Changes in home care clients' characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data.

BACKGROUND: Policymakers advocate extended residence in private homes as people age, rather than relocation to long-term care facilities. Consequently, it is expected that older people living in their own homes will be frailer and have more complex health problems over time. Therefore, community care for aging people is becoming increasingly important to facilitate prevention of decline in physical and cognitive abilities and unnecessary hospital admission and transfer to a nursing home. The aim of this study was to examine changes in the characteristic of home care clients and home care provided in five European countries between 2001 and 2014 and to explore whether home care clients who are most in need of care receive the care required. METHODS: This descriptive study used data from two European research projects, Aged in Home Care (AdHOC; 2001-2002) and Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care (IBenC; 2014-2016). In both projects, the InterRAI-Home Care assessment tool was used to assess a random sample of home care clients 65 years and older in five European countries. These data facilitate a comparison of physical and cognitive health and the provided home care between countries and study periods. RESULTS: In most participating countries, both cognitive (measured on the Cognitive Performance Scale) and functional ability (measured on the Activities of Daily Living Hierarchy scale) of home care clients deteriorated over a 10-year period. Home care provided increased between the studies. Home care clients who scored high on the physical and cognitive scales also received home care for a significantly higher duration than those who scored low. CONCLUSION: Older people in several European countries remain living in their own homes despite deteriorating physical and cognitive skills. Home care services to this group have increased. This indicates that the government policy of long-term residence at own home among older people, even in increased frailty, has been realised.

Protective effects of organic acids on survival of Escherichia coli O157:H7 in acidic environments.

Outbreaks of disease due to acid-tolerant bacterial pathogens in apple cider and orange juice have raised questions about the safety of acidified foods. Using gluconic acid as a noninhibitory low-pH buffer, we investigated the killing of Escherichia coli O157:H7 strains in the presence or absence of selected organic acids (pH of 3.2), with ionic strength adjusted to 0.60 to 0.68. During a 6-h exposure period in buffered solution (pH 3.2), we found that a population of acid-adapted E. coli O157:H7 strains was reduced by 4 log cycles in the absence of added organic acids. Surprisingly, reduced lethality for E. coli O157:H7 was observed when low concentrations (5 mM) of fully protonated acetic, malic, or l-lactic acid were added. Only a 2- to 3-log reduction in cell counts was observed, instead of the 4-log reduction attributed to pH effects in the buffered solution. Higher concentrations of these acids at the same pH aided in the killing of the E. coli cells, resulting in a 6-log or greater reduction in cell numbers. No protective effect was observed when citric acid was added to the E. coli cells. d-Lactic acid had a greater protective effect than other acids at concentrations of 1 to 20 mM. Less than a 1-log decrease in cell numbers occurred during the 6-h exposure to pH 3.2. To our knowledge, this is the first report of the protective effect of organic acids on the survival of E. coli O15:H7 under low-pH conditions.

Health promotion in the workplace: the perspective of unskilled workers in a hospital setting.

It is important to explore the potential for health promotion from the perspective of participants in a particular situation. This study focuses on experiences of well-being and the potential for health promotion among unskilled workers in the kitchen and laundry room in an acute care hospital in Iceland. These experiences are analysed in light of the material and structural factors that shape working conditions. The research method used was grounded theory. The data were formal and informal interviews, and participant observation. The findings revealed considerable differences between the two work groups. At both sites strain on the body, caused by excessive noise, heavy lifting and uncomfortable working arrangements, were identified. Similarly, the work was often experienced as monotonous and demanding. Human relations were identified as a key factor in ameliorating the conditions that led to experiences of strain by the workers at both work sites. This was however where the two work places differed. In the laundry room, the workers felt respected and acknowledged by their coworkers and managers. Belonging to the work group was important and they felt listened to by the supervisor. Very little cohesiveness was observed among the workers in the kitchen. The managers seemed to be absent from the floor, workers were divided into work groups that sometimes showed antagonism towards each other and few channels were available for complaints and suggestions for improvement. The workers in the laundry room, on the other hand, related positive experiences of work. They felt that steps were taken by managers to improve working conditions to the extent possible and participated in those attempts by bringing up suggestions, implementing change and developing their own ways of coping with the work. This study gives important directions for health promotion in the workplace, emphasizing human relations at work, rather than individual health behaviour away from the work setting.

Language, research and nursing practice.

AIM OF THE PAPER: This paper highlights the centrality of language in constructing knowledge. It aims at making us sensitive to the political nature of knowledge production and the complex power relationships that may emerge as a result of our efforts to create new knowledge. BACKGROUND: Science, as understood here, is a linguistic construction, rather than a mirror reflection of reality. A number of examples are presented, demonstrating the complex ways in which language is central in shaping all our attempts to know, science included, and nursing practice. CONCLUSION: Based on the analysis presented in this paper an argument is made for a substantial re-thinking of nursing research and its relationship to nursing practice. Research needs to be an integral part of everyday nursing practice, a way of posing questions and reflecting on answers. Further, nurses need to be aware of the potentially coercive nature of knowledge as well as its liberating effect.

Language, ideology, and nursing practice.

This article explores the ways in which nursing practice is shaped by language and ideology. It is based on an ethnographic study conducted at two general surgical units in one of the main acute care hospitals in Iceland. The data used were qualitative: transcribed semistructured interviews with registered nurses on two acute care units, field notes from a participant observation on the two units and contextual information from written documents, such as yearly reports from the hospital and newspaper articles. The main findings revealed a stark contrast between the two discourses noticed. The public discourse, observed at team meetings in giving reports and in the written documentation, was characterized by objectivity and distancing from patients' personal understandings. The style of presentation was distant and mechanical. The private discourse, which emerged in private discussions between staff on the units and in interviews with the researcher, reflected the nurses' attempts to understand each patient's situation and outlook on life. This discourse was much more engaged, reflecting the nurses' energy and interest in being of assistance. By highlighting the difference between private and public discourses, this study provides important insight into the complex ways in which language and power interact to create different conditions for nursing practice. Based on these findings inferences are made as to how nursing practice is shaped by ideology.