Three-month follow-up effects of a medication management program on nurses' knowledge.

This quasi-experimental study examined the effects of a medication management program on nurses knowledge of medication management, three months after program completion. Fifty-seven nurses took a multiple-choice test both immediately after the program and three months later. Changes in test performance were assessed using McNemar's test and generalized estimating equations for binary outcomes. Test results were generally consistent from immediately post-program to three months later, though four items differed significantly. From immediately post-program to three months later, fewer nurses correctly answered the items: documenting no medication administration (98.2 vs 86.6, p = 0.04); documenting opioid administration (56.1 vs 33.3, p = 0.01); and observation after opioid administration (35.1 vs 19.3, p = 0.08. Significantly more nurses correctly answered the item concerning the pharmacology of medication administered with food (64.9 vs 77.2, p = 0.09). We recommend both continuous medication management training and focusing on the correspondence between theory-based knowledge and clinical practice routines.

The last three days of life: a comparison of pain management in the young old and the oldest old hospitalised patients using the Resident Assessment Instrument for Palliative Care.

BACKGROUND: Pain is a common symptom in older patients at the end of life. Little research has evaluated pain management among the oldest hospitalised dying patients. AIMS AND OBJECTIVES: To compare the pain characteristics documented by healthcare workers for the young old and the oldest old hospitalised patients and the types of analgesics administered in the last three days of life. DESIGN: A retrospective cross-sectional comparative study. METHODS: The study included 190 patients from a Norwegian general hospital: 101 young old patients (aged 65-84 years) and 89 oldest old patients (aged 85-100 years). Data were extracted from electronic patient records (EPRs) using the Resident Assessment Instrument for Palliative Care. RESULTS: No significant differences were found between the young old and the oldest old patients with regard to pain characteristics. Pain intensity was poorly recorded in the EPRs. Most of the patients received adequate pain control. Morphine was the most frequently administered analgesic for dying patients. Compared to the oldest old patients, a greater proportion of the young old patients received paracetamol combined with codeine (OR = 3.25, 95% CI 1.02-10.40). CONCLUSIONS: There appeared to be no differences in healthcare workers' documentation of pain characteristics in young old and oldest old patients, but young old patients were more likely to receive paracetamol in combination with codeine. IMPLICATIONS FOR PRACTICE: A limitation of the study is the retrospective design and that data were collected from a single hospital. Therefore, caution should be taken for interpretation of the results. The use of systematic patient-reported assessments in combination with feasible validated tools could contribute to more comprehensive documentation of pain intensity and improved pain control.

Agreement in documentation of symptoms, clinical signs, and treatment at the end of life: a comparison of data retrieved from nurse interviews and electronic patient records using the Resident Assessment Instrument for Palliative Care.

AIMS AND OBJECTIVES: To assess agreement between data retrieved from interviews with nurses and data from electronic patient records (EPR) about hospitalised patients' symptoms, clinical signs and treatment during the last three days of life. BACKGROUND: Patient records have been used to map symptom prevalence in dying hospitalised patients. However, deficiencies have been found regarding nursing documentation. To our knowledge, this is the first study to assess the agreement between nurse interviews and patient electronic records during the last three days of life in a hospital. DESIGN: This retrospective study was undertaken in a Norwegian hospital. METHOD: We used the resident assessment instrument for palliative care to interview nurses on 112 dying patients, and we independently extracted data from EPR. The agreement between the two data sets was computed with the kappa coefficient. Sensitivity and specificity were calculated. Interview data were used as a reference. RESULTS: The agreement between the two data sets ranged from poor to good and was highest among symptom variables, including pain, dyspnoea, nausea and the clinical sign falls. In contrast, several clinical variables ranged from poor to fair levels of agreement. The majority of the treatment variables ranged from moderate to good levels of agreement. CONCLUSIONS: Data from the EPR on symptoms (e.g., pain, dyspnoea and nausea) and treatment variables appeared to be reliable and trustworthy, but the data related to fatigue, dry mouth, bloating and sleep interfering with normal functioning should be interpreted carefully. RELEVANCE TO CLINICAL PRACTICE: This study contributed to knowledge of agreement between data from nurse interviews and electronic records on symptoms, clinical signs and treatment of dying patients in last three days of life.

The characterisation of workloads and nursing staff allocation in intensive care units: a descriptive study using the Nursing Activities Score for the first time in Norway.

OBJECTIVE: This study compares the Nine Equivalents of Nursing Manpower Use Score (NEMS) to the Nursing Activities Score (NAS) in terms of characterising the nursing workload by examining and calculating the per-nurse NAS% over a 24-h period. METHOD: The sample consisted of 235 patients from four volunteered for the study multidisciplinary ICUs in Norway. The daily NEMS, NAS and number of nurses who were involved in patient care per ICU were measured over one month from 2008 to 2009. RESULTS: The average length of stay for the included patients was 5 days, and the mean patient age was 52.8 years. The mean NEMS was 32.7 points (S.D., 8.98 points), and the mean NAS was 96.24% (S.D., 22.35%). Several nurses exhibited mean NEMS points that ranged from 16 to 39.7 per ICU per day. The correlation between the NEMS and NAS could only be separately determined for each ICU. The correlation was r=0.16-0.40 [significant at the 0.01 level (2-tailed)] per unit. Depending on which unit was investigated, each nurse was observed to perform of capacity with a NAS as high as 75-90%. CONCLUSION: The study suggests that the actual numbers of nurses might explain the calculated NAS of 75-90% per nurse.

Pain control at the end of life: a comparative study of hospitalized cancer and noncancer patients.

BACKGROUND: Pain is a common symptom in dying patients. Previous studies have paid little attention to pain and pain control in terminally ill patients with diseases other than cancer. AIMS: This study investigated whether there were differences in healthcare workers' documentation of pain characteristics in cancer and noncancer patients. We investigated what types of analgesics were administrated to dying patients, and if there were differences in the administration routes of opiates in cancer patients compared to noncancer patients in the last 3 days of life. METHODS: Data were collected retrospectively in a cross-sectional comparative study at a hospital. The sample included 220 deceased patients (110 died of cancer and 110 died of other causes). Data were extracted from patients' medical records using the Resident Assessment Instrument of Palliative Care. RESULTS: Healthcare workers consistently documented more pain in cancer patients during their last 3 days of life than in noncancer patients. The odds for having severe to excruciating pain was four times higher in cancer patients compared to noncancer patients. Morphine was the most frequently administrated analgesic for all dying patients; however, the odds ratio of cancer patients compared to noncancer patients receiving morphine plus scopolamine was 0.27. The odds of a cancer patient receiving analgesics classified as fentanyl, ketobemidone and oxycodone was more than 4-5 times higher than for noncancer patients. Opiates were more frequently administered transdermally or by oral administration on an as-need basis in cancer patients; 10% in both groups did not receive adequate pain control. CONCLUSIONS: Pain is a highly prevalent symptom among dying hospitalized patients. Healthcare workers consistently documented more pain in cancer patients and also assessed that the intensity of pain was more severe in these patients than in noncancer patients. The dying patients' intensity of pain was poorly documented.

Prognostic value of health-related quality-of-life parameters in early-stage breast cancer: an 8-year follow-up study.

OBJECTIVE: The purpose was to investigate whether self-reported health-related quality-of-life (HRQOL) parameters at time of diagnosis and/or 1-year follow-up are prognostic for disease-free survival (DFS) in early-stage breast cancer patients. METHODS: Data from 195 women, diagnosed with early-stage breast cancer, who had filled in the EORTC QLQ-C30 and the Hospital Anxiety and Depression Scale (HADS) at time of diagnosis and 1 year after surgery, were analyzed. RESULTS: After a median follow-up of 8.2 years (range 0.09-9.45), 27 (14.1%) deaths and 22 (11.5%) recurrences were observed. Using Cox multivariate regression analysis, appetite loss reported 1-year following surgery (HR 2.92, 95% CI 1.50-5.66), p=0.002) was significantly predictive for shorter DFS, even after controlling for age and depression. None of the clinical or biological prognostic factors was found to have a confounding effect. CONCLUSION: The findings indicate that loss of appetite probably is of prognostic value in addition to well-recognized clinical and biological data, in early-stage breast cancer.

Psychological distress after severe trauma: a prospective 1-year follow-up study of a trauma intensive care unit population.

BACKGROUND: The aim of the study was to investigate the level of psychologic distress after trauma and intensive care unit (ICU) stay, memory from the ICU, and predictors for psychologic distress at 12 months. METHODS: Prospective single center study in a trauma referral center for Eastern and Southern Norway. Participants were 150 trauma patients treated in an ICU for > 24 hours. Assessments were performed after discharge, at 3 months, and at 12 months using the Impact of Event Scale, Hospital Anxiety and Depression Scale, ICU memory tool, and Life Orientation Test-Revised. RESULTS: At baseline, the mean Impact of Event scores were 22.7 decreasing to 18.4 at 12 months (p = 0.039). At 1-year follow-up, mean anxiety scores were 5.5 (95% confidence interval [CI]: 4.6-6.4) and depression scores 3.8 (95% CI: 3.1-4.5). Factual memories from ICU (odds ratio [OR] 6.58, [95% CI: 2.01-21.52], p = 0.002), low educational level (OR 0.29, [95% CI: 0.10-0.86] p = 0.025), not having care of children (OR 0.14, [95% CI: 0.04-0.47] p = 0.002), and female gender (OR 2.95, [95% CI: 1.04-8.34] p = 0.042) predicted posttraumatic stress symptoms at 12 months. Anxiety at 12 months was predicted only by pessimism (OR 0.83, [95% CI: 0.75-0.93] p = 0.001). Depression at 12 months was predicted by being out of work before the injury (OR 3.64, [95% CI: 1.11-11.94] p = 0.033) and pessimism (OR 0.83, [95% CI: 0.73-0.93] p = 0.002). CONCLUSIONS: Many patients suffer from posttraumatic stress symptoms, anxiety, and depression after trauma and ICU stay. The strongest predictors of psychologic distress 12 months after discharge were having factual memories from the ICU stay, being pessimistic, and being out of work before the injury.

The Norwegian version of the Mini-Mental Adjustment to Cancer Scale: factor structure and psychometric properties.

OBJECTIVE: The object of the study was to examine the factor structure and the psychometric properties of the Mini-Mental Adjustment to Cancer Scale (Mini-MAC) among a large sample of Norwegian breast cancer patients. METHODS: A total of 402 patients with breast cancer completed the Mini-MAC. RESULTS: Principal component analysis with varimax rotion confirmed four factors. Three had psychometric properties to the original Mini-MAC Helpless-Hopeless (HH), Anxious Preoccupation (AP) and Cognitive Avoidance (CA) subscales. The fourth, named Positive Attitude (PA) combined the Fighting Spirit (FS) and the Fatalism subscales of the original Mini-MAC. Construct validities were assessed by examining the interscale correlations as well as the correlations between the Mini-MAC subscales and the HADS subscales scores. Internal consistency of the five subscales was satisfactory for the original (HH, AP, CA, FA, coefficients=0.60-0.83), except for the FS subscale (coefficient=21). CONCLUSION: In view of the low internal reliability for the Norwegian Mini-MAC FS subscale coefficient; it appears to be more appropriate to use the Norwegian Mini-MAC as a four-factor model. If researcher or clinicians in Norway use the five-factor model, they should take great care when interpreting the fighting spirit subscale.