Caring for older people with dementia reliving past trauma.

BACKGROUND: The occurrence of behavioural changes and problems, and degree of paranoid thoughts, are significantly higher among people who have experienced extreme trauma such as during the Holocaust. People with dementia and traumatic past experiences may have flashbacks reminding them of these experiences, which is of relevance in caring situations. In nursing homes for people with dementia, nursing assistants are often the group of staff who provide help with personal needs. They have firsthand experience of care and managing the devastating outcomes of inadequate understanding of a person's past experiences. AIM: The aim was to describe nursing assistants' experiences of caring for older people with dementia who have experienced Holocaust trauma. RESEARCH DESIGN: A qualitative descriptive and inductive approach was used, including qualitative interviews and content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Nine nursing assistants from a Jewish nursing home were interviewed. ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethical Review Board, Stockholm. FINDINGS: The theme 'Adapting and following the survivors' expression of their situation' was built on two categories: Knowing the life story enables adjustments in the care and Need for flexibility in managing emotional expressions. DISCUSSION AND CONCLUSION: The world still witnesses genocidal violence and such traumatic experiences will therefore be reflected in different ways when caring for survivors with dementia in the future. Person-centred care and an awareness of the meaning of being a survivor of severe trauma make it possible to avoid negative triggers, and confirm emotions and comfort people during negative flashbacks in caring situations and environments. Nursing assistants' patience and empathy were supported by a wider understanding of the behaviour of people with dementia who have survived trauma.

Newly graduated nurses' experiences of a trainee programme regarding the introduction process and leadership in a hospital setting-A qualitative interview study.

AIM AND OBJECTIVES: This study aimed to describe newly graduated nurses' experiences of introduction processes and leadership within a hospital trainee programme. BACKGROUND: For many, being a newly graduated nurse is associated with stress, influenced by the challenge of the transition to independent nurse, coupled with the loss of mentorship due to nurse turnover and rapidly changing demands. METHODS: A qualitative design with an inductive approach was chosen, and four focus groups were convened. A total of nineteen nurses were included in the study. Data were analysed using qualitative content analysis. COREQ was used as EQUATOR checklist. FINDINGS: The analysis resulted in three themes: Need for an introduction when facing a complex reality, Striving to stand on my own and The importance of having an accessible and multiskilled manager. The transition is a complex, dynamic and demanding process. CONCLUSIONS: The orientation process from student to becoming an independent nurse is a challenging period. A flexible manager and a readily accessible leadership facilitate the newly graduated nurse's striving to become an independent nurse. The study demonstrates that a trainee programme and support are essential in this process. There are indications that today's newly graduated nurses have high expectations of coaching from the manager during the orientation process. RELEVANCE TO CLINICAL PRACTICE: The hospital setting and its organisation are rapidly changing in relation to the increasing number of patients and their health status. In addition, there is a need for newly graduated nurses to secure regrowth, to fill the ranks of experienced nurses leaving the field. Newly graduated nurses increasingly perceive a gap between their training and clinical realities, thus necessitating changes in tutoring and their introduction to the work.

Experiences of home care assistants providing social care to older people: A context in transition.

AIM: The aim was to describe home care assistants' (HCA) experiences of providing social care in older people's own homes. BACKGROUND: With the increase in average life expectancy and related growth of the elder population, addressing geriatric care needs has become an increasingly vital issue. However, the frontline workforce faces major challenges in meeting these needs, including a lack of trained professionals entering the field. DESIGN: A qualitative inductive design was used. METHODS: A descriptive, qualitative study using focus group interviews and content analysis. FINDINGS: The findings revealed that HCAs are active in an area facing challenges due to an older home-dwelling generation. Transfer of tasks should be reviewed considering changes to the workforce's skill mix brought on by task shifting. CONCLUSIONS: Certain prerequisites are needed to enable unlicensed assistive personnel to perform a good job; they also need to receive affirmation that they are a crucial workforce carrying out multifaceted tasks. To improve and maintain the pull factors of social care work, it is crucial to clarify how older people's requirements influence the daily care relation. IMPLICATIONS FOR PRACTICE: The findings highlight HCAs' blurred responsibility when providing nursing and care to older people with multiple chronic conditions and functional disabilities. Increasing expectations are placed upon HCAs to cope with practical situations that are theoretically outside the bounds of social care. The findings contribute knowledge to further development of collaboration between social and health care providers as well as the important affirmation of this unlicensed personnel group in transition. A long-term plan is therefore needed to provide HCAs with the skills and tools they need to deliver care and support to older people with a variety of needs.

Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study.

Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

Evolution of accesses to information on breast cancer and screening on the Brazilian National Cancer Institute website: an exploratory study / Evolução no acessos à informação sobre câncer de mama e seu rastreio no site do Instituto Nacional de Câncer: um estudo exploratório

Abstract Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA's website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

Resumo Demoras no diagnóstico do câncer de mama (CM) são comuns no Brasil, talvez devido à ineficácia de estratégias de divulgação sobre os meios para a identificação precoce. Admitida como equivalente ao interesse coletivo sobre CM, analisou-se a evolução de acessos às páginas sobre CM e seu rastreio (RCM) no site do INCA durante 48 meses. Empregou-se analisadores de log files para construir uma série temporal (2006-2009) de médias mensais de acessos às CM e RCM estudadas por análise de variância (ANOVA). Aumentos significativos e "picos de atenção" transitórios nas CM; ampliação nas diferenças CM/RCM, por incrementos crescentes nas CM associados à estabilidade nas RCM. Os resultados são consistentes com relatos anteriores que descrevem expressivo interesse em CM e relativa indiferença ao RCM. No contexto de um estudo exploratório, discute-se: a "fraca cultura de prevenção"; falta de confiança no SUS e nos programas de rastreio; "efeito celebridade" no contexto do framing das mídias; percepção de riscos coletivos ampliada por vulnerabilidades sociais. Os achados sugerem que estratégias de comunicação adaptadas à cultura são essenciais à divulgação dos programas de rastreio. Pesquisas futuras são necessárias para estudar com mais detalhe as construções sociais sobre temas relativos ao CM.

Time trends in 20 years of medication use in older adults: Findings from three elderly cohorts in Stockholm, Sweden.

New drugs and expanded drug indications are constantly being introduced. Welfare states strive to provide equity in drug treatment for all of its citizens and todaýs healthcare systems spend financial resources on drugs for the elderly in a higher rate than for any other age group. Drug utilization in elderly persons has an impact in health and wellbeing in older people. THE PURPOSE OF THE RESEARCH: It was to describe the changes in medication use including people aged 78 years and over regardless of residence and other characteristics over 20 years. MATERIALS AND METHODS: The study population consisted of 4304 participants in three population-based cross-sectional surveys conducted in the Kungsholmen area of central Stockholm, Sweden. The participant's current drug utilization was reviewed by physicians following standardized protocols. Data were statistical analyzed. Logistic regression models was used to estimate odds ratios and 95% confidence intervals for use of analgesics and psychotropic drugs in the cohorts of 2001 and 2007, controlling for age, gender, education and cognition. THE PRINCIPAL RESULTS AND MAJOR CONCLUSIONS: Results shows that the prevalence of medication use and polypharmacy in older adults has increased dramatically the late 1980s to the 2000s in central Stockholm, Sweden. In particular, the use of analgesics increased significantly, while some drug groups decreased, i.e., antipsychotics. Women used more medication than men in all three cohorts. Older adults living in service buildings used the largest amount of drugs in 1987, whereas those living in institutions were the most frequent users in 2001 and 2007.

Older people's experience of utilisation and administration of medicines in a health- and social care context.

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.