METHODS IN NURSING

Inventory as a Basis for SBU Alert Evaluations Ania Willman, Anna Forsberg, Anna Strmberg

2003

METHODS IN NURSING
INVENTORY AS A BASIS FOR SBU ALERT EVALUATIONS

PREFACE
This report was written with the assistance of Sara Carlsson RN from the Unit for Evidencebased 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 Malm

Anna Forsberg Gteborg

Anna Strmberg Linkping

The Swedish Society of Nursing, 2003 ISBN No: 91-85060-07-0 Cover picture: Roland Nilsson English Translation: Gullvi Nilsson versttningar AB

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

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 findings with Swedish healthcare practice. The goal is to provide a better basis for decision-making for all 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 reporting new medical 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

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) theorybased 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

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 book Vrdteknologi use 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 al in 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 technology denotes 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 methodology refers to the approaches used in various disciplines to obtain knowledge or solve problems, cf. methodology (www.ne.se). The term technique denotes all available methods or procedures for the use of physical appliances in order to achieve a specific result (www.ne.se). The term method is 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) or form of treatment (www.skolverket.se/skolnet/lexikon).. The term nursing intervention is 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."

(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 procedure intended 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 new medical 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 examination are 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

If, for example, "injection technique" is used as an umbrella term for various methods for the administration of injections (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 the correct way. When the injection technique and the injection method are adapted to an individual patient, it is described as a nursing intervention in the sense used in The National Board of Health and Welfare Guidelines.

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 Advisory Committee. 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 changed approach 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

the reviewers have in-depth knowledge of the fields examined and could thereby identify the methods and nursing practice described. 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 content of 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 VIPS book (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

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 to human 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 as presence, active listening, being involved and present as a witness have 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-based approaches 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 of their dissemination curve, we recommend that an in-depth study be done in this field.

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EXAMPLES OF METHODS FOR ASSESSING SUFFERING/WELLBEING 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 measures used 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 interventions in 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 1 provides 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 present any 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 many RCTs (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 nursing researchers 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 focuses to 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 both SBU 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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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 to evaluate 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 maturity level 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 1 Examples of value-based approaches in the care relationship. Result

Security and safety for the patient, support for the patient's selfdetermination and integrity. The Model for confirming nursing is aimed at supporting the individual's self-esteem/self-determination. Individual-specific nursing. Conscious approach to the individual with ill health/disease and his/her family. Education of close relatives. Workshop for relatives. Systematic application of theory through cultural support. Show interest in, and assess, the patient's situation. Gardner D.L (1985). Sodergren K M (1985). Swanson K (1991). Enhanced quality of life.

Value-based approach

Implementation

Reference
Gustafsson B (2000). Gustafsson B & Prn I (1994). Gustafsson B & Andersson L (2001a). Gustafsson B & Andersson L (2001 b).

SAUC model

Presence: present as a witness, active listening, advice, guidance, humour, social support

Transcultural nursing theory

Culture-congruent nursing

Leininger M (1991). Leininger M & McFarland M R (2002).

Confirmation from carer during feeding

Gustafsson B (1992).

The Symtom Management Model

Larson et al. (1994). Dodd M et al. (2001). Lenz E R et al. (1997).

The Middle Range Theory of Unpleasant Symptoms

Evolution of the the Mid Range Theory of Comfort

Reinforces the patient's feeling of Continuity in feeding. receiving help and the experience that Same carer and the ability to swallow is improved. Confirmation. Individual pain treatment. An explanation model that takes into account that each individual has a unique experience of long-term pain. Individual pain treatment. An explanation model that takes into account that each individual has a unique experience of long-term pain. Individual pain treatment. An explanation model that takes into account that each individual has a unique experience of long-term pain.

Kolcaba K (2001).

Contd.on page 17

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

Value-based approach
Value-based approach based on Rogers' SUHB (Science of Unitary Human Being) nursing theory. Objective is that the individual can assist in changing his/her own health pattern. Barrett E A M (2000).

Result

Implementation

Reference

Barretts power theory and measurement instrument, the Power as Knowing Participation in Change Tool

Value-based tools for mapping and inventory based on SUHB (Science of Unitary Human Beings) Holistic Assessment of Chronic Pain Client

Garon M (1991).

Human Energy Field Assessment Form

Wright S M (1989). Wright S M (1991) Whall A L (1981). Johnston (1986).

Family Assessment Tool

An Assessment Guideline to Work with Families

ASA-scale, (the Appraisal of Self care Agency-scale

Evers G C M (1989). Sderhamn O et al. (1996a). Sderhamn O et al. (1996b).

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Table 2 a Examples of nursing methods for the provision of support and treatment. Result
Promote health, increase understanding and motivation. Prevent ill-health. Oral and written information. Guidance, advice, instruction and demonstration. Special programmes for people with diabetes, asthma, colostomies, heart failure, myocardial infarction, incontinence, pain, overweight, smoking and alcohol dependency, multiple sclerosis, epilepsy and Parkinson's disease.

Method

Implementation

Reference
Devine EC, Cook TD (1986). Hjelm-Karlsson K (1988). Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 2 Ek A-C, Nordstrm G & Lindgren M. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 5 Wredling R. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 6 Bjrvell H & Engstrm B. Beaver et al. (1996).

Information and education to various patient groups

Mapping the type of participation that a woman diagnosed with breast cancer wants.

Simple sorting of cards with various participation alternatives.

Method of mapping the need for participation in patients with breast cancer "P-LI-SS-T" (Permission, Limited Information, Specific Suggestions, Intensive Therapy) Psychosocial support when diagnosed with cancer The patient began to integrate body, soul and spirit and had a smoother transition phase.

Ranch M (1995).

Kumasaka LM, Dungan JM (1993). Perkins PJ (1993).

Jairath N (1994). Gordon VC, Gordon E M (1987). Gordon VC et al (1988).

Psychosocial support in heart disease Cognitive Orientation Treatment with the help of a manual Reduced degree of depression, reduced feeling of hopelessness, increased self-esteem. Reduced degree of depression, reduced feeling of hopelessness, reduced anxiety, increased selfesteem.

Model describing four counselling levels in the encounter with people with sexual problems. The nurse identified stress factors, support systems, ordinary coping strategies and the patient's knowledge of the disease. Training of motivation to participate in cardiac rehabilitation. 10 people, 2 hours/week for 14 weeks. No medication. Two nurses are responsible. 9-10 people, 90 min/week for 12 weeks. No medication. Two nurses are in charge.

Educational programme with cognitive orientation

Maynard C (1993).

Contd. on page 19

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

Metod
Effect on post-partum depression and the mother-child relationship. Seeley S et al. (1996).

Resultat

Genomfrande

Referens

Individually-adapted support and advice with cognitive orientation

Psychotherapy in groups

Reduced degree of manodepressive condition. Reduced degree of depression Reduced degree of depression. 10 people, 45 minutes/session, twice/ week for 24 weeks. 10 people, 45 minutes/session, twice/ week for 24 weeks. 10 people, 45 minutes/session, twice/ week for 24 weeks. 8 people, 1 hour/week for 9 weeks.

Health visitor in the form of a nurse, outpatient care one hour/week for 8 weeks, focus on solving practical problems. Twice/week for 20 weeks, nurse with training in psychotherapy. Simultaneous medication. Pollack LE (1993). Abraham IL et al. (1991). Beck AT (1967). Abraham IL et al. (1991). Beck A (1967). Abraham IL et al. (1991). Beck AT ( 1967). Dhooper SS et al. (1993).

Cognitive behavioural therapy in groups Visual imaging therapy in groups

Training in groups

Reduced degree of depression.

Coping therapy in groups Reduced degree of depression.

Reduced degree of depression.

Psychosocial activities (social therapist took part in the design)

1-2 h/day, 5 days/week for a total of 8 Rosen J et al. (1997). weeks. Simultaneous medication in all except one participant. Twice/week for 8 weeks. Campbell JM (1992).

Individual cognitive therapy Reduced degree of depression. Reduced degree of depression.

Reduced degree of depression.

Reminiscence therapy

Cognitive therapy in groups

Twice during the first week, then Youssef F (1990). once/week for ten weeks. 6-7 people 1 h/session, twice/week for Zerhausen JD et al. (1995). 10 weeks.

Contd. on page 20

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

Method
Calming the patients, improving memory function, food intake etc. Reduced post-operative pain. Randomised study comparing the effects of three non-pharmacological treatments for pain: relaxation, music and these two in combination. Quasi-experimental randomised single-blind study with the aim of comparing how ICU nurses handle endotracheal suction before and after a research-based training programme. Good M et al. (2001). For example, playing pleasant music at mealtimes. Ragneskog H (2001).

Result

Implementation

Reference

Music in the treatment of people with dementia

Relaxation and music, separately and in combination

Information and patient participation Reduced stress, reduced anxiety, in endotracheal suction maximised result of suction.

Day T, Wainwright SP, Wilson-Barnett J (2001).

Computer-based patient education, patients with cancer

Effective training strategy for patients with cancer, providing knowledge about the disease, choices of treatment etc.

Lewis D (1999). Randomised studies comparing computer-based education with traditional education. Measurement of knowledge before and after education. Also pre-and postmeasurement of one group. Lewis D (1999.)

Computer-based patient education for patients with asthma

Reduced consumption of health care. Increased knowledge and self-care by means of computer education compared to no education at all. Computer-based patient education resulted in increased patient knowledge of heart failure, and older people without computer skills had no difficulty using the computer.

Computer-based patient education for patients with heart failure

Randomised studies comparing computer-based education with no education at all. Comparison of health care consumption. Randomised studies comparing computer-based education with traditional nurse led teaching. Measurement of knowledge before and after the intervention and observation of user-friendliness.

Strmberg et al. (2002). Bjrck Linne A, Liedholm H & Israelsson B (1999).

Contd. on page 21

20

Table 2 a Examples of nursing methods for the provision of support and treatment. Result
Computer-based patient education is an effective strategy for educating patients with diabetes to increase the patients knowledge about disease and self-care. Effects on HbA1C vary. Lewis D (1999).

Method

Implementation

Reference

Computer-based patient education, patients with diabetes

Structured follow-up at nurse-led primary care clinics in secondary prevention of heart disease

Randomised studies comparing computer-based education with traditional nurse led teaching. Measurement of knowledge and metabolic balance before and after the intervention. Randomised study comparing patients who received structured follow-up and advice from a nurse with a control group who did not receive structured follow-up.

Follow-up at nurse-led asthma clinics

Follow-up at nurse-led heart failure clinics

Follow-up at nurse-led cancer clinics The intervention as a whole had no effect, but sub-studies showed that some types of emotional support reduced worry.

Campbell NC et al. (1998). Nurse-led clinics in primary health care effectively increased secondary prevention of cardiovascular disease. Most patients adopted at least one preventive measure, such as ASA, BP reduction, diet, physical activity and reduced lipids. The number of events fell by up to a third. Lindberg M et al. (2002). Study with measurement pre and Increased self-care and reduction in the number of asthma symptoms. The post-intervention in nurse-led asthma clinic in primary health care. The clinic was cost-effective. result was compared to health centres without asthma clinics. Grady KL et al. (2000). Randomised studies comparing Follow-up of patients after discharge patients who were followed up by from hospital reduces the number of re-admissions, improves self-care as nurses in the home or in an outpatient clinic with a control group who did not well as reduces mortality. receive any structured follow-up. Loftus LA, Weston V (2001). Randomised study comparing individualised follow-up oriented towards psychosocial needs after myocardial infarction with control group. Cossette et al. (2002).

Nurse-led psychosocial intervention in the home by means of advice over the telephone and home visits following myocardial infarction

Contd. on page 22

21

Table 2 a Examples of nursing methods for the provision of support and treatment. Result Implementation Reference

Method

IT based support for elderly family carers Manual pressure to reduce intramuscular injection pain

Physical training for patients with heart failure

Individually-designed training programmes for serious eating problems

EU project on IT support to elderly Magnusson et al. (2002). family carers. Chung et al. (2002). Reduced pain if manual pressure is Comparative study on whether applied before intramuscular injection. manual pressure before intramuscular injection reduces post-injection pain. Eur Heart J (2001). Physical training for patients with Randomised studies comparing chronic heart failure increases various types of physical training physical performance, oxygen uptake (both central and peripheral training) and quality of life. with a control group that did not participate in training. The patient regains the ability to eat Jacobsson C et al. (2000). orally and experiences a better health-related quality of life. Costeffective.

22

Table 2 b Examples of methods for assessing suffering/well-being in health, ill-health and disease. Result
Systematic assessment of pain. The patient rates the intensity of the pain on a 10 cm scale. The patient rates the intensity of the pain by means of the tool. The patient rates the intensity of the pain by means of the tool. The patient rates the intensity of the pain by means of the tool. The patient rates the intensity of the pain by means of the tool. Gaston-Johansson F (1985). Brattberg G (1989). Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 9 Carleson B. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 9 Carleson B. Kvalitetsindikatorer inom omvrdnad, (2001) Kapitel 9 Carleson B Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 9 Carleson B. McGuire D (1988). Gaston-Johansson F (1996). Hawthorn J & Redmond K (1999).

Method/Tool

Implementation

Reference

Pain Assessment VAS Visual Analogue Scale

NRS Numerical Scale

Systematic assessment of pain.

VDS Verbal Scale

Systematic assessment of pain.

BPI-SF Breif Pain Inventory Short Form Systematic assessment of pain. Systematic assessment of pain.

Structured questionnaire for pain history

McGill Pain Questionnaire

Pain-O-Meter (POM)

Multidimensional assessment of patient's pain. Systematic assessment and evaluation of acute and long-term pain. Measure of presence and degree of excitation.

Tool to asses the patient's overall experience of pain. The patient assesses his/her own pain via a plastic slide rule containing a VAS scale, and affective and sensory terms.

Objective Pain Discomfort Scale

Walker S M et al. (1997).

Assessment of eating and swallowing problems SSA The Standardized Swallowing Assessment tool Screening for dysphagia.

Stepwise implementation of the water swallowing test on conscious patients in a sitting position. Carried out by nurses.

Perry L (2001b). Ellul J, et al. (2001).

Observation/assessment of the ability to swallow various foodstuffs

Screening for dysphagia.

Perry L (2001a).

Contd. on page 24

23

Table 2 b Examples of methods for assessing suffering/well-being in health, ill-health and disease.

Method/Tool
Screening for dysphagia. Perry L (2001a).

Result

Implementation

Reference

Assessment of eating and swallowing problems contd Clinical screening tools "Any two" BDST The Burke Dysphagia Screening Test The Timed Test BSA The Bedside Swallowing Assessment The patients are monitored for three months. Westergren A, et al. (1999).

Screening of dysphagia

Method for diagnosing eating problems

Identification of obstacles to optimal nutritional intake in the form of insufficient energy, fatigue and ability to concentrate. Testing of individual programmes to train the ability to eat. Observation of special test meals, together with dialogues. Mapping the ability to eat without assistance, aids and compensatory strategies.

Jacobsson C, et al. (2000a). Jacobsson C, et al. (1996). Westergren A, et al. (2001).

Standardised assessment of eating by means of guide

Model for assessment of eating

Axelsson K. (1988). Axelsson et al. (1988). Axelsson et al. (1989).

Assessment of pressure ulcers Norton Scale Pressure sore prevention.

NortonD, et al. (1979).

Modified Norton Scale

Pressure sore prevention.

Assessment of risk of pressure ulcers, involving five factors: physical condition, mental condition, activity, mobility and incontinence. Norton Scale with addition of nutritional and fluid status as predictors of pressure ulcers.

Ek AC (1985). Ek et al. (1988). Ek AC & Bjurulf P (1987). Gunningberg L, et al. (1999; 2001).

Contd. on page 25

24

Table 2 b Examples of methods for assessing suffering/well-being in health, ill-health and disease.

Method/Tool
Pressure sore prevention. Identify patients at risk of developing pressure ulcers.

Result

Implementation

Reference
Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 2 Ek A-C, et al.

Assessment of pressure ulcers contd. Assessment Scale RBT (Risk Assessment Pressure Ulcers)

Assessment of risk of injuries due to falls Assessment of risk of injuries due to Prevention of injuries caused by falls falls Prevention of injuries caused by falls

Tool for identifying patients at high risk of injuries due to falls

Udn G (1985). Assessment of frequency of factors that can give rise to injuries caused by falls. Screening. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 3 Udn G.

Individually-adapted sore treatment. Individually-adapted sore treatment.

Assessment of ulcers Method/tool for the assessment of ulcers Srbedmningsmall fr bensr

Planning for prevention and treatment of pressure ulcers. Assessment of leg ulcers using a given template.

Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 2 Ek A-C, et al. Lindholm C et al. (1993).

Other Tool to assess the need for patient education Individually-adapted education.

Assess level of knowledge and ability to use that knowledge.

Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 6 Bjrvell H & Engstrm B.

Neonatal Infant Pain Scale (NIPS)

Pain relief of newborns adapted to age and the individual.

Jrnvik-Karlsson A & Kosinsky E Assessment of postoperative pain in (1995). newborns, including assessment of facial expression, breathing patterns, leg and arm tonus, degree of wakefulness and movement in fingers and hands.

Contd. on page 26

25

Table 2 b Examples of methods for assessing suffering/well-being in health, ill-health and disease.

Method/Instrument
Early discovery of changes in patients' degree of consciousness. Individually-adapted treatment of thrombophlebitis. A scale from 0-4 that grades the degree of complication and types of symptoms. Systematic assessment of degree of consciousness. Jones C (1979). Fraser M.C (1988). Lundgren A, et al. (1993). Idvall E & Lundgren A (1996).

Result

Implementation

Reference

Contd. Other The Glasgow Coma Scale (GCS)

Tool for the grading of thrombophlebitis

Nausea diary

Improved self-monitoring.

Regional Oncological Centre, Uppsala (1990). Jenns K (1994). Eilers J, et al. (1988).

VAS registration of nausea Overall assessment of oral cavity status. Early discovery of malnutrition. Individually-adapted treatment.

Improved self-monitoring.

Assessment of oral cavity

Subjective global assessment scale

Detsky, et al. (1987). Ouslander JG, et al. (1986).

Incontinence Monitoring Record

Scale for constipation assessment

Individually-adapted constipation prevention. No constipation. No constipation.

The patients themselves keep a diary of their experiences of nausea during cytostatic treatment. Self-assessment of nausea during cytostatic treatment. The tool comprises assessment of voice, throat, lips, tongue, mucous membranes, gums, teeth etc. Subjective assessment of nutritional status. Assessment of incontinency problems in elderly people who are disoriented or have communication problems. Assessment of constipation during course of medication.

McMillan SC & Williams FA (1989). Emly, et al. (1998).

Massage as treatment for constipation Treatment measures for constipation

Systematic literature review, describing seven RCTs that have examined constipation treatment methods.

Wiesel, et al. (2002).

Contd. on page 27

26

Table 2 b Examples of methods for assessing suffering/well-being in health, ill-health and disease. Result
Indirectly measured via HI index (general well-being). Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 6 Bjrvell H & Engstrm B. Hulter-sberg K (1986).

Method/Tool

Implementation

Reference

Contd. Other Tool for assessment of self-care ability

Katz ADL index

Individually adapted ADL training.

Barthels ADL index A measure of degree of cognitive dysfunction.

Individually adapted ADL training.

Assessment of independence or dependency on help based on activities of daily living. Assessment of ADL ability with the help of a tool.

Mahoney FI & Bartehl DW (1965). Ragneskog H (2001).

Mini Mental State Exam

27

Table 2 c Examples of methods for preventing ill-health and/or treating ill-health. Result
Prevention of pressure ulcers or promotion of healing of pressure ulcers. Glen S & Jownally S (1995). Reduce stress in premature babies. Als H (1986). Symnington A & Pinelli J (2002). Unosson M (1993). Graham et al. (1993). Nordenram et al. (1994). Cullum N, et al.(1995).

Method/Tool

Implementation

Reference

Use special mattress e.g. water, air or foam mattress

Seclusion as a care environment measure Individual adaptation of external stimuli in neonatal care based on maturity level Dietary supplements for the elderly Functional condition is preserved and mortality decreased. Improved nutritional intake. Adaptation of sound, light and the immediate environment in child's incubator. Individual systematic administration of dietary supplement. Intervention programme including screening of oral cavity, consultation with dentist, oral care techniques and patient training.

Oral care

Bathing

Treatment of dry skin.

Andersson Hardy M (1992.) Weinrich S & Weinrich M (1990). Conell Meehan T (1992). Ferell Torry A & Glick O (1993).

Touching skin/massage

Relaxation training

Influence on release of hormones and positive effects on anxiety, pain, general health and healing. Also aimed to reduce muscular tension and stress injuries. To help patients better cope with stress through increased self-control.

Scandrett-Hibdon S & Uecker S (1992). Snyder M (1994).

Contd. on page 29

28

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

Method/Tool
Intensification of factors promoting healing in the area around the sore. Speeding up healing by increasing the temperature in the sore to 38 degrees. Treatment of infected ulcers. Compression of leg sore oedema Cleaning of ulcers with water at body temperature Vacuum therapy negative pressure in the sore through the application of a polyurethane sponge connected to a suction device Application of honey to infected ulcers Application of fly maggots of the Lucilia family to necrotic ulcers. Alvarez O M, et al. (1983). Briggs M & Nelson E (2001). Banwell P (1999). Cooper R A, et al. (1999). Thomas S, et al. (1998).

Result

Implementation

Reference

Methods for treatment of ulcers: Compression Cleaning with water at body-temperature Vacuum therapy Honey and maggot therapy

Method for the use of mattresses with a preventive function

Prevention of pressure ulcers.

Method for providing an adequate amount of nutritional food

Prevention of pressure ulcers.

Cullum N, Deeks J, Sheldon TA, Song F, Fletcher AW (2002). (Cochrane Review) Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 2 Ek A-C, et al. Individually-adapted hip protectors in cotton pants. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 3 Udn G. Lauritzen JB, Petersen MM, Lund B (1993). SBU (1994). Rapport nr.123, Kapitel 3 Bonair A.

Hip protection

Prevention of hip fractures in falls.

Hip protection

Prevention of hip fractures in falls.

Method for pre-operative instructions Effects on fear and anxiety Postoperative breathing function Use of analgesics Use of tranquillising drugs Time in recovery room Number of in-patient days Post-operative complications Earlier discharge

Contd. on page 30

29

Table 2 c Examples of methods for preventing ill-health and/or treating ill-health. Implementation
SBU (1994). Rapport nr.123. SBU (1994). Rapport nr.123. SBU (1994). Rapport nr.123. Plastow L et al. (2001). Plastow L et al. (2001). Bowl or shower. Evaluation of municipal nursing organisation. Selim P, et al. (2001). Buss I C, et al. (1997). Nelson E A, et al.( 2001). Jacobsson C, et al. (1997).

Method/Tool Reference

Result

Method of "guided imagery"

Non-pharmacological treatment of pain.

Bulechek GM & McCloskey JC (1992).

Methods for preventing contractures

Toilet training methods Monitoring methods

Lotion

Elimination of head lice.

Elimination of head lice.

Combing in combination with hair shampoo Tap water Sterile salt solution Massage Compression bandage

Clean sore.

Pressure sore prevention. Improved healing of ulcers.

Individual programme to train eating ability

The patients felt it was easier to eat. Systematic focus on, and training of, Before the treatment, no one ate. After functions required for eating and treatment, 6 patients ate and 4 discussions with the patient. patients had their tube removed.

30

Table 2 d. Examples of methods for evaluating planned individual care Result

Safe care environment. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 3 Udn G. Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 5 Wredling R.

Method/Tool

Implementation

Reference

Higher quality in the care of patients with diabetes.

Tools and methods for evaluating prevention and treatment of patients with high risk of fall injuries Tool for systematic evaluation of patient satisfaction with treatment. Treatment Satisfaction DTSQ and DTSQc Methods/tools for evaluating patient self-care and coping ability and compliance (concordance) EORTC QLQ-C30 (questionnaire) Measure of quality of life. Assessment based on self-rated coping strategies, self-care ability and compliance. Patients with cancer. Maughan K & Clark C (2001).

Kvalitetsindikatorer inom omvrdnad, (2001). Kapitel 5 Wredling R.

Originally developed for patients with Maughan K & Clark C (2001). breast cancer. Questionnaire (five-point Likert scale), Weitzner M A et al. (1999). 10 minute duration. Weitzner M A & McMillan S C (1999). Ware & Sherbourne (1992) Bowling (1997).

Lasry Sexual Functioning scale data Measure of effects of cancer on sexual functioning. CQOLC (Caregiver Quality of Life Measure of quality of life in caregivers Index-Cancer Scale) who are caring for a close relative with cancer in the home. SF-36 (Medical Outcomes Study Measure of health and health-related Short Form) quality of life. Measure of health and health-related quality of life. Measure of health and health-related quality of life.

NHP- Nottingham Health Profile

SIP- Sickness Impact Profile

The patient rates his/her perceived health and various functioning by completing a questionnaire. The patient rates his/her perceived health and various functioning by completing a questionnaire. The patient rates his/her perceived health and various functioning by completing a questionnaire.

Hunt SM et al. (1980) Hunt SM, Mc Kenna SP, Williams J (1981). Bergner M, Bobitt RA, Carter WB, Gilson BS (1981).

31

Table 3 Examples of methods for the organisation of individual care. Results

Reed S E (1988). Giovanetti P (1986). Johnson T & Tahan H (1997). Segersten K (1996). Zander K (1988 a). Zander K (1988 b). Enhanced quality of nursing Increased patient satisfaction Shorter in-patient times Increased cost-effectiveness.

Method

Implementation

Reference

Primary nursing

Group care

Nursing Case Management

Individual care planning

Each patient is listed with a specific nurse who is responsible for the patient's overall care during hospitalisation including any readmission. The group is deemed to provide better A limited number of carers tending the care than a single carer patient. A controlled balance between One and the same nurse plans, organises, co-ordinates, implements, cost and quality. A result-based care process. documents and evaluates the care. This also includes overall responsibility for goal attainment within the framework of a predetermined care period and the planned use of resources. Written directives for nurses. Documented individual plans for each patient. Facilitates continuity of care for the patient. Aids the prioritising of nursing interventions. Carpenito L J (2000). Preparation of general care plans Increased care quality. based on a medical diagnosis, More time for patient care, Increased exchange of skills, treatment or nursing aspects. Facilitates the introduction of new employees and students. Ryan K A (1989). Hellgren A & Edlund K (1996). Edlund K & Forsberg A (1999).

Standard care plans

32

LIST OF APPENDICES APPENDIX 1. LIST OF MEMBERS OF THE AL ERT ADVISORY COMMITTEE IN THE YEAR 2002 APPENDIX 2. DESCRIP TION OF SCIENTIF IC J OURNAL S EXAMINED WHEN MAPPING NURSING METHODS

A P P E N D I X 1 . L I S T O F M E M B E R S O F T H E A L E RT A DV I S O RY C O M M I T T E E I N T H E 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

34

APPENDIX 2. DESCRIPTION OF THE JOURNALS EXAMINED WHEN MAPPING NURSING METHODS

Circulation is a medical journal in the field of cardiovascular disease containing some basic research as well 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.

35

Theoria, Journal of Nursing Theory, focuses on theory development, theoretical understanding of nursing practice, and implementation of theory and theoretical understanding in clinical practice.

36

REFERENCES
Abraham IL, Neese JB, Westerman PS. Depression. Nursing implications of a clinical and social problem. Nursing Clinics of North America. 1991; 26 (3): 527-544. Als H. A syanactive model of neonatal behavioural organization: framework for the assessment and support of the neurobehavioral development of the premature infant and his parents in the environment of the neonatal intensive care unit. In: Sweeny JK. (ed) The high-risk neonate: developmental therapy perspectives. Physical & Occupational Therapy in Pediatrics. 1986; 3-4: 3-55. Alvarez O M, Mertz P m, Eaglstein W H. the effect of occlusive dressing on collagen synthesis and reepithelialization in superficial wounds. Journal of Surgical Research. 1983; 35: 142-148. Andersson Hardy M. Dry skin care. In: Bulechek GM & Mc Closkey JC. (eds) Nursing interventions. Essential Nursing Treatments. (2nd ed.) Philadelphia, W.B Saunders Company, 1992. Axelsson K. Eating problems and nutritional status after stroke. Ume University Medical Dissertation. New series no 218. Ume 1988. Axelsson K et al. Nutritional status in patients with acut stroke. Acta Medica Scandinavica. 1988; 224, 217224. Axelsson K et al. Eating problems and nutritional status during hospital stay of patients with severe stroke. Journal of Dietary Association. 1989; 89: 1092-96. Banwell P E. Topical negative pressure in wound care. Journal of Wound Care. 1999; 8 (2): 79-84. Barrett E A M. The Theoretical Matrix for a Rogerian Nursing Practice. Theoria Journal of Nursing Theory. 2000, 9 (4): 3-7. Beaver et al. Treatment decision making in woman newly diagnosed with breast cancer. Cancer Nursing. 1996;19,:8-19. Beck A T. Depression: Clinical, Experimental, and Theoretical Aspects. New York: Harper & Row, 1967. Bergner M, Bobitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: Development and final revision of a health status measure. Med Care. 1981; 19: 796-799. Bjrck Linne A, Liedholm H, Israelsson B. Effects of systematic education on heart failure patients knowledge after 6 months. A randomised, controlled trial. European Journal of Heart Failure. 1999; 1: 219227. Bonair, A. Hur ska sjukskterskans arbetsmetoder utvrderas? In: SBU. Behov av utvrdering av sjukskterskans arbete. Stockholm: SBU-rapport 123, 29-41, 1994.

37

Bowling A. Measuring Health. A review of quality of life measurement scales. (2nd edition). Buckingham: Open University Press, 1997. Briggs M, Nelson E A. Topical agents of dressings for pain in venous leg ulcers. (Cochrane Review). In: The Cochrane Library 2001; 4. Oxford: Update Software. Braden B, Bergstrom N. Predictive validity of the Braden scale for pressure sore risk in nursing home population. Research in Nursing and Health. 1994; 17: 459-470. Brorsson B. & Wall S. Vrdering av medicinsk teknologi problem och metoder. Stockholm: MFR, 1984. Bulechek GM, McCloskey JC. Defining and validating nursing interventions. Nurs Clinics N Am. 1992; 27: 289-297. Buss I C, Halfens R J, Abu-Saad H H. The effectiveness of massage in preventing pressure sores: a literature review. Rehabilitation Nursing. 1997; 22 (5): 229-234. Campbell J M. Treating depression in well older adults: use of diaries in cognitive therapy. Issues in Mental Health Nursing. 1992; 13(1): 19-29. Campbell N C, Ritchie L D, Thain J, Deans H G, Rawles J M, Squair J L. Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care. Heart. 1998; 80: 447-52. Carpenito L J. Nursing diagnosis: Application to clinical practice. (8th ed) Philadelphia: J.B. Lippincott, 2000. Chung et al. An experimental study on the use of manual pressure to reduce pain in intramuscular injections. Journal of Clinical Nursing. 2002; 11: 457-462. Conell Meehan T. Therapeutic touch. In: Bulechek G M & Mc Closkey J C (eds) Nursing interventions. Essential nursing treatments (2nd ed.) Philadelphia: WB Saunders Company, 1992. Cooper R A, Molan P C, Harding K G. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. Journal of Social Medicine. 1999; 6: 283-285. Cossette et al. Nursing approaches to reducing psychological distress in men and women recovering from myocardial infarction. International Journal of Nursing Studies. 2002; 39: 479-494. Cullum N, Deeks J J, Fletcher A W, Sheldon T A, Song F. Preventing and treating pressure sores. Quality in Health Care. 1995; 4: 289-297. Cullum N, Deeks J, Sheldon T A, Song F, Fletcher A W. Beds, mattresses and cushions for pressure sore prevention and treatment. (Cochrane Review). In : The Cochrane Library Issue 4 2002. Oxford: Update Software. Day T, Wainwright S P, Wilson-Barnett J. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. Journal of Clinical Nursing. (2001); 10: 682-696.

38

Detsky et al. What is a subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition. 1987; 11: 8-13. Devine E C, Cook T D. Clinical and cost-saving effects of psycho educational interventions with surgical patients: A meta analysis. Research in Nursing and Health. 1986; 9: 89-105) Dhooper S S, Green S M, Huff M B, Austin-Murphy J. Efficasy of a group approach to reducing depression in nursing home elderly residents. Journal of Gerontological Social Work. 1993; 20: 87-100. Dodd M et al. Advancing the science of symptom management. Journal of Advanced Nursing. 2001; 33(5): 668-676. Edlund K, Forsberg A. Standardvrdplanen kan bli en vg till hgre vrdkvalitet. Vrdfacket. 1999 ; 23 (11): 48-51. Ehnfors M, Nordstrand K. Distriktsskterskans patientrelaterade omvrdnadstgrder. Socialmedicinsk tidskrift. 1995; 4-5: 177-193. Ehnfors M, Ehrenberg A, Thorell-Ekstrand I. VIPS-boken. Om en forskningsbaserad modell fr dokumentation av omvrdnad i patientjournalen. FoU 48. Vrdfrbundet, Stockholm 1998. Eilers J, Berger A M, Petersen M C. Development, testing and application of the oral assessment guide. Oncology Nursing Forum. 1988; 15. 325-330. Ek A C. Pressure sores a problem in nursing care. A study of skin blood flow, risk factors, prevalence, prevention and treatment in long term care patients. Dissertation. University of Linkping, Linkping 1985. Ek A-C, Bjurulf P. Interrater variability in a modified Norton Scale. Scandinavian Journal of Caring Sciences. 1987, 1: 99-102. Ek A C et al. The Modified Norton Scale and the nutritional state. Scandinavian Journal of Caring Sciences. 1988; 3: 183-187. Ek A C, Nordstrm G, Lindgren M. Kvalitetsindikatorer fr patienter med eller med risk fr trycksr. I: Idwall E. Kvalitetsindikatorer inom omvrdnad nr 9. [Quality Indicators in Nursing] Svensk sjukskterskefrening (SSF) och Frlagshuset Gothia AB, Stockholm 2001. Ellul J, Watkins C, Barer D. Frequency, clinical course and complications of dysphagia in acute stroke, studied using a standardised bedside swallowing assessment. URL: http:// www.ncl.ac.uk/strokeresearch-unit/costar/pap D1.doc. Emly M, Cooper S och Vail A. Colonic Motility in Profoundly Disabled People. A comparison of massage and laxative therapy in the management of constipation. Physiotherapy. 1998, 84 (4), 178-183. Evers G C M. Appraisal of self-care agency. ASA-scale. Dissertation. Assen/Maastricht: Van Gorcum, 1989. Ferell Torry A, Glick O. The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nursing. 1993;16: 93-101.

39

Flanagan M. Assessment criteria. Nursing Times. 1994 ; 90: 76-88. Fletcher A, Cullum N, Sheldon T A. A systematic review of compression treatment of venous leg ulcers. British Journal of Medicine. 1997; 6(315): 576-580. Fraser M C. Measuring mental status and level of consciousness. In: Frank Stomberg M. (ed) Instruments for clinical nursing research. Norwalk: Appleton & Lange, 1988. Gardner D L. Presence. In: Bulechek GM & McCloskey JC. (eds) Nursing Interventions. Treatments for nursing diagnosis. Philadelphia: W. B Saunders Company, 1985. Garon M. Assessment and management of pain in the home care setting: Application of Rogersscience of unitary human beings. Holistic Nursing Practice. 1991, 6(1). 47-57. Gaston-Johansson F. Pain assessment with particular reference to pain terms, instrument develoopment and pain descriptors. Dissertation. Gteborg University, Gteborg 1985. Gaston-Johansson F. Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple inexpensive assessment tool that could change health care practices. Journal of Pain Symptom Management. 1996; 12(3): 172-181. Giovanetti P. Evaluation of primary nursing. Annual Review of Nursing Research. 1986; 13: 383-395. Glen S, Jownally S. Privacy: a key nursing concept. British Journal of Nursing. 1995; 4: 69. Glenister D. Patient participation in psychiatric services: a literature review and proposal for a research strategy. Journal of Advanced Nursing. 1994; 19: 802-811. Good M, Stanton-Hicks M, Grass J A, Cranston Anderson G, Lai H-L, Roykulcharoen V, Adler P. Relaxation and music to reduce post surgical pain. Journal of Advanced Nursing. 2001; 33(2): 208-215. Gordon V C & Gordon E M. Short-term group treatment of depressed women: a replication study in Great Britain. Archives of Psychiatric Nursing.1987; 1(2): 111-124. Gordon V C, Matwychuk A K, Sachs E G, Canedy B H. A 3-year follow-up a cognitive - behavioural therapy intervention to reduce depression in women. Archives of Psychiatric Nursing. 1988; 2 (4), 218-226. Grady K L et al. Team management of patients with heart failure: A statement for healthcare professionals from the cardiovascular nursing council of the American Heart Association. Circulation. 2000; 102: 24432456. Graham et al. Reducing the incidence of stomatitis using a quality assessment and improvement approach. Cancer Nursing. 1993; 16: 117-122. Gunningberg L, Lindholm C, Carlsson M, Sjden P O. Implementation of risk assessment and classification of pressure ulcers as quality indicators for patients with hip fractures. Journal of Clinical Nursing. 1999; 8: 396-406.

40

Gunningberg L, Lindholm C, Carlsson M, Sjden P O. Reduced incidence of pressure ulcers in patients with hip fractures: a 2-year follow up of quality indicators. International Journal of Quality in Health Care. 2001; 13(5): 399-407. Gustafsson B. Living with dysphagia, some aspects of the experimental meaning of handicap, adaptedness and confirmation. Dissertation. University of Linkping, Linkping 1992. Gustafsson B. The SAUC Model for Confirming Nursing. An Action-theoretic Approach to Theory Building and Nursing Practice. Theoria Journal of Nursing Theory. 2000, 9 (1). 6-21. Gustafsson B, Andersson L. The Nine-Field-Model for Evaluation of Theoretical Constructs in Nursing. Part one: Development of a new model for nursing theory evaluation and application of this model to theory description of the SAUC Model. Theoria Journal of Nursing Theory. 2001 a, 10 (1). 10-34. Gustafsson B, Andersson L. The Nine-Field-Model for Evaluation of Theoretical Constructs in Nursing. Part two: Application of the evaluation model to theory analysis, theory critique and theory support of the SAUC Model. Theoria Journal of Nursing Theory. 2001 b, 10 (2). 19-38. Gustafsson B, Prn I. A motivational approach to confirmation. An interpretation of some dysphagic patients experiences. Theoretical Medicine. 1994; 15: 409-430. Hawthorn J & Redmond K. Smrta-bedmning och behandling. Lund: Studentlitteratur 1999. Hellgren A, Edlund K. Standardvrdplanen ger bas fr god dokumentation. Vrdfacket. 1996; 20 (8): 3739. Hjelm-Karlsson K. Dispelling the unknown. Effects of information to patients undergoing intravenous pyelography. Dissertation. Uppsala University, Uppsala 1988. Hunt SM, McKenna SP, Mc Ewen J, Backet EM, Williams J, Pappp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Commun Health. 1980; 34: 281-286. Hunt SM, McKenna SP, Williams J. Reliability of a population survey tool for measuring perceived health problems: a study of patients with osteoarthrosis. J Epidemiol Commun Health. 1981; 35: 297-300. Idwall E, Lundgren A. Kvalitetsindikatorer fr patienter med perifer intravens venkanyl. I: Kvalitetsindikatorer i omvrdnad 1 [Quality Indicators in Nursing]. Stockholm: Svensk sjukskterskefrening (SSF) och Spri 1996. Jacobsson C, Axelsson K, Wennergren B I, Norberg A. Eating despite severe difficulties: assessment of poststroke eating. Journal of Clinical Nursing. 1996; 5: 23-31. Jacobsson C, Axelsson K, Norberg A, Asplund K, Wenngren B I. Outcomes of individualized interventions in patients with severe eating difficulties. Clinical Nursing Research. 1997; 6: 25-44. Jacobsson C, Axelsson K, sterlind P O, Norberg A. How people with stroke and healty older people experience the eating process. Journal of Clinical Nursing. 2000a; 9: 255-264.

41

Jacobsson C, Lindholm L, Waldau S, Engstrm B. Cost effectiveness of nursing interventions in a post stroke eating training programme- a pilot study. Journal of Nursing Management. 2000b; 8: 1-11. Jairath N. Strategies for motivating CCU patients. Critical Care Nursing. 1994; 13: 324-333. Jenns K. Importance of nausea. Cancer Nursing. 1994; 17: 488-93. Johnson T, Tahan H. Care management: Outcomes-based practice for the primary nurse. Journal of Care Quality. 1997; 11: 55-68. Johnston R L. Approaching family intervention through Rogersconceptual model. In A L Whall (Ed.). Family therapy theory for nursing: Four approaches (pp 11-32). Norwalk 1986. CT: Appleton-Centuty-Crofts. Jones C. Glasgow Coma Scale. American Journal of Nursing. 1979; 79: 1551. Kolcaba K. Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook. 2001; 49. 86-92. Kumasaka L M, Dungan J M. Nursing strategy for initial emotional response to cancer diagnosis. Cancer Nursing. 1993; 16: 296-303. Larkin D M, Zahourek R P.Therapeutic storytelling and metaphores. Holistic Nursing Practice. 1988; 2: 4553. Larson Et al. A model for symptom management. IMAGE. Journal of Nursing Scholars. 1994; 26(4): 272276. Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet. 1993, 2; 341 (8836). 11-13. Leininger M.Transcultural care diversity and universiality. A theory of nursing. Nursing and Health Care. 1985; 6: 209-212. Leininger M. Culture Care Diversity and Universality: A theory of nursing. New York: National League for Nursing 1991. Leininger M. Transcultural Nursing Concepts, Theories, Research and Practices. (2nd ed) New York: Mc Graw-Hill, 1995. Leininger M, McFarland M R. Transcultural nursing: concepts, theories, research & practice. New York: Mc GrawHill, Medical Pub. Division, cop. 2002. Lenz E R et al. The middle-range theory of unpleasant symptoms: an update. Advances in Nursing Science. 1997; 19(3): 14-27. Lehtinen U, hln J, Asplund K. Grundforskning ngot fr omvrdnad? Svensk sjukskterskefrening, Stockholm, 2002. Lewis D. Computer-based approaches to patient education. A review of literature. Computers in Patient Education. 1999; 6: 272-282.

42

Lindberg, M et al. Asthma nurse practice improves outcomes and reduces costs in primary health care. Scandinavian Journal of Caring Sciences. 2002; 16: 73-78. Lundgren A, Jorfeldt E, Ek A C. The care and handling of peripheral intravenous cannulae on 60 surgery and internal medicine patients. An observation study. Journal of Advanced Nursing. 1993;18: 963-971. Loftus L A. Weston V. The development of nurse-led clinics in cancer care. Journal of Clinical Nursing. 2001;10: 215-20. Magnusson et al. Supporting family carers through the use of information and communication technology the EU project ACTION. International Journal of Nursing Studies. 2000; 39: 369-381. Marshall J L, Mead P, Jones K, Kaba E, Roberts A P. The implementation of venous leg ulcer guidelines: process analysis of the intervention used in multi-center, pragmatic, randomized, controlled trial. Journal of Clinical Nursing. 2001; 10 (6): 758-766. Maughan K, Clarke C. The effect of a clinical nurse specialist in gynaecological oncology on quality of life and sexuality. Journal of Clinical Nursing. 2001;10, 221-229. Maynard C. Comparison of effectiveness of group interventions for depression in women. Archives of Psychiatric Nursing. 1993; 7: 277-283. McMillan S C & Williams F A. Validity and reliability of the constipation assessment scale. Cancer Nursing. 1989; 12: 183-188. Nelson E A, Bell-Syer S E M, Cullum N A. Compression for preventing recurrence of venous ulcers. (Cochrane Review). In: The Cochrane Library, 4, 2001. Oxford: Update Software. Nordenram G, Ronnberg L, Winblad B. The percieved importance of apperance of oral function, comfort and health for severely demented personsrated by relatives, nursing staff and hospital dentists. Gerodontology. 1994;11:18-24. Norton D, McLaren R, Exton-Smith A N. An investigation of geriatric problems in hospital. (3rd ed) London: Churchill Livingstone 1979. Ouslander J G, Urman H N, Uman C G. Development and testing of an incontinence monitoring record. Journal of American Geriatric Society. 1986; 34: 83-90. Perkins P J. Psychosocial support and malignant melanoma. European Journal of Cancer Care. 1993;2:161164. Perry L. Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses. Journal of Clinical Nursing. 2001;10: 463-473. Perry L. Screening swallowing function of patients with acute stroke. Part two: detailed evaluation of the tool used by nurses. Journal of Clinical Nursing. 2001;10: 474-481. Plastow L, Luthra M, Powell R, Wright J, Russell D, Marshall M. Head lice infestation: bug busting vs. traditional treatment. Journal of Clinical Nursing. 2001; 10: 775-783.

43

Pollack L E. Content analysis of groups for inpatients with bipolar disorder. Applied Nursing Research. 1993;6 (1): 19-27. Plsson et al. Burnout, empathy and sense of coherence among Swedish district nurses before and after systematic clinical supervision. Scandinavian Journal of Caring Science. 1996;10:19-26. Ragneskog H. Music and other strategies in the care of agitated individuals with dementia. A nursing perspective. Dissertation. Gteborg University, Gteborg 2001. Ragneskog H, Gerdner LA, Hellstrm L. Integration of lucid individuals and agitated individuals with dementia in different care units. Journal of Clinical Nursing. 2001;10: 730-736. Rappaport M, Dougherty A M, Kelting D L. Evaluation of coma and vegetative states. Archives in Physical and Medical Rehabilitation. 1992; 7: 628-634. Recommendations for exercise training in chronic heart failure patients. European Heart Journal. 2001; 77: 25-31. Reed S E. A comparision of nurse-related behavior, philosophy of care and job satisfaction in team and primary nursing. Journal of Advanced Nursing. 1988; 13: 383-395. Regionalt onkologiskt centrum. Vrdprogram. Omhndertagande av patienter med cancer. ROC Omvrdnadsprojekt. Uppsala: Akademiska sjukhuset 1990. Rosen J, Rogers J, Marin R, Mulsant B, Shahar A, Reynolds C. Control-relevant intervention in the treatment of minor and major depression in a long term care facility. American Journal of Geriatric Psychiatry. 1997; 5: 247-257. SBU. Behov av utvrdering inom sjukskterskans arbetsomrde. Rapport nr 123. Stockholm: SBU 1994. SBU & SSF. Strlbehandling av patienter med cancer. Rapport nr 1. Stockholm: SBU 1998. (a). SBU & SSF. Behandling av patienter med mttligt frhjt blodtryck. Rapport nr 2. Stockholm: SBU 1998. (b). SBU & SSF. Behandling av personer med depression. Rapport nr 3. Stockholm: SBU 1999. (a). SBU & SSF. Caring for Persons With Schizophrenia. Report No 4. Stockholm: SBU 1999 (translation 2001) (b). Scandrett-Hibdon S, Uecker S. Relaxation training. In: Bulechek GM & Mc Closkey JC (eds) Nursing interventions. Essential nursing treatments (2nd ed) Philadelphia: W. B. Saunders Company 1992. Seeley S, Murray L, Cooper P J. Postnatal depression: the outcome for mothers and babies of health visitors intervention. Health Visitor.1996; 69(4): 135-138.

44

Segersten K. The dream team Bemanning och arbetsmodeller p vrdavdelning. Linkping: Socialstyrelsen, 1996. Selim P, Bashford C, Grossman C. Evidence-based practice: tap water cleansing of ulcers in the community. Journal of Clinical Nursing. 2001; 10: 372-379. Snyder M. Progressive relaxation as a nursing intervention: an analysis. Advances in Nursing Science. 1994; (April): 47-58. Socialstyrelsen. (1989). tproblem inom vrden. En kunskapsversikt. SoS-rapport 1989:36. Stockholm: Gotab 1989. Sodergren KM. Guided Imagery In: Snyder M. (ed) Independent nursing interventions. New York: John Wiely & Sons, 1985. SSF & Gothia. Kvalitetsindikatorer inom omvrdnad. [Quality Indicators in Nursing] Omvrdnad nr.9. Stockholm : Gothia 2001. Strmberg et al. Interactive education on CD-ROM - a new tool in education of heart failure patients. Patient Education and Counseling. 2002; 46: 75-81. Swanson K. Empirical development of a middle range theory of caring. Nursing Research. 1991; 40:161-166. Symington A, Pinelli J. Developmental care for promoting development and preventing in preterm infants. (Cochrane Review) In: The Cochrane Library, Issue 4 2002. Oxford: Update Software. Stterlund-Larsson U. Being involved. Patient participation in health care. Studies in art and Sciences No 36, Linkping University, Linkping 1989. Sderhamn O, Evers G, Hamrin E. A Swedish version of the Appraisal of Self-care Agency (ASA) scale. Scandinavian Journal of Caring Sciences. 1996a, 10: 3-9 Sderhamn O, Lindencrona C, Ek A-C. Validity of two self-care instruments for the elderly. Scandinavian Journal of Occupational Therapy. 1996b, 3: 172-179. Unosson M. Malnutrition in hospitalised elderly patients. Dissertation. Linkping University, Linkping 1993. Thomas S, Andrews A, Jones M. The use of larval therapy in wound management. Journal of Wound Care. 1998; 7(10): 521-524. Walker S M, Haugen R D, Richards A. A comparison of sevoflurane with halothane for paediatric day case surgery. Anaesthesia Intensive Care. 1997, 25, 643-649. Ware JE, Sherbourne CD. The SF-36 Health Status Survey: I. Conceptual framework and item selection. Med Care. 1992; 30: 473-483. Weinrich S & Weinrich M. The effect of massage on pain in cancer patients. Applied Nursing Research. 1990; 3: 140-145.

45

Westergren A, Karlsson S, Andersson P, Ohlsson O, Hallberg I R. Eating difficulties, assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation. Journal of Clinical Nursing. 2001; 10: 257-269. Weitzner M A, Jacobson P B, Wagner J R H, Friedland J, Cox C. The Caregiver Quality of Life Index Cancer(CQOLC)Scale: development and validation of an instrument to measure quality of life of the family caregiver of patients with cancer. Quality of Life Research. 1999, 8, 55-63. Weitzner M A & McMillan SC. The caregiver Quality of Life Index-Cancer(CQOLC) Scale: Revalidation in a Home Hospice Setting. Journal of Palliative Care. 1999, 15(2), 13-20. Whall A L. Nursing theory and the assessment of families. Journal of Psychiatric Nursing and Mental Health Services. 1981, 19(1): 30-36 Wiesel PH; Norton C; Brazzelli M. Management of faecal incontinence and constipation in adults with central neurological diseases (Cochrane-review). In: The Cochrane Library. 2002, Issue 4. Oxford: Update Software. Willman A & Stolz P. Evidensbaserad omvrdnad en bro mellan forskning och klinisk verksamhet Studentlitteratur, Lund 2002. Wright S M. Development and construct validity of the energy field assessment form. Dissertation Abstracts International 1989, 49, 3113B. Wright S M. Validity of the human energy field assessment form. Western Journal of Nursing Research. 1991,13, 635-647. Youssef F. The impact of group reminiscence counselling on a depressed elderly population. Nurse Practitioner. 1990;15 (32): 35-38. Zander K. Nursing case management: Strategic management of cost and quality outcomes. JONA. 1988; 18 (5): 23-30. Zander K. Managed care within acute care settings: Design and implementation via nursing case management. Health Care Supervision. 1988; 6(2): 27-43. Zerhausen J D, Boyle K, Wilson W. Out of the darkness: group cognitive therapy for depressed elderly. Reprinted with permission from the Journal of Psychosocial Nursing, copyright 1991. Journal of Military Nursing Research.1995; 1(4): 28-32. vriga kllor Nationalencyklopedin p Internet: www.ne.se Skoldatantet. Lexikon online och uppslagsverk: www.skolverket.se/skolnet/lexikon

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