Nurses' and patients' communication in smoking cessation at nurse-led COPD clinics in primary health care.

BACKGROUND: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. OBJECTIVE: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. METHODS: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. RESULTS: Only to a small extent did nurses' evoke patients' reasons for change, stimulate collaboration, and support patients' autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients' communication was mainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. CONCLUSION: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. PRACTICE IMPLICATIONS: To make patients more active, the nurses need more education and continuous training in motivational communication.

End of life of patients treated with haemodialysis as narrated by their close relatives.

AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives. INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation. DESIGN: Qualitative and descriptive. METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved. FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal. CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.

Meanings of being a close relative of a family member treated with haemodialysis approaching end of life.

AIMS AND OBJECTIVES: To describe and elucidate the meanings of being a close relative of a severely ill family member treated with maintenance haemodialysis approaching the end of life. BACKGROUND: End-stage renal disease together with comorbidities, haemodialysis treatment and high mortality rates also affects the lives of close relatives, who report burdens and impaired quality of life. To improve care, more understanding is needed of close relatives' experiences during these patients' end of life. DESIGN: This study has a qualitative interpretative design. METHODS: Fourteen retrospective qualitative interviews were conducted with close relatives (aged 48-93 years) of deceased patients who had been treated with haemodialysis. The interview text was interpreted using a phenomenological hermeneutical method in three phases. RESULTS: The findings of the structural analysis were formulated as six themes: Striving to be supportive and helpful without doing harm to the ill person's self; Needing increasing strength and support; Balancing the will to help with one's own ongoing life; Increasing responsibility involving dilemmas; Striving for a good life together in the present and Living with awareness of death. CONCLUSIONS: Close relatives strive for balance and well-being accompanying their ill family member through the end of life. They are facing moral dilemmas and growing demands as their responsibility increases with the deterioration of their family member. Support from and interaction with the healthcare professionals is then of significance. RELEVANCE TO CLINICAL PRACTICE: Findings challenge healthcare professionals in haemodialysis settings to identify close relatives' individual resources and needs towards the patients' end of life. Healthcare professionals in haemodialysis settings need to offer close relatives opportunities to talk about the future and what may be expected at end of life, with or without haemodialysis. They should also contact the closest relative after the death as they may need confirmation and closure.

Satisfactory reliability among nursing students using the instrument PVC ASSESS to evaluate management of peripheral venous catheters.

PURPOSE: Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. METHODS: PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n=4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n=3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (κ) were calculated. RESULTS: For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (<0.70) for two items: "adherence of inner dressing to the skin" and "PVC location." In 81% of the items, κ was between moderate and almost perfect: moderate (n=5), substantial (n=3), almost perfect (n=5). For edema at insertion site and two items on PVC dressing, κ was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the κ ranged between moderate and almost perfect (0.41-1) in 90%-95%. CONCLUSIONS: PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.

Thoughts on death and dying when living with haemodialysis approaching end of life.

AIMS AND OBJECTIVES: To describe inner thoughts and feelings relating to death and dying when living with haemodialysis approaching end of life. BACKGROUND: Patients who undergo maintenance haemodialysis suffer a significant symptom burden and an impaired quality of life. The high mortality rate in these patients indicates that about one-fourth of them are in their last year of life, suggesting the presence of death and dying in the haemodialysis unit. DESIGN: A qualitative descriptive design was used. Methods. A total of 31 qualitative interviews were conducted with eight patients (aged 66-87) over a period of 12 months. Qualitative content analysis was used to analyse data. RESULTS: The analysis revealed 10 subthemes that were sorted into three main themes. Being aware that death may be near comprises being reminded of death and dying by the deteriorating body, by the worsening conditions and deaths of fellow patients, and by knowing haemodialysis treatment as a border to death. Adapting to approaching death comprises looking upon death as natural, preparing to face death, hoping for a quick death and repressing thoughts of death and dying. Being alone with existential thoughts comprises a wish to avoid burdening family, lack of communication with healthcare professionals and reflections on haemodialysis withdrawal as an hypothetic option. CONCLUSIONS: Living with haemodialysis approaching, the end of life involves significant and complex existential issues and suffering, and patients are often alone with their existential thoughts. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals in haemodialysis settings need to combine technical and medical abilities with committed listening and communication skills and be open to talking about death and dying, with sensitivity to individual and changeable needs.

Learning to live with diabetes--integrating an illness or objectifying a disease.

AIM: This paper is a report of a study of illuminating the meaning of 'learning to live with diabetes' 3 years after being diagnosed. BACKGROUND: A changed situation, for example, in relation to living with diabetes, raises a need to understand. How time for experience contributes to this learning process for people living with diabetes is not yet well understood. It would therefore seem valuable to ask people, who have had diabetes over a similar length of time, to narrate their experience in relation to daily life situations in order to understand better how learning is established. DESIGN: The study has a qualitative design. METHODS: A life world approach was used, with interviews being conducted with 13 people who had been diagnosed with diabetes 3 years earlier. Data were collected in 2007, and analyses were conducted using a phenomenological-hermeneutic method. FINDINGS: How a person experiences the physical body was found to be crucial in the learning process. If the body with its signals is understood it can be a tool for experiencing and understanding the world and oneself. Feeling insecure about one's own needs, and not trusting or understanding bodily signs, made participants dependent on others to make decisions for them. CONCLUSION: This study showed that duration of illness was 'not' of importance for the understanding of living with diabetes. Living with diabetes 3 years after being diagnosed meant to experience both an overall balance in one's existence and a daily struggle.

Differences in clinical reasoning among nurses working in highly specialised paediatric care.

AIMS AND OBJECTIVES: The aim of the study was to examine differences in clinical reasoning among novice, experienced and specialist paediatric nurses. BACKGROUND: Highly specialised paediatric care requires specific knowledge and ongoing skill performance of the nurses employed. There is a lack of research in how paediatric nurses manage the daily care problems they encounter and how they acquire the skills required to give patients the best possible care. More knowledge is needed about how paediatric nurses with different experience and education reason and communicate about paediatric patient situations. DESIGN: The study was based on six recorded group discussions of a fictitious, but realistic paediatric case. Three categories of nurses: novices (n = 7), experienced (n = 7) and specialists (n = 7) from a paediatric hospital participated. A qualitative content analysis approach was chosen to examine differences in clinical reasoning. RESULTS: Several themes were uncovered: child's social situation, child abuse and the child's illness, qualitative differences emerged in how the nurses discussed the case. Three approaches were identified: a task-oriented approach (novices and experienced), an action-oriented approach (novices and experienced) and hypothesis-oriented approach (specialists) while discussing the case. CONCLUSION: When comparing nurses in three competence groups, it was established that the groups with extensive experience and specialist education reasoned differently than the other groups. Between the novice and experienced groups, no obvious differences were found. Thus, the importance of experience alone for the development of competence is still an open question. Experience combined with further education appears important for developing professional competence in paediatric care. RELEVANCE TO CLINICAL PRACTICE: Nurses' reasoning in clinical paediatric care is related to experience and training.

Living with haemodialysis when nearing end of life.

AIMS AND OBJECTIVES: The aim of this study was to describe and to elucidate the meanings of being severely ill living with haemodialysis when nearing end of life. INTRODUCTION: To have end stage renal disease and to be treated with maintenance haemodialysis implies being dependent on lifelong treatment. Several studies have reported that these patients suffer a high symptom burden and an impaired quality of life due to both disease and treatment. In the dialysis unit, where the focus is on handling technology and maintaining life, end of life care may be neglected or overlooked. Nevertheless, mortality rates show that about one-fourth of patients in haemodialysis care are in their last year of life. DESIGN: A qualitative interpretative design was used. METHODS: Serial qualitative interviews over a period of 12 months were conducted with eight patients (aged 66-87). Altogether text of 31 interviews was interpreted using a phenomenological hermeneutical method in three phases. The study is ethically approved. FINDINGS: The structural analysis resulted in 11 subthemes and thereafter the following three themes were formulated; being subordinate to the deteriorating body, changing outlook on life and striving for upheld dignity. The comprehensive interpretation revealed that being severely ill living with haemodialysis near the end of life means living with suffering simultaneously with reconciliation and well-being. Further, the meanings are understood as intertwined with being old. CONCLUSIONS: Findings contribute to an increased awareness of the complexities of these patients' life worlds and their meanings, and thus of the importance to listen to their experiences and their understandings. Findings suggest that to integrate the philosophy of palliative care in haemodialysis units may improve care for patients who are living with haemodialysis and approaching the end of their lives.

Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics.

AIM: This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care. BACKGROUND: For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking. METHOD: The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses' smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing. RESULTS: Evocation', 'collaboration', 'autonomy-support' and 'empathy' averaged between 1·31 and 2·23 whereas 'direction' scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by 'closed questions', 'motivational interviewing non-adherent' and 'simple reflections'. 'Motivational int erviewing adherent', 'open questions' and 'complex reflections' occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations. CONCLUSION: In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.

Learning to live with illness: experiences of persons with recent diagnoses of diabetes mellitus.

BACKGROUND: The process of learning to live with an illness is complex. By better understanding the learning process for persons with diabetes in the early stage of the illness, the role of the health care can be shown. AIM: To reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis. METHOD: A qualitative descriptive design was used, and interviews were conducted. Thirteen participants with a recent diagnosis of diabetes were included and asked to narrate about their experience of living with diabetes. Qualitative inductive content analysis was used. FINDINGS: Four themes emerged: 'taken over by a new reality', 'the body plays a role in life', 'different ways of learning' and 'the healthcare service as a necessary partner'. CONCLUSION: People with short-term experience of the illness gained knowledge through personal resources such as their own experience and self-reflection. The learning process includes an inner dialogue between the self, the body and the life. Participants were concerned with grasping a new reality and understanding a different self and body where lifestyle changes and uncertainty were present. When health care was accessible and sensitive to their needs, those with short-term experience of diabetes chose the staff as key players in the early stages of their life with diabetes.

Wound care by district nurses at primary healthcare centres: a challenging task without authority or resources.

There is a lack of studies that describes how district nurses experience the care they provide in connection with wound care. The aim of this study was therefore to describe district nurses experiences of their nursing actions when treating patients with different kinds of wounds at primary healthcare centres and in the home care in order to increase understanding of this kind of care. A qualitative, descriptive study was conducted, with interviews of eight district nurses. Data were analysed using qualitative content analysis. Three themes and nine sub-themes were identified. The first theme included two sub-themes which revealed that in performing wound care district nurses feel responsible for administering wound care, and they feel confident in making independent assessments. The second theme included three sub-themes which revealed that district nurses endeavour to assess all aspects of their patient's situation and to maintain continuity in both their contact with the patient and the treatment. A treatment plan for wound care and regular reports were identified as being important in collaboration with other healthcare professionals. District nurses wanted their own procedure for referral to facilitate the patient's direct contact with a dermatologist. The third theme included four sub-themes which revealed difficulties associated with ambiguous organisation. Lack of time led to the dressing of wounds being delegated to nursing assistants. Limited access to treatment rooms and equipment made wound care difficult and inefficient. Wound care in the home care was regarded as challenging due to the lack of equipment, and poor lighting, ergonomics and hygiene. The results of this study thus identified the aspirations of district nurses to provide expert wound care while working independently. However, these aspirations were aggravated by organisational shortcomings, such as a lack of authority and the resources required to carry out their nursing actions optimally.

A new reliable tool (PVC assess) for assessment of peripheral venous catheters.

RATIONALE AND AIMS: To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability. METHOD: The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n=3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n=3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability. RESULTS: Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa=0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40). CONCLUSIONS: The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed.

Wound care in primary health care: district nurses' needs for co-operation and well-functioning organization.

Most patients with leg- and foot ulcers are managed within non-institutional care. The aim of this study was to investigate the district nurses' wound management, including wound appearance, assignment of responsibility, guidelines for wound treatment and co-operation with other professional groups. The study has a descriptive quantitative approach. Data was collected using a wound registration form and a questionnaire. The selection of participants was made by random sampling. District nurses (n = 26) in five health-care centers situated in central Stockholm and two of its suburbs, participated in the study. The results show that the wound appearance is dominated by traumatic wounds. Approximately 40% of the wounds were not medically diagnosed. The area of responsibility of different professional groups was not defined and guidelines for wound treatment were mostly lacking. The decision about wound management was generally made by the district nurse. Co-operation with the general practitioner was lacking and when a consultation with dermatologist was required, the routines concerning referral were undefined. Co-operation with the assistant nurses consisted of redressing the wounds in home care. Interprofessional co-operation was regarded as important for wound healing. The paper provides insights into the district nurses' wound management and co-operation in wound care.

Accuracy in documentation - a study of peripheral venous catheters.

AIM: The aim was to explore the extent of postinsertion documentation of peripheral venous catheters (PVCs) in patients' medical records, including the descriptions used to explain the PVC insertion site and determinants of PVC documentation. BACKGROUND: Documentation in medical records is an important precondition for the safe handling of patients PVC. However, factors associated with documentation of PVCs and how the insertion site is described in medical records has not previously been studied. DESIGN: This was a cross-sectional and descriptive study. METHODS: A sample of 933 adult inpatients (women 45.7%) with PVC was recruited from medical and surgical wards at one university hospital and two general hospitals. A data collection form was used for registration of the insertion site of the PVC, hand side, lumen size, patient's age and gender. PVC documentation from medical records was transcribed. Factors associated with the documentation were analysed using logistic regression. RESULTS: Ten descriptions used to explain the insertion site of the PVCs were identified in the patients' medical record. Any kind of PVC documentation was found in 71.8% and documentation that included insertion site, hand side and lumen size was recorded in 46.2% of the observed PVCs. Multivariate logistic regression revealed that PVC documentation was associated with medical wards at general hospitals (OR 4.59; 95% CI 3.10-6.81; p < 0.0001) and smaller lumen size (22 gauge) (OR 1.81; 95% CI 1.19-2.84, p = 0.006). CONCLUSION: The extent of PVC documentation in medical records was low and descriptions used to explain the PVC insertion sites were found to vary appreciably. General hospitals and in particular medical wards and smaller lumen size, were associated with PVC documentation that included insertion site, hand side and lumen size. RELEVANCE TO CLINICAL PRACTICE: Development of terms is needed to assure standardisation of postinsertion PVC documentation. Education of nurses on proper PVC documentation should be given priority.

Communication and self-management education at nurse-led COPD clinics in primary health care.

OBJECTIVE: The aim of the study was to explore the structure, content in communication and self-management education in patients' first consultations at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary healthcare. METHOD: Thirty consultations performed by seven registered nurses were videotaped; structure and content in the consultation was analyzed using Pendleton's Consultation Map. Nurses' self-management education was assessed from the content of the conversation: whether important and relevant information and self-management education was given, and how investigations were performed. RESULTS: Each consultation lasted for a mean time of 37.53 min. Communication about reasons for consultations concerned mainly medical and physical problems and to a certain extent patients' perceptions. Teaching about self-management and smoking cessation was of an informative nature. Two consultations ended with shared understanding, and none of the patients received an individual treatment-plan. CONCLUSION: Nurses rarely planned the consultations on an individual basis and rarely used motivational dialogue in self-management education and in smoking cessation. PRACTICE IMPLICATIONS: The findings could be used to help nurses to reflect on how to improve the structure of the visit, self-management education, smoking cessation and patient communication.

Hypoventilation does not explain the impaired quality of sleep in postpolio patients ventilated noninvasively vs. invasively.

In a previous study, it was found that patients treated with noninvasive ventilation (NIV) reported larger dysfunctions in sleep-related parameters as assessed with the Sickness Impact Profile (SIP) and Health Index questionnaires than those treated with tracheostomy. The aim of the current study was to further evaluate these sleep limitations and relate these limitations to blood gas analyses in the groups to investigate, if the differences could be related to differences in the efficacy of ventilation. We compared postpolio patients treated with tracheostomy (PPT, n = 17), NIV (PPN, n = 14) and patients with neuromuscular disorders treated with NIV (NMN, n = 15). Significantly fewer patients in the PPT group scored large dysfunctions in the SIP sleep (SIP score >10 points) compared with the PPN and NMN patients. The PPT patients scored significantly higher regarding quality of sleep and less sense of tiredness than the PPN and NMN patients. No differences were found between the groups regarding blood gas parameters neither before nor during or after the study period. In conclusion, postpolio patients treated with invasive home mechanical ventilation seem to experience better sleep and less sense of tiredness than patients on NIV. These differences cannot be explained by differences in alveolar ventilation as assessed with blood gas analyses.

Hip fracture and pressure ulcers - the Pan-European Pressure Ulcer Study - intrinsic and extrinsic risk factors.

Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8.8% and 55% have been reported. There are few studies focusing on the specific patient-, surgery- and care-related risk indicators in this group. The aims of the study were: - to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery, - to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age >or=71 (P = 0.020), dehydration (P = 0.005), moist skin (P = 0.004) and total Braden score (P = 0.050) as well as subscores for friction (P = 0.020), nutrition (P = 0.020) and sensory perception (P = 0.040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0.005) and pulmonary disease (P = 0.006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.

Informational needs in families after their child's mild head injury.

OBJECTIVE: When a child is hospitalized due to an illness or injury, the entire family may experience stress and/or anxiety. According to parents who have been in such a situation, providing adequate information is one of the most valuable ways to help the family deal with such feelings. Most mild head injuries suffered by children do not require hospitalisation and in such cases, their families should be provided with appropriate information in connection with their visit to the emergency ward. In the present study, family informational needs are characterized. METHODS: The families of 57 children who had suffered a mild head injury at 0-15 years of age answered one open-ended question. The analysis was carried out using content analysis. RESULTS: This analysis revealed two types of needs, i.e., a need for information concerning the head injury itself and how to provide care, as well as a need for reassurance and support in sharing and coping with the emotional burden. CONCLUSION: Despite differences in the severity of the child's head injury and requirement for hospitalisation, all the families expressed the same informational needs but also the need for emotional support. PRACTICE IMPLICATIONS: In connection with the treatment of children with head injuries, health-care personnel should provide the parents both with information concerning the injury and its treatment and with emotional support.

Nurses in paediatric care--self-reported professional self and perceived research utilization.

The aim was to describe how nurses in different professional levels evaluated their professional self and perceived barriers to research utilization in paediatric care. The sample consisted of three groups of nurses: control, trainee and specialists (n = 113) employed at two Paediatric University hospitals in Sweden. The control and trainee groups were nurses with a general education and the specialists had a specialist education in paediatric care. The nurses answered the two questionnaires: the Professional Self Description Form (PSDF) and the Barriers Scale. The results showed that the highest scores in the PSDF were found in sensitivity in all the three groups and consideration (in control and specialist group) and creativity (trainee group). The control group scored significantly higher in the item persistence. In the Barriers Scale, the three groups scored the greatest barriers in; 'there is insufficient time on the job to implement new ideas' and 'the nurses do not have time to read research'. The lowest barriers were found in; 'the nurse is unwilling to change/try new ideas' and 'the nurse is unaware of research'. The specialist nurses had significantly higher barriers in; 'the nurse is isolated from knowledgeable colleagues with whom to discuss the research', 'the nurse is unwilling to try new ideas' and 'administration will not allow implementation'. No correlations were found between the PSDF and the Barriers Scale. In conclusion, the self-evaluation of professional self and perceived research utilization showed few differences between the nurses. These findings indicate that the professional self is independent of educational level and work experiences while barriers to research utililization increases with competence and experience.

Professional roles and research utilization in paediatric care: newly graduated nurses experiences.

The aim of the study was to describe and analyse how newly graduated nurses perceive themselves as professionals and their perceptions of barriers to research utilization when starting to work within paediatric care. The nurses were employed in two paediatric university hospitals in Sweden and had been working as staff nurses for 1-3 months. They answered two questionnaires: The Professional Self-Description Form and the Barriers Scale. The results showed that in the assessment of their professional level the highest scores were found in consideration, ambition and sensitivity, and the lowest scores in grasp of ideas, leadership and discrimination. In perceptions of research utilization (Barriers Scale), the items with the most common barriers were 'there is insufficient time on the job to implement new ideas', 'the nurse does not have time to read research' and 'the facilities are inadequate for implementation'. These results indicate that newly graduated nurses seem to be prepared for the nursing profession when it concerns themselves as human individuals but not so prepared for the practice in the real day-to-day work. The most common barriers in the research utilization were connected to the work organization and not to themselves as individuals. The evaluation of professional self, barriers to research utilization and the relationship between these aspects indicates a need for further investigation into the significant meaning of professional self and how this influences the implementation and use of research in everyday work. The results so far also raise the question of how to best support and develop newly graduated nurses in their professional role, to help them to be the highly competent nurses that we need in providing the best and evidence-based care to those who need it.