicated their need for support to increase self-management. In conclusion, an improved understanding of the implementation outcomes will have an impact on best practice for depressed elderly persons and dissemination purposes. Quality management and highly action-oriented involvement are necessary in implementation research. These will also affect the professional development of interdisciplinary teams as well as constitute a basis for further research on understanding and improving the care of depressed elderly individuals.

Older Patients’ Involvement in Shared Decision-Making—A Systematic Review

Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.

The Evidence of Interdisciplinary Teamwork in the Rehabilitation of Stroke Patients with Aphasia

The aim of this review was to investigate the evidence of interdisciplinary teamwork in the rehabilitation of stroke patients with aphasia. A total of 248 studies were read and nine included. The papers were analysed and data were extracted by categorizing the four components of rehabilitation: assessment, goal setting, intervention and reassessment. The results revealed that interdisciplinary teamwork was a prerequisite for rehabilitation and that nurses’ position in post-stroke care was unclear and limited. In addition, rehabilitation strategies, interdisciplinary cooperation, education and training are important aspects of the rehabilitation process. This study highlights the need for one valid and reliable assessment tool that incorporates communication problems. In conclusion, persons with aphasia should be more involved in their own rehabilitation, which means that the interdisciplinary team members must be educated to communicate appropriately with them.

Patient Safety,Adverse Healthcare Events and Near-Misses in Obstetric Care—A Systematic Literature Review

Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals’ perspectives on ethical conflicts, attributing blame and responsibility, and patients’ perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge about the risk of AEs and the use of best practice guidelines are also essential.

Patients’ Experiences of Trust in the Patient-Nurse Relationship——A Systematic Review of Qualitative Studies

Aims and Objectives: To report a synthesis of the literature on the meaning of trust in the context of patients’ experiences of nursing. The review question was “How do patients describe the meaning of trust in the nursing relationship?” Background: Trust is essential in nursing as it has the potential to create opportunities for the human being to gain faith, hope and meaning in life as well as open up for new experiences. Trust is an interpersonal and essential element of all patient-nurse relationships and requires nurses to create a trusting relationship with the patients. Design: Systematic qualitative literature review. Methods: Systematic searches were conducted for the period January 2002 to December 2012, updated in January 2014. 20 papers were included. Results: Four categories emerged: Attitudes related to trust, indicating that trust is fundamental and existential;Experiences of trust, concerning how trust can be sensed;The patient-nurse relationship, revealing the qualities of the person who creates trust;and Where trust occurs, illuminating the contextual relevancies of trust. Conclusions: Patients’ experiences of trust in nursing are dependent on the nurses’ knowledge, level of commitment in the dialogue to creating and developing the relationship and contextual issues. Implications for nursing practice: Reflection on a trusting relationship with the patient is necessary for a deeper conceptual understanding of trust in nursing. Clinical nurse researchers nurse supervisors, managers and nurse educatorsshould discuss different areas of trust during nursing supervision and focus-group meetings as well as with nursing graduates to ensure that nurses develop knowledge of how to create a trusting patient-nurse relationship.

How Can Manual Rotation Reduce Vacuum, Forceps and Caesarean Deliveries?—A Review of the Evidence

The aim of this review was to investigate whether manual rotation can be used to reduce vacuum, forceps and caesarean deliveries in women with occiput posterior or occiput transverse positions from 7 cm dilation in labour. A search strategy was developed and relevant papers published between 1946 and January 2015 were identified from electronic databases. Key search terms used were manual and digital rotation, labour presentation, obstetric labour complications, occiput posterior and version foetal. The search revealed 330 papers. A short list of 33 publications of possible relevance was compiled and assessed using the following criteria: primary studies on the effectiveness of manual rotation performed in women with singleton occiput posterior or occiput transverse presentations published in English or the Scandinavian languages. The quality of the included studies was evaluated by means of the critical appraisal tools for quantitative studies. Seven studies were included in the thematic analysis. The results varied but the main finding was that in order to decrease vacuum, forceps and caesarean deliveries by means of manual rotation, it is essential that the procedure is successful. The success rate of manual rotation is dependent on the experience of the healthcare professionals who perform the rotation procedure rather than the technique employed. Predictors of successful manual rotation were used after engagement of the foetal head, at full dilatation and prophylactic use before failure to progress in labour. In conclusion, although the results vary, there is a consensus in all the studies that manual rotation is worth considering and that it can contribute to decreasing vacuum, forceps and caesarean deliveries. The implications for practice are that successful manual rotation can reduce caesarean delivery and increase spontaneous vaginal delivery, but experience is necessary to perform successful rotations. Because there are no risk factors associated with manual or digital rotation when performed after engagement of the head and at full dilatation, they are worth considering. The central role of the midwife in each individual labour makes her important for ensuring that manual rotation can be considered at the right time in labour.

Norwegian Nurse Managers’ Perceptions of Ethical Conflicts in Community Healthcare When Caring for Older Persons Who Wish to Die

The complexity of the healthcare organization with emphasis on efficiency and productivity has led to an increase in value conflicts as well as moral and ethical conflicts. The aim of this study was to explore nurse managers’ perceptions of ethical conflicts when caring for older patients who wish to die. A qualitative method was employed and data were collected by means of a focus group interview with eight nurse managers. The results revealed one theme: A struggle due to responsibility for decision making and four sub-themes:?Understanding the meaning of free will, wondering about how serious the death wish is, providing more worthy elder care and lack of competent healthcare professionals to provide safe care. Nurse managers’ have no structure for bringing ethical conflicts to the attention of their leaders or the next level of the organization. Consequently, they appear to need supervision, support and clear, flexible lines of communication with leadership.

Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

Lost in a Nameless Chaos—Women’s Experiences of Postpartum Depression: A Meta-Ethnographic Study

Postpartum depression is a common complication related to childbearing with an estimated prevalence of 10% - 15%. The aim of the study was to explore and synthesize qualitative empirical studies published between 2005 and 2016 that describe women’s experiences of postpartum depression. Ten qualitative studies describing different perspectives on women’s experiences of postpartum depression were summarized and synthesized using Noblit and Hare’s 7-step meta-ethnographical method. Four central metaphors described women’s experiences of postpartum depression: Feeling trapped by reality, Experiencing a nameless chaos, Struggling to find a way out and Being seen as a normal but suffering person. The findings resulted in the following synthesis: The women expected the transition to motherhood to be a joyous experience. Instead, they found it painful, lonely and experienced losing themselves in a nameless chaos. Motherhood is challenged when women experience losing themselves due to depression rather than building a new identity as a mother. Such a situation causes chaos, shame, anxiety and isolation. When seeking professional help, it is essential that the woman is encountered with empathy and professional knowledge, rather than a pat on the back and an underestimation of her problems.

Patients’ Role in Their Own Safety—A Systematic Review of Patient Involvement in Safety

It is necessary to evaluate progress in the area of patient safety. However, although there has been an increase in number of quality and safety related studies have increased, the topics of patient involvement and patient safety are not automatically linked. The aim of this systematic review was to identify and evaluate the evidence contributed by studies of patient involvement in the provision of safe care. Inclusion criteria were studies undertaken to promote involvement in safety, covering patients’ attitudes, unsafe and safe care, risk reduction and handover practices during discharge from hospital to primary care. The results revealed three themes: satisfaction with and need for knowledge about healthcare and the health system, sharing responsibility and accountability for safety and the need to overcome language barriers to prevent harm and error. In conclusion, there is an increased focus on the role of the patient in the provision of safe care. Existing evidence is related to medication rather than patients’ capability and willingness to be involved. It is recommended that patient participation in the provision of safe care should be explored in relation to phenomena such as trust, responsibility, shared decision-making and powerlessness. It is also important to investigate the patient’s role with respect to patient rights.

Managing the Needs of Older Patients with Multimorbidity—A Systematic Review of the Challenges Faced by the Healthcare Services

Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.

A Systematic Review of Intuition—A Way of Knowing in Clinical Nursing?

The aim of this systematic review was to illuminate intuition in clinical nursing. Frequently described as a defining characteristic of professional expertise, intuition is gaining acceptance as a legitimate form of knowledge in clinical nursing. A total of 352 abstracts were read and eight quantitative studies included. A thematic analysis was performed to one main theme, two themes, and four sub-themes emerged. The main theme was: Sensing an unconscious and conscious state of mind, and the two themes were: A sudden emotional awareness and reflection, and arousal of conscious thought processes. The first theme included two sub-themes: Sensing spiritual connections with patients and experiencing physical sensations;worrying and reassuring feelings. The second theme comprised two sub-themes: Willingness to act on personal, interpersonal, and clinical experiences;the influence of maturity and social support in clinical decision-making. An implication for clinical nursing was the need to develop sensitivity as a key to understanding the patient’s illness. In conclusion, leadership and management could facilitate discussions about intuition as a legitimate method of processing information and making decisions about patient care.