Relationships between Emotional Well-Being, Patient Activation and Social Support among Adults with Severe Obesity Who Have Undergone Gastric Bypass Surgery

Objective: To examine the relationship between emotional well-being, patient activation and social support in a cohort of adults with severe obesity who underwent gastric bypass surgery from January to December 2012. Design: Cross-sectional survey. Subjects: Of a total population of 129 people, aged 18 - 68 years, at a local hospital in central Norway, 64 (50%) responding to the questionnaire, 52 (81%) being women. Main Outcome Measures: The World Health Organization—Five Well-Being Index (WHO-5), the 13-item Patient Activation Measure (PAM-13), a 16-item instrument on the frequency and content of social support, and demographic and clinical data. Results: A significant positive association was found between higher level of patient activation and better emotional well-being (P = 0.02) in linear regression analysis. A higher level of family support was significantly associated with better emotional well-being (practical social support from the family (P = 0.04), emotional social support from family (P = 0.01) and from friends (P = 0.005)). Conclusion: Screening tools for emotional well-being should be used systematically in postoperative consultations to recognize those who need a more individually tailored post-surgery follow-up care after gastric bypass surgery. In addition, health care providers in both specialist and primary health care settings should consider assessing the level of social support as part of regular follow-up routines.

Content of nursing discharge notes: Associations with patient and transfer characteristics

Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.

Modification of the Brief Smell Identification Test by Introduction of a Placebo

Objective: To introduce the concept that there might be “nothing to smell” to the Brief Smell Identification Test (B-SIT), with a view to masking olfactory deficits, particularly from healthy control participants in research studies. Methods: Seventy-one elderly individuals, healthy for their age, were recruited to the study. They were blindfolded and carried out a modified B-SIT where one item had been replaced with a placebo, and one odour alternative answer to three other items was replaced by the alternative “none/other” (actual odour unchanged). Results: There was no overall difference in the median or mean score achieved by the cohort compared to results obtained previously using the conventional B-SIT. The replacement of the item “turpentine” with a placebo resulted in an improved score for the item in a Norwegian setting. The overall scores were not improved. Conclusions: It is possible to introduce the concept that there may be “nothing to smell” to the B-SIT without compromising the test for healthy control individuals. This may be a more appropriate approach to olfactory testing of control individuals or patients with suspected early neurodegenerative diseases.

Perceptions and barriers that influence the ability to provide appropriate incontinence care in nursing home residents: Statements from nursing staff

Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. Three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: “physical and cognitive problems”. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: “lack of knowledge”, “attitudes and beliefs” and “lack of accessibility”. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: “rigid routines”, “lack of resource”, “lack of documentation” and “lack of leadership”. The findings from this study show that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.

Urinary incontinence in Norwegian nursing home residents

Urinary incontinence is a multi-factorial condition that has a high impact on older persons living in nursing homes. While urinary incontinence is common, only a small percentage of nursing home residents have an official diagnosis. Factors influencing urinary incontinence in this population are poorly understood. The aim of this study was to evaluate the prevalence of urinary incontinence in Norwegian nursing home residents and to study the factors associated with urinary incontinence in this population. Residents from six different nursing homes were included in this study. Data on sex, age, medication, comorbid illnesses, urinary incontinence and the use of absorbent pads was collected. Barthel`s Index of Activities of Daily Living (ADL) was used to estimate residents’ functional levels. Post-voiding residual urine was measured by means of a portable ultrasound. A questionnaire was completed by the nursing staff for each of the residents. In total, 173 residents participated in the study. One hundred and twenty-two residents (69%) were incontinent for urine and 144 used absorbent pads (83%). Fourteen percent of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine. The prevalence of urinary incontinence in Norwegian nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are significantly associated with urinary incontinence.