Mitra Unosson

The relationship between European joint arthroplasty patients' preferences and the knowledge they have received requires further research.

In 2003 the Council of Europe published a resolution on food and nutritional care in hospitals. The resolution suggests screening of nutritional status for all patients and a care plan should be established for malnourished patients or patients at risk of malnutrition. In 2004 a survey amongst Swedish physicians, nurses and dieticians focusing on education, knowledge in clinical nutrition, division of responsibilities and guidelines was made. The results showed that Swedish hospitals did not meet the standards set by the Council. This study is a ten year follow-up of the original study from 2004. Data from 2014 show only minor improvements. Screening of nutritional status was still performed in less than fifty percent of all hospitalisations. The level of knowledge is still seen as a barrier against optimal treatment of malnutrition. Lack of guidelines was mentioned as another barrier, and a majority of physicians and nurses were not aware of the existing guidelines.

Objectives: To determine whether being overweight or obese is associated with significant health outcomes in an 85‐year‐old population. Design: A cross‐sectional population‐based study. Setting: L inköping, S weden. Participants: Three hundred thirty‐eight people born in 1922 were identified using the local authority's register. Measurements: Data related to sociodemographic characteristics, health‐related quality of life ( HRQoL ), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double‐checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. Results: Overweight (body mass index ( BMI ) 25.0–29.9 kg/m ² ) and obese ( BMI ≥ 30.0 kg/m ² ) participants perceived more difficulty performing instrumental activities of daily living ( IADLs ) and had more comorbidity than their normal‐weight counterparts ( BMI 18.5–24.9 kg/m ² ), but their overall HRQoL and health service costs did not differ from those of normal‐weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio ( OR ) = 2.1, 95% confidence interval ( CI ) = 1.1–4) and cleaning ( OR = 2.2, 95% CI = 1.2–4.2) than their normal‐weight counterparts. Although obesity was also associated with multimorbidity ( OR = 3, 95% CI = 1.2–8), the health service cost of each case of multimorbidity (n = 251) was highest in normal‐weight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1–8.1). Conclusion: For 85‐year‐olds, being obese, as opposed to overweight, is associated with self‐reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well‐being similar to that of those with normal weight.

Aim. The aim of this study was to illuminate the significance of routines in nursing practice.Background. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action.Design. A qualitative design using a phenomenological‐hermeneutic approach.Method. Data collection from three focus groups focused on nurses’ experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as ‘qualified nursing pool’ nurses.Result. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient’s integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it.Conclusions. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice.Relevance to clinical practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine.

Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patient's recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach's alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearson's correlation coefficient. Patients' ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbach's coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

Background and objective Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery. Methods Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14. Results We found a positive correlation in changes of ‘physical independence’ and ‘extroversion’ (r = 0.20; P = 0.010) and ‘intellect’ (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between ‘physical interdependence’ and ‘agreeableness’ and between ‘physical interdependence’ and ‘conscientiousness’ (r = −0.17; P = 0.028–0.030 for both). Conclusion Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.