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M E T H O D S I N N U R S I N G
Inventory as a Basis for SBU Alert Evaluations
Ania Willman, Anna Forsberg, Anna Strmberg
2 0 0 3
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M E T H O D S I N N U R S I N G
INVENTORY AS A BASIS FOR SBU ALERT
EVALUATIONS
PREFACE
This report was written with the assistance of Sara Carlsson RN from the Unit for Evidence-based Nursing, School of Health and Society, Malm University. We are very grateful for her
commitment, valuable input and practical assistance in compiling this report. We would also like
to thank Christel Bahtsevani, RN, doctoral student, School of Health and Society, Malm
University, for critically reviewing our text.
12 April 2003
Ania Willman Anna Forsberg Anna Strmberg
Malm Gteborg Linkping
The Swedish Society of Nursing, 2003
ISBN No: 91-85060-07-0
Cover picture: Roland Nilsson
English Translation: Gullvi Nilsson versttningar AB
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TABLE OF CONTENTS
TERMS OF REFERENCE OF THE WORKING GROUP AND DESIGN
OF THE REPORT...4
PROCEDURE..8
USE OF REFERENCES..9
RESULTS....10
Examples of value-based approaches in the care relationship.11
Examples of nursing methods for the provision of support
and treatment.11
Examples of methods for assessing suffering/well-being in
health, ill-health and disease...12
Examples of methods for preventing ill-health and/or treating
ill-health12
Examples of methods for evaluating planned individual care12
Examples of methods for the organisation of individual care.....13
DISCUSSION..13
Tables...16
List of appendices.33
References37
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TERMS OF REFERENCE OF THE WORKING GROUP
AND THE DESIGN OF THE REPORT
Today prioritisation influences the choice of care provided, something that is expected to
become increasingly common in the near future. The hope is that such setting of priorities will
take place more openly than previously as well as be increasingly based on scientific facts: facts
that can be evaluated with reference to ethical, social and other considerations, including financial
ones. The Swedish Council on Technology Assessment in Health Care (SBU) is a government
agency that evaluates the methods used in health care. The SBU analyses the cost and benefits of
various health care methods and compares the research findingswith Swedish healthcare
practice. The goal is to provide a better basis for decision-making forall those who determine
what care should be provided. This approach is sometimes called evidence-based care.
Evidence-based health care is a popular term, both in Sweden and abroad, and can be defined in
various ways. In these definitions, the common denominator is a willingness to use the best
available scientific evidence as a basis for care decisions. The evidence in question is the result of
scientific investigations in the field. The work of compiling this evidence is usually described as
evaluation research since it involves the systematic compilation, critical assessment, valuation and
interpretation of existing research results. Evidence-based health care can therefore best be
described as both an approach and a systematic process for the critical appraisal of research
results reported in scientific articles (Willman & Stoltz, 2002).
The 1990s have seen the emergence of systems for reportingnewmedical methods (known as
early warning systems) in a number of countries. In Sweden, the SBU was given the task of
building up a national system for the identification and early assessment of new methods, and
SBU Alert was established in 1997. The objective of Alert is to report methods that may be of
vital importance to health care. No areas of the health care sector are excluded. The most
important target groups for Alert are politicians, senior civil servants and other decision-makers.
All of the Alert reports are available on the SBU website to cater for interest from, for example,
the mass media, nursing staff and patients. Identification and prioritisation of new methods to be
examined are the responsibility of the Alert secretariat at the SBU. The secretariat is supported by
an Advisory Committee made up of individuals with broad experience in the area of health care
(Appendix 1). The Alert Advisory Committee determines which methods are to be studied.
When a method has been studied, a 6-8 page report is produced that describes the method and
its effects. Finally, the conclusions of the Alert Advisory Committee are published together with
an assessment of the existing body of knowledge. The publications are available from the SBU
Alert website at www.sbu.se. Since its inception, the Alert Advisory Committee has selected
about 80, mainly medical methods for study. The ambition of the Alert Advisory Committee to
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carry out more evaluations, particularly in the nursing field, has led to the appointment of a
working group by The Swedish Society of Nursing (SSF). The task of the group has been to map
methods used in nursing and to suggest suitable methods for evaluation.
The SSF is a professional society of the country's nurses. The SSF wishes to assist nurses in
providing the highest standards of care through an inspirational and influential role. The SSF
works on projects within prioritised areas considered strategic in nature due to health care
developments achieved in those areas. In order to develop a long-term strategy for research,
development and quality issues, the SSF has a Scientific Advisory Council, an Ethics Advisory
Council and a Quality Advisory Council.
The Scientific Advisory Council of The Swedish Society for Nursing monitors the field of
evidence-based nursing in collaboration with other bodies, including SBU Alert. The Scientific
Advisory Council and the Board of SSF have appointed Anna Forsberg, Gothenburg, Anna
Strmberg, Linkping, and Ania Willman, Malm, to a Working Group with the task of mapping
and proposing methods suitable for evaluation. Karin Axelsson, Lule, who is also a member of
SBU Alert, has functioned as an expert advisor. The SSF decision sets out the group's terms of
reference as follows:
- to design procedures for the study of 1) methods, 2) working practices and 3) theory-
based approaches to, for example, empowerment
- to propose methods, modes of working and theories as a basis for approaches in nursing
that could be evaluated within the framework of SBU Alert.
Evaluation research in health care has focused on health methods/technology. The English term
technology denotes technical methods or engineering, but is often translated into Swedish as
method. Brorsson & Wall (1984) state that the evaluation of health technology aims to illuminate
the extent to which the specific technology the method is safe and beneficial. For this to be
possible, the aims and outcome criteria of the method must be pre-defined. No methods in
health care have been excluded in advance; a broad definition is usually employed to determine
the methods eligible for inclusion. One example of a definition is that of the Health Technology
Assessment Group, an evaluation group set up in 1991, which defines health technology as "any
method used by those working in the health services to promote health, prevent and treat disease
and improve rehabilitation and long-term care." (Department of Health, Research for Health: a
Research Development Strategy for the NHS. London: Department of Health, 1991). Such a
broad definition means that all methods, from methods for counselling to methods for
organisation, can be the object of evaluation. In nursing contexts, it has been more common to
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use words such as intervention or mode of working to describe existing methods and less
common to use the word technology. This has been remarked upon by Bonair (1994) as follows:
"In nursing contexts, and in research into the clinical work of the nurse, it is less common to
speak of technology, while others, including Eriksson et al., in the bookVrdteknologiuse the
term health technology in the sense of "the theory of health care methods" or knowledge of the
practical provision of health care. The term technology as used by Eriksson et alin the evaluation
of health technology builds on a broad definition of technology; in other words, technology is
defined as knowledge applied to achieve set goals in a given situation." (Bonair, 1994, pp. 29-30).
In view of the fact that the terms: method, technology, and intervention are used
interchangeably in spite of the fact that they do not exactly correspond to each other, it is
important to define what they mean in order to avoid misunderstanding. Below, we show how a
number of terms with similar meanings are used in this work:
The term technologydenotes the science of engineering and is used in relation to
a) techniques, technical appliances and similar,
b) application of technical methods and ideas in a field other than engineering, for
example teaching methods the use of technical aids in teaching (www.ne.se).
The term methodologyrefers to the approaches used in various disciplines to
obtain knowledge or solve problems, cf. methodology (www.ne.se).
The term techniquedenotes all available methods or procedures for the use of
physical appliances in order to achieve a specific result (www.ne.se).
The term methodis defined as a planned procedure intended to achieve a
predetermined result (www.ne.se).
The term intervention is defined as an action (to achieve a specific purpose) orform of treatment (www.skolverket.se/skolnet/lexikon)..
The term nursing interventionis clarified in the following: "In a broad sense,
nursing interventions mean that the staff become involved in collaboration with
the patient, and where appropriate the patient's close relatives, formulate and
define physical, mental, social and spiritual health goals. Nursing interventions
span a wide area, from high-technology to moral support in existential crises."
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(The National Board of Health and Welfare Guidelines, 1993:17).1 Nursing
measures also include assessment, planning, implementation and evaluation of
results.
Against this background, the term "method" is defined as a planned procedureintended to
achieve a specific result. This means that a "method" can consist of several sub-components and
can therefore be understood as meaning both a "package" of methods and sub-components of
planned procedures, possible to evaluate individually.
To help establish an improved basis for decision-making in healthcare, the 1990s have seen the
growth of reporting systems for newmedical methods ("early warning systems") in several
countries. In Sweden, SBU Alert was formed in 1997 with the aim of identifying and carrying out
early assessment of new methods. SBU Alert defines the expression "new method" as a method
that is not common but may have a major impact on the health care system in a broad sense. The
SBU Alert criteria for selecting a method suitable for examinationare as follows:
- the method must have been tested on patients in a standard health care or research
setting
- results published in a scientific journal or presented at a conference
- the method should have the potential to play an important role within the health services
- the method should have the potential to lead to significant advances in the medical field
- the method is relevant to common health problems/many patients
- the method influences the structure of health care provision
- the method is controversial or has ethical implications
- the method has substantial economic impact.
This report describes the working group's method of working and the results obtained. The
nursing methods identified are shown in table form accompanied by an explanatory text. The
results shown in the tables are those of the authors, in the sense that the range of journals
searched reflects the fields of interest of the working group. We wish to emphasize that each
individual method must be further examined in order to ascertain whether or not the effects of
the method are supported by scientific evidence. No such review of each individual method has
been carried out within the framework of this remit. In this report, we propose methods that
should be capable of evaluation. Finally, the working group will submit a proposal to the SSF
1 If, for example, "injection technique" is used as an umbrella term for various methods for the administration ofinjections (subcutaneous, intramuscular) involving knowledge of the properties of materials, asepsis etc, the term"nursing method" in this context describes a planned procedure to give the correct patient the correct dosage in thecorrect way. When the injection technique and the injection method are adapted to an individual patient, it is describedas a nursing intervention in the sense used in The National Board of Health and Welfare Guidelines.
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Board for discussion and decision concerning nursing methods, nursing practice and theories
that the Board may wish to propose for further evaluation within the framework of SBU Alert.
PROCEDURE
The working group has met on three occasions and has operated on the basis of the following
strategy:
1. Description of the work methods of the Alert Advisory Committee and criteria for the
assessment of methods.
2. Definition of method.
3. Screening of nursing methods on the basis of the established definition.
4. Selection of methods on the basis of the assessment protocol of the Alert AdvisoryCommittee.
5. Selection of methods in consultation with the relevant experts in the respective field.
6. Final proposal to the SSF Board on possible methods for evaluation.
In addition to this strategy, there have been discussions about methods that are not compatible
with the Alert Advisory Committee's current methods of evaluation and about possible ways of
assessing these. The results contain various examples of theoretical approaches (Table 1). We do
not equate theoretical approaches with "methods", in the sense in which it is used in this work.An approach is a basic view that becomes clear and apparent in dialogue. Dialogue presumes a
mutual exchange. This mutual exchange means that even if an action is planned, it is not planned
in the sense that permits pre-determined endpoints, such as effects and goals. In our view,
theoretical approach implies basic research, which we understand/consider as a systematic and
methodological search for new knowledge and new ideas without any pre-determined benefit
(Lehtinen et al., 2002). The fact that we do not define a theoretical approach as a method does
not mean that we believe it cannot be evaluated. Since instruction in a theoretical approach has
the aim of achieving certain results, it should be possible to test the effects of a changedapproach in scientific studies. In such a study, it is of great importance to choose the "correct"
measure of effect.
Screening of nursing methods has been performed to identify on methods for patient care. We
have focused on Swedish material and have taken a broad approach to each field. The selection
of journals was influenced by a wish to find new publications about nursing methods, but also by
the fields of interest of the working group. The disadvantage of this approach may be that only
some areas of nursing and nursing duties are illuminated. The advantage of the approach is that
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the reviewers have in-depth knowledge of the fields examined and could thereby identify the
methods and nursing practicedescribed. The screening phase identified methods for patient care,
documentation and clinical supervision. In the report, we have chosen to focus on methods for
patient care.
Manual searches have been carried out in the following journals for the years 2000-2002.
- Circulation
- European Heart Journal
- Heart
- Heart and Lung
- International Journal of Nursing Studies
- Journal of Advanced Nursing
- Journal of Clinical Nursing
- Patient Education and Counselling
- Scandinavian Journal of Caring Sciences
- Theoria, Journal of Nursing Theory
Appendix 2 provides an overview of the objective, target group and contentof each journal. All
journals included have peer-reviewed articles and are indexed in the MedLine and/or CINAHL
databases. Searches have also been carried out on reference lists contained in these articles
pertaining to methods deemed relevant. Literature searches were also carried out in the form of a
review of all SBU and SSF reports referring to nursing (SBU, 1994; SBU & SSF, 1998 a;b; 1999,
a;b), the VIPSbook (Ehnfors et al., 2001), Kvalitetsindikatorer inom omvrdnad [Quality Indicators in
Nursing](2001), and the two SSF reports Omvrdnad som akademiskt mne(2001) and (2002)
[Nursing as a Scientific Subject].
USE OF REFERENCES
Stated references describe the method or the approach that we have chosen to report. The aim
was to identify as many methods and modes of nursing practice as possible in the available
journals and reports in the short time allocated for the task. The intention was not to cover entire
fields or to identify the main reference. The report only gives examples of references that deal
with the stated method. The reference is not necessarily the source of this method. We have not
carried out a systematic search of databases. The assumption is that those who choose to
examine any of the examples we have given will themselves carry out a systematic search to
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examine the scientific basis. We have not investigated whether each method is an example of
methods used by nurses or purely a nursing method (nurses can use medical methods as well).
We have listed and referred to methods and theoretical approaches that can be described as
nursing methods and/or that are used by nurses. This report makes no attempt to be
comprehensive with respect to references or methods.
RESULTS
The results of the mapping of nursing methods carried out by the working group are presented in
six separate sections. Table 1 differs from the rest in that it describes theoretical approaches,
which we have not classified as methods. Tables 2a-d give examples of methods that can be
individually adapted. Table 3 describes methods for the organisation of the nurses duties and
care of the individual:
Examples of value-based approaches in the care relationship (Table 1)
Examples of nursing methods for the provision of support and treatment (Table 2a)
Examples of methods for assessing suffering/well-being in health, ill-health and disease
(Table 2b)
Examples of methods for preventing ill-health and/or treating ill-health (Table 2c)
Examples of methods for treating and evaluating planned individual care (Table 2d)
Examples of methods for the organisation of individual care (Table 3)
No significance is attached to the order in which the methods are presented. Some boxes in the
tables are empty, the reason being the working groups lack of time to ascertain whether or not
the method was implemented and if so, its outcome. An empty box in the table should not be
interpreted as meaning that the value of the method in question is negligible compared to the
other methods presented in each table.
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EXAMPLES OF VALUE-BASED APPROACHES IN
THE CARE RELATIONSHIP
The examples of theoretical approaches given in Table 1 include confirmation during feeding as
well as the "SAUC" model. The ability to give and receive confirmation is intimately linked tohuman existence and well-being. All care work involves encounters, and it is in the encounter, the
dialogue, that the attitudes of an individual and his/her outlook on humanity become clear. The
confirming dialogue can be used to gain an understanding of the patient's situation and to design
the nursing care to meet the needs of that individual. In the Handbook for Swedish healthcare
(www.infomedica.se/handboken), the SAUC method is described as a method that outlines the
correct attitude towards and confirmation of patients.
The value-based approaches that emphasise nursing actions such aspresence, active listening, being
involvedand present as a witnesshave their roots in current nursing theories. Several modern nursing
theories are based on a humanitarian view and focus on the encounter between the nurse (carer)
and the patient/family. They also give concrete advice and directions on how the relationship can
be established, developed and concluded without loss of autonomy, integrity and self-esteem. An
evaluation of value-based approaches could deepen and clarify the present knowledge about "the
human being in focus" and "care needs time" contained in, for example, the Handbook for
Swedish healthcare. Reporting in this table is very limited since we only refer to the references
that we have encountered in our review, and we recommend that the section "value-basedapproaches in the care relationship" be studied in more depth by means of a new literature
review.
EXAMPLES OF NURSING METHODS FOR THE PROVISION OF
SUPPORT AND TREATMENT
The examples in Table 2a represent nursing methods that aim to strengthen the patient's ability
to deal with changes in his or her new health situation. The methods consist of individually
designed support, therapy of various kinds as well as education and information, with or without
IT support. Examples are also given of nurse-led clinics in various specialist fields. Since there are
a number of methods in Table 2a that can be deemed new or at the start oftheir dissemination
curve, we recommend that an in-depth study be done in this field.
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EXAMPLES OF METHODS FOR ASSESSING SUFFERING/WELL-
BEING IN HEALTH, ILL-HEALTH AND DISEASE
The examples in Table 2b illustrate the wide-ranging work of the nurse in assessing suffering and
well-being in health, ill-health and disease. Traditionally nurses have worked to assess the state of
the patient's health using more or less systematic methods. The methods given here involve tools
for assessing a large number of symptoms and clinical conditions such as pain, constipation, oral
status, consciousness, incontinence, ADL capacity and the risk of pressure ulcers. Several of the
tools are well established, but just as many are at the start of their dissemination curve.
EXAMPLES OF METHODS FOR PREVENTING ILL-HEALTH
AND/OR TREATING ILL-HEALTH
Table 2c shows methods of a preventive nature. In our view it is important to evaluate these
methods since the outcome of well-designed prevention can be decisive for the health status and
rehabilitation capacity of large groups of patients. The table provides examples of methods to
prevent pressure ulcers, hip fractures due to falls, and constipation. The methods represent
nursing interventions undertaken in close co-operation with the patient with the aim of creating a
significant improvement in patient well-being.
EXAMPLES OF METHODS FOR EVALUATING PLANNED
INDIVIDUAL CARE
In spite of the fact that the nursing profession in general lacks a tradition of evaluating the effects
of treatment measures, there is, in research, great use of tools to measure quality of life in various
types of ill health, disease and treatment. The use of evaluation tools in clinical work is not
systematic, nor have the effects of measurements on planned individual care been evaluated.
Assessment of the effect of treatment measuresused in the planned care of the individual can
therefore be seen as a "new" method that requires evaluation. Against this background, we have
chosen to show, in Table 2d, examples of tools for evaluating how patient quality of life is
affected. We are aware that these methods in some cases touch on the quality assurance field and
that tools used for research often cannot be implemented in day-to-day work without adaptation.
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EXAMPLES OF METHODS FOR THE ORGANISATION OF
INDIVIDUAL CARE
This section touches on the field of organisational theory and models that we do not define as
nursing methods. On the other hand, we wish to show examples where a planned approach to
organizing direct patient care can have consequences for the individual patient. A documentation
model that is frequently used and that influences the care of the individual patient is that of
Standard Care Plans. These care plans have not yet been adequately evaluated. The examples
presented in Table 3 illustrate the need for outcomes research when many patients, nurses and
employers are involved, which is difficult to evaluate using traditional measurements.
DISCUSSION
While working on this task, we have become aware of the considerable difficulties involved in
mapping nursing methods suitable for evaluation by Alert. It is not easy to identify specific
nursing interventionsin the research literature. Nurses make wide-ranging assessments within the
parameters of their clinical work, but seldom carry out evaluations and lack a tradition of
comparing different methods. We have also identified a large number of methods that are
compatible with the working group's definition "planned approach for achieving a given result in
health care" and that might be suitable for evaluation using current Alert methods. Table 1provides examples of methods or approaches that are unsuitable for evaluation using Alerts
current methods. There is a need here for alternative approaches to evaluation. Since the working
group had very little time in which to complete the task, we have not been able to presentany
proposal pertaining to alternative evaluation approaches in this report. The working group has,
however, identified several difficulties in the evaluation of nursing methods using current Alert
methods:
- Several nursing methods are presented and evaluated in descriptive studies. In
comparison with the medical literature, the nursing literature does not contain very manyRCTs (Randomised Controlled Trials), a study design that is used to demonstrate the
effect of a certain intervention. This lack of RCTs means that the method cannot be
evaluated using Alert's current approach. The lack of RCTs can be due to many factors.
One is that in nursing research there has been, and to an extent still is, scepticism about
whether the design of RCT studies is suitable for conducting research into nursing
issues. Another reason is that some nursing methods are not deemed suitable for
evaluation in randomised studies. Instead, evaluation using qualitative methods has been
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preferred. We wish to emphasize that it is possible to use both qualitative and
quantitative methods within the framework of an RCT design.
- The evaluations reported in the literature sometimes lack a clear connection between
intervention and the selection of outcome variable. It is not always clear whether the
intervention has the potential to influence the selected outcome variable, for example
quality of life. There is often a lack of studies that demonstrate the link between
intervention and outcome.
- In the evaluation of nursing methods, hard end points, such as survival, health care
consumption, progress of condition or similar are seldom used.
- Many nursing methods are evaluated qualitatively and there are today shortcomings in
the evaluation and assessment of qualitative studies.
- A very large number of patients are affected every day by various nursing methods, but
research within nursing has a relatively short history, and the number of nursingresearchers is small in relation to the extent of the clinical work and the number of
methods available. There is therefore a lack of studies evaluating nursing methods.
Dissemination of new methods is sometimes slow because of the lack of communication
of new research results between researchers and clinically active nurses. This is a
situation that can be both positive and negative. Negative if it is a good method that can
help many patients, and positive if it is the case that we need more evaluation studies to
be able to pass judgment on the outcome of the method.
Actions are needed at several levels to deal with these difficulties. The Swedish Society of
Nursing, with its Scientific Advisory Council, can and should work in various contexts to ensure
that future nursing research focusesto a greater extent on studies of nursing methods, their
effects and their applications. A progressive research policy that encourages a diversity of
research approaches and methods could foster a new tradition in which nursing care becomes a
natural field for research, development and training. The importance of a planned approach to
nursing should be given greater emphasis in clinical training. Studies of the effects of nursing
methods could be carried out as master degree projects at universities. Collaboration with bothSBU and Alert is expected to continue to reinforce the view that evaluation of the effects of
nursing methods is of great importance for the dissemination of research results, as well as of
both new and established methods, to clinically active nurses.
In the course of the work we have discussed organisational models that have a major impact on
the patient and the continuity of individual care. One such model is known as the "laundry-room
model" and involves staff drawing up their schedules on the basis of individual considerations.
We have, for obvious reasons, not discussed this working practice here since it is not a nursing
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15
method. On the other hand, we do see the modes of working as such as a widespread system in
Sweden that has not been satisfactorily evaluated in terms of the consequences for the continuity
of patient care. Perhaps an evaluation of this type could be initiated by the SSF.
Finally, the working group proposes the following nursing methods for evaluation within Alert:
Music in the care of people with dementia
Change of peripheral vein cannula (PVC) every 24 hours
Nurse-led clinics
Hip protectors to prevent injuries resulting from falls in geriatric care
Patient education with the help of computer support and/or interactive systems
Individual adaptation of external stimuli in neonatal care related to the level of maturity.
Our proposal to evaluate the use of music in the care of people with dementia is based on the
fact that it is a method at the start of its dissemination curve and is supported by scientific
evidence. The importance of changing peripheral venal cannula every 24 hours is well described
in the scientific literature but it has not received much attention in health care. Focusing on and
examining the method in an Alert Report would improve dissemination. Our proposal about
nurse-led clinics is based on our identification of evaluation studies of this type of clinic. Our
view is that knowledge should be gathered, not about the clinics in general, but rather restricted
to certain types of clinic that exist in the Swedish health services. Examples of these are nurse-led
clinics for patients with diabetes or heart failure. The same applies to our recommendation toevaluate methods for patient education. We do not believe it is possible to evaluate patient
education as a single method, since many approaches are reported in the literature. Our proposal
is that the evaluation should be limited to certain patient groups and that methods of informing
and educating them, covering both oral and written instruction, be evaluated. Above all, we
recommend the rapid evaluation of computer-assisted teaching. This can be regarded as a new
method and a method that can be evaluated using Alert's current procedure. Hip protectors to
prevent injuries due to falls in geriatric care is also a method that is compatible with Alert's
current model. Finally, the fact that individual adaptation of external stimuli related to maturitylevel has been evaluated in a Cochrane report increases the potential for evaluation within Alert.
Since the method can be regarded as "new" in Sweden, Alert, with the support of the Cochrane
report, could issue recommendations for possible Swedish implementation.
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Table
1Examplesofvalue-basedappr
oachesinthecarerelationship.
16
Value-basedapproach
Result
Implementation
Refere
nce
SAUCmodel
S
ecurityandsafetyforthepatient,
s
upportforthepatient'sself-
d
eterminationandintegrity.
TheModelforconfirmingnursingis
aimedatsupportingtheindividual's
self-esteem/self-determination.
Individual-specificnursing.
GustafssonB(2000).
GustafssonB&Prn
I(1994).
GustafssonB&Ande
rssonL(2001a).
GustafssonB&Ande
rssonL(2001b).
Presence:presentasawitness,
activelistening,advice,guidance,
humour,socialsupport
E
nhancedqualityoflife.
Consciousapproachtotheindividual
withillhealth/diseaseandhis/her
family.
Educationofclosere
latives.
Workshopforrelatives.
GardnerD.L
(1985).
SodergrenKM(1985
).
SwansonK(1991).
Transculturalnursingtheory
C
ulture-congruentnursing
Systematicapplicationoftheory
throughculturalsupport.
Show
interestin,andassess,
thepatient's
situation.
LeiningerM(1991).
LeiningerM&McFarlandMR(2002).
Confirmationfromcarerduring
feeding
R
einforcesthepatient'sfeelingof
r
eceivinghelpandtheexperience
that
t
heabilitytoswallowisimproved.
Continuityinfeeding
.
Samecarerand
Confirmation.
GustafssonB(1992).
TheSymtomManagementModel
I
ndividualpaintreatment.
Anexplanationmodelthatta
kesinto
accountthateachindividual
hasa
uniqueexperienceoflong-te
rmpain.
Larsonetal.(1994).
DoddMetal.(2001).
TheMiddleRangeTheoryof
UnpleasantSymptoms
I
ndividualpaintreatment.
Anexplanationmodelthatta
kesinto
accountthateachindividual
hasa
uniqueexperienceoflong-te
rmpain.
LenzERetal.(1997).
Evolu
tionofthetheMidRange
Theo
ryofComfort
I
ndividualpaintreatment.
Anexplanationmodelthatta
kesinto
accountthateachindividual
hasa
uniqueexperienceoflong-te
rmpain.
KolcabaK(2001).
Contd.onpage17
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Table
1Examplesofvalue-basedappr
oachesinthecarerelationship.
17
Value-basedapproach
Result
Implementation
Refere
nce
Barr
ettspowertheoryand
measurementinstrument,the
Powe
rasKnowingParticipationin
Chan
geTool
Value-basedapproachbase
don
Rogers'SUHB(ScienceofU
nitary
HumanBeing)nursingtheory.
Objectiveisthattheindividu
alcan
assistinchanginghis/herow
nhealth
pattern.
BarrettEAM(2000).
Value-basedtoolsformapping
andinventorybasedonSUHB
(Scie
nceofUnitaryHuman
Bein
gs)
Holis
ticAssessmentofChronicPain
Clien
t
GaronM(1991).
HumanEnergyFieldAssessment
Form
WrightSM(1989).
WrightSM(1991)
FamilyAssessmentTool
WhallAL(1981).
AnAssessmentGuidelinetoWork
withFamilies
Johnston(1986).
ASA-scale,
(theAppraisalofSelf
care
Agency-scale
EversGCM(1989).
SderhamnOetal.(1996a).
SderhamnOetal.(1996b).
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Table
2aExamplesofnursingmethodsfortheprovisionofsupportandtreatment.
18
Method
Result
Implementation
Reference
Informationandeducationto
variouspatientgroups
P
romotehealth,
increase
u
nderstandingandmotivation.
P
reventill-health.
Oralandwritteninformation.
Guidance,advice,
instructionand
demonstration.
Specialprog
rammes
forpeoplewithdiabetes,asthma,
colostomies,
heartfailure,m
yocardial
infarction,
incontinence,pain
,
overweight,smokingandalcohol
dependency,multiplesclero
sis,
epilepsyandParkinson'sdis
ease.
DevineEC,
CookTD
(1986).
Hjelm-KarlssonK(1988).
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel2Ek
A-C,
Nordstrm
G&LindgrenM.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel5WredlingR.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel6BjrvellH&
EngstrmB.
Meth
odofmappingtheneedfor
partic
ipationinpatientswithbreast
cancer
M
appingthetypeofparticipationthat
a
womandiagnosedwithbreast
c
ancerwants.
Simplesortingofcardswith
various
participationalternatives.
Beaveretal.(1996).
"P-LI-SS-T"(Permission,
Limited
Information,
SpecificSuggestions,
Inten
siveTherapy)
Modeldescribingfourcouns
elling
levelsintheencounterwithpeople
withsexualproblems.
RanchM(1995).
Psychosocialsupportwhen
diagn
osedwithcancer
T
hepatientbegantointegratebod
y,
s
oulandspiritandhadasmoother
t
ransitionphase.
Thenurseidentifiedstressfactors,
supportsystems,ordinarycoping
strategiesandthepatient'sknowledge
ofthedisease.
KumasakaLM,
DunganJM(1993).
PerkinsPJ(1993).
Psychosocialsupportinheart
disea
se
Trainingofmotivationtopar
ticipatein
cardiacrehabilitation.
JairathN(1994).
Cogn
itiveOrientationTreatment
withthehelpofamanual
R
educeddegreeofdepression,
r
educedfeelingofhopelessness,
increasedself-esteem.
10people,
2hours/weekfor
14
weeks.
Nomedication.
Two
nurses
areresponsible.
GordonVC,
GordonE
M(1987).
GordonVCetal(1988).
Educ
ationalprogrammewith
cognitiveorientation
R
educeddegreeofdepression,
r
educedfeelingofhopelessness,
r
educedanxiety,
increasedself-
e
steem.
9-10people,
90min/weekfo
r12
weeks.
Nomedication.
Two
nurses
areincharge.
MaynardC(1993).
Contd.onpage19
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Table
2aExamplesofnursingmethodsfortheprovisionofsupportandtreatment.
19
Metod
Resultat
Genomfrande
Refere
ns
Individually-adaptedsupportand
advic
ewithcognitiveorientation
E
ffectonpost-partumdepressionand
t
hemother-childrelationship.
Healthvisitorintheformofanurse,
outpatientcareonehour/we
ekfor8
weeks,
focusonsolvingpractical
problems.
SeeleySetal.(1996)
.
Psychotherapyingroups
R
educeddegreeofmanodepressive
c
ondition.
Twice/weekfor20weeks,nursewith
traininginpsychotherapy.
Simultaneousmedication.
PollackLE(1993).
Cogn
itivebehaviouraltherapyin
groups
R
educeddegreeofdepression
10people,
45minutes/session,
twice/
weekfor24weeks.
AbrahamILetal.(1991).
BeckAT(1967).
Visua
limagingtherapyingroups
R
educeddegreeofdepression.
10people,
45minutes/session,
twice/
weekfor24weeks.
AbrahamILetal.(1991).
BeckA(1967).
Train
ingingroups
R
educeddegreeofdepression.
10people,
45minutes/session,
twice/
weekfor24weeks.
AbrahamILetal.(1991).
BeckAT(1967).
Copingtherapyingroups
R
educeddegreeofdepression.
8people,
1hour/weekfor9
weeks.
DhooperSSetal.(19
93).
Psychosocialactivities(social
thera
pisttookpartinthedesign)
R
educeddegreeofdepression.
1-2h/day,5days/weekfora
totalof8
weeks.
Simultaneousmedic
ationinall
exceptoneparticipant.
RosenJetal.(1997).
Individualcognitivetherapy
R
educeddegreeofdepression.
Twice/weekfor8weeks.
CampbellJM(1992).
Reminiscencetherapy
R
educeddegreeofdepression.
Twiceduringthefirstweek,
then
once/weekfortenweeks.
YoussefF(1990).
Cogn
itivetherapyingroups
R
educeddegreeofdepression.
6-7people1h/session,
twice/weekfor
10weeks.
ZerhausenJDetal.(1995).
Contd
.onpage20
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Table
2aExamplesofnursingmethodsfortheprovisionofsupportandtreatment.
20
Method
Result
Implementation
Referen
ce
Musicinthetreatmentofpeople
withdementia
C
almingthepatients,
improving
m
emoryfunction,
foodintakeetc.
Forexample,playingpleasa
ntmusic
atmealtimes.
RagneskogH(2001).
Relaxationandmusic,separately
andincombination
R
educedpost-operativepain.
Randomisedstudycomparin
gthe
effectsofthreenon-pharmacological
treatmentsforpain:relaxatio
n,music
andthesetwoincombination.
GoodMetal.(2001).
Informationandpatientparticipation
inendotrachealsuction
R
educedstress,reducedanxiety,
m
aximisedresultofsuction.
Quasi-experimentalrandomised
single-blindstudywiththeaimof
comparinghowICUnurseshandle
endotrachealsuctionbefore
andafter
aresearch-basedtraining
programme.
DayT,
WainwrightSP
,Wilson-Barnett
J(2001).
Computer-basedpatienteducation,
patientswithcancer
E
ffectivetrainingstrategyforpatients
w
ithcancer,providingknowledge
a
boutthedisease,choicesof
treatmentetc.
Randomisedstudiescomparing
computer-basededucationw
ith
traditionaleducation.
Measu
rementof
knowledgebeforeandafter
education.
Alsopre-andpost-
measurementofonegroup.
LewisD(1999).
Computer-basedpatienteducation
forpatientswithasthma
R
educedconsumptionofhealthca
re.
Increasedknowledgeandself-care
by
m
eansofcomputereducation
c
omparedtonoeducationatall.
Randomisedstudiescomparing
computer-basededucationw
ithno
educationatall.
Comparisonofhealthcare
consumption.
LewisD(1999.)
Computer-basedpatienteducation
forpatientswithheartfailure
C
omputer-basedpatienteducation
r
esultedinincreasedpatient
k
nowledgeofheartfailure,andold
er
p
eoplewithoutcomputerskillshad
no
d
ifficultyusingthecomputer.
Randomisedstudiescomparing
computer-basededucationw
ith
traditionalnurseledteaching
.
Measurementofknowledge
before
andaftertheinterventionand
observationofuser-friendliness.
Strmbergetal.(2002
).
BjrckLinneA,
LiedholmH&
IsraelssonB(1999).
Contd.onpage21
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Table
2aExamplesofnursingmethodsfortheprovisionofsupportandtreatment.
21
Method
Result
Implementation
Referen
ce
Computer-basedpatienteducation,
patientswithdiabetes
C
omputer-basedpatienteducation
is
a
neffectivestrategyforeducating
p
atientswithdiabetestoincreasethe
p
atientsknowledgeaboutdisease
a
ndself-care.
EffectsonHbA1Cvary.
Randomisedstudiescomparing
computer-basededucationw
ith
traditionalnurseledteaching
.
Measurementofknowledge
and
metabolicbalancebeforean
dafter
theintervention.
LewisD(1999).
Struc
turedfollow-upatnurse-led
primarycareclinicsinsecondary
preve
ntionofheartdisease
N
urse-ledclinicsinprimaryhealth
c
areeffectivelyincreasedseconda
ry
p
reventionofcardiovasculardisease.
M
ostpatientsadoptedatleastone
p
reventivemeasure,suchasASA,
B
Preduction,
diet,physicalactivity
a
ndreducedlipids.
Thenumberof
e
ventsfellbyuptoathird.
Randomisedstudycomparin
g
patientswhoreceivedstructured
follow-upandadvicefroma
nurse
withacontrolgroupwhodid
not
receivestructuredfollow-up.
CampbellNCetal.(1998).
Follow-upatnurse-ledasthma
clinic
s
Increasedself-careandreductionin
thenumberofasthmasymptoms.The
c
linicwascost-effective.
Studywithmeasurementpre
and
post-interventioninnurse-ledasthma
clinicinprimaryhealthcare.
The
resultwascomparedtohealthcentres
withoutasthmaclinics.
LindbergMetal.(200
2).
Follow-upatnurse-ledheartfailure
clinic
s
F
ollow-upofpatientsafterdischarge
fromhospitalreducesthenumberof
r
e-admissions,
improvesself-care
as
w
ellasreducesmortality.
Randomisedstudiescomparing
patientswhowerefollowedupby
nursesinthehomeorinanoutpatient
clinicwithacontrolgroupwh
odidnot
receiveanystructuredfollow
-up.
GradyKLetal.(2000).
Follow-upatnurse-ledcancer
clinic
s
LoftusLA,
WestonV(2001).
Nurse-ledpsychosocialintervention
inthe
homebymeansofadvice
over
thetelephoneandhomevisits
follow
ingmyocardialinfarction
T
heinterventionasawholehadno
e
ffect,butsub-studiesshowedthat
s
ometypesofemotionalsupport
r
educedworry.
Randomisedstudycomparin
g
individualisedfollow-uporien
ted
towardspsychosocialneeds
after
myocardialinfarctionwithco
ntrol
group.
Cossetteetal.(2002).
Contd.onpage22
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Table
2aExamplesofnursingmethodsfortheprovisionofsupportandtreatment.
22
Method
Result
Implementation
Referen
ce
ITba
sedsupportforelderlyfamily
carers
EUprojectonITsupporttoelderly
familycarers.
Magnussonetal.(200
2).
Manu
alpressuretoreduce
intram
uscularinjectionpain
R
educedpainifmanualpressureis
a
ppliedbeforeintramuscularinject
ion.
Comparativestudyonwheth
er
manualpressurebeforeintramuscular
injectionreducespost-injectionpain.
Chungetal.(2002).
Phys
icaltrainingforpatientswith
heartfailure
P
hysicaltrainingforpatientswith
c
hronicheartfailureincreases
p
hysicalperformance,oxygenupta
ke
a
ndqualityoflife.
Randomisedstudiescomparing
varioustypesofphysicaltraining
(bothcentralandperipheral
training)
withacontrolgroupthatdid
not
participateintraining.
EurHeartJ(2001).
Individually-designedtraining
programmesforseriouseating
problems
T
hepatientregainstheabilitytoea
t
o
rallyandexperiencesabetter
h
ealth-relatedqualityoflife.
Cost-
e
ffective.
JacobssonCetal.(20
00).
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Table
2bExamplesofmethodsforassessingsuffering/well-beinginhealth,
ill-healthanddisease.
23
Method/Tool
Result
Implementation
Reference
PainA
ssessment
VAS
VisualAnalogueScale
S
ystematicassessmentofpain.
Thepatientratestheintensityofthe
painona10cmscale.
Gaston-JohanssonF
(1985).
BrattbergG(1989).
NRS
NumericalScale
S
ystematicassessmentofpain.
Thepatientratestheintensityofthe
painbymeansofthetool.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel9Ca
rlesonB.
VDS
VerbalScale
S
ystematicassessmentofpain.
Thepatientratestheintensityofthe
painbymeansofthetool.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel9Ca
rlesonB.
BPI-S
FBreifPainInventoryShort
Form
S
ystematicassessmentofpain.
Thepatientratestheintensityofthe
painbymeansofthetool.
Kvalitetsindikatorerinomomvrdnad,
(2001)Kapitel9CarlesonB
Struc
turedquestionnaireforpain
history
S
ystematicassessmentofpain.
Thepatientratestheintensityofthe
painbymeansofthetool.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel9Ca
rlesonB.
McGillPainQuestionnaire
M
ultidimensionalassessmentof
p
atient'spain.
Tooltoassesthepatient'so
verall
experienceofpain.
McGuireD(1988).
Pain-O-Meter(POM)
S
ystematicassessmentand
e
valuationofacuteandlong-term
p
ain.
Thepatientassesseshis/he
rown
painviaaplasticsliderulec
ontaining
aVASscale,andaffectivea
nd
sensoryterms.
Gaston-JohanssonF
(1996).
HawthornJ&RedmondK(1999).
ObjectivePainDiscomfortScale
M
easureofpresenceanddegreeof
e
xcitation.
WalkerSMetal.(1997).
Assessmentofeatingand
swallo
wingproblems
SSA
TheStandardized
SwallowingAssessmenttool
S
creeningfordysphagia.
Stepwiseimplementationof
thewater
swallowingtestonconsciouspatients
inasittingposition.
Carriedoutby
nurses.
PerryL(2001b).
EllulJ,etal.(2001).
Obse
rvation/assessmentofthe
abilitytoswallowvariousfoodstuffs
S
creeningfordysphagia.
PerryL(2001a).
Contd.o
npage24
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Table
2bExamplesofmethodsforassessingsuffering/well-beinginhealth,
ill-healthanddisease.
24
Method/Tool
Result
Implementation
Reference
Assessmentofeatingand
swallo
wingproblemscontd
Clinicalscreeningtools
"Anytwo"
BDSTTheBurkeDysphagia
ScreeningTest
TheTimedTest
BSATheBedsideSwallowing
Assessment
S
creeningfordysphagia.
PerryL(2001a).
Scree
ningofdysphagia
I
dentificationofobstaclestooptimal
n
utritionalintakeintheformof
insufficientenergy,fatigueandability
t
oconcentrate.
Thepatientsaremonitoredforthree
months.
WestergrenA,etal.(1999).
Meth
odfordiagnosingeating
problems
T
estingofindividualprogrammesto
t
raintheabilitytoeat.
Observationofspecialtestm
eals,
togetherwithdialogues.
JacobssonC,etal.(2
000a).
JacobssonC,etal.(1
996).
Standardisedassessmentofeating
bymeansofguide
Mappingtheabilitytoeatwithout
assistance,aidsandcompe
nsatory
strategies.
WestergrenA,etal.(2001).
Mode
lforassessmentofeating
AxelssonK.
(1988).
Axelssonetal.(1988).
Axelssonetal.(1989).
Assessmentofpressureulcers
Norto
nScale
P
ressuresoreprevention.
Assessmentofriskofpressureulcers,
involvingfivefactors:physic
al
condition,mentalcondition,
activity,
mobilityandincontinence.
NortonD,etal.(1979)
.
ModifiedNortonScale
P
ressuresoreprevention.
NortonScalewithadditiono
f
nutritionalandfluidstatusas
predictorsofpressureulcers.
EkAC(1985).
Eketal.(1988).
EkAC&BjurulfP(19
87).
GunningbergL,etal.
(1999;2001).
Contd.
onpage25
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Table
2bExamplesofmethodsforassessingsuffering/well-beinginhealth,
ill-healthanddisease.
25
Method/Tool
Result
Implementation
Reference
Assessmentofpressureulcers
contd.
Asse
ssmentScaleRBT(Risk
Asse
ssmentPressureUlcers)
P
ressuresoreprevention.
Identifypatientsatriskofde
veloping
pressureulcers.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel2Ek
A-C,etal.
Assessmentofriskofinjuriesdue
tofalls
Asse
ssmentofriskofinjuriesdueto
falls
P
reventionofinjuriescausedbyfa
lls
Assessmentoffrequencyof
factors
thatcangiverisetoinjuries
causedby
falls.
UdnG(1985).
Tool
foridentifyingpatientsathigh
risko
finjuriesduetofalls
P
reventionofinjuriescausedbyfa
lls
Screening.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel3Ud
nG.
Assessmentofulcers
Meth
od/toolfortheassessmentof
ulcers
I
ndividually-adaptedsoretreatmen
t.
Planningforpreventionand
treatment
ofpressureulcers.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel2Ek
A-C,etal.
Srbedmningsmallfrbensr
I
ndividually-adaptedsoretreatmen
t.
Assessmentoflegulcersus
inga
giventemplate.
LindholmCetal.(199
3).
Other
Tool
toassesstheneedforpatient
education
I
ndividually-adaptededucation.
Assesslevelofknowledgea
ndability
tousethatknowledge.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel6BjrvellH&
EngstrmB.
Neon
atalInfantPainScale(NIPS)P
ainreliefofnewbornsadaptedto
a
geandtheindividual.
Assessmentofpostoperativepainin
newborns,
includingassessmentof
facialexpression,
breathing
patterns,
legandarmtonus,
degreeo
f
wakefulnessandmovementinfingers
andhands.
Jrnvik-KarlssonA&
KosinskyE
(1995).
Contd.onpage26
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Table
2bExamplesofmethodsforassessingsuffering/well-beinginhealth,
ill-healthanddisease.
26
Method/Instrument
Result
Implementation
Reference
Contd.
Other
TheGlasgowComaScale(GCS)
E
arlydiscoveryofchangesin
p
atients'degreeofconsciousness.
Systematicassessmentofd
egreeof
consciousness.
JonesC(1979).
FraserM.C
(1988).
Tool
forthegradingof
throm
bophlebitis
I
ndividually-adaptedtreatmentof
t
hrombophlebitis.
Ascalefrom0-4thatgrades
the
degreeofcomplicationandtypesof
symptoms.
LundgrenA,etal.(19
93).
IdvallE&LundgrenA
(1996).
Naus
eadiary
I
mprovedself-monitoring.
Thepatientsthemselveskeepadiary
oftheirexperiencesofnauseaduring
cytostatictreatment.
RegionalOncological
Centre,
Uppsala
(1990).
VAS
registrationofnausea
I
mprovedself-monitoring.
Self-assessmentofnausea
during
cytostatictreatment.
JennsK(1994).
Asse
ssmentoforalcavity
O
verallassessmentoforalcavity
s
tatus.
Thetoolcomprisesassessm
entof
voice,
throat,lips,
tongue,m
ucous
membranes,gums,
teethetc.
EilersJ,etal.(1988).
SubjectiveglobalassessmentscaleE
arlydiscoveryofmalnutrition.
Subjectiveassessmentofnutritional
status.
Detsky,etal.(1987).
Incon
tinenceMonitoringRecord
I
ndividually-adaptedtreatment.
Assessmentofincontinency
problems
inelderlypeoplewhoaredis
oriented
orhavecommunicationprob
lems.
OuslanderJG,etal.(1986).
Scale
forconstipationassessmentI
ndividually-adaptedconstipation
p
revention.
Assessmentofconstipation
during
courseofmedication.
McMillanSC&William
sFA(1989).
Mass
ageastreatmentfor
constipation
N
oconstipation.
Emly,etal.(1998).
Treatmentmeasuresfor
constipation
N
oconstipation.
Systematicliteraturereview,
describingsevenRCTsthat
have
examinedconstipationtreatment
methods.
Wiesel,etal.(2002).
Contd.onpage27
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Table
2bExamplesofmethodsforassessingsuffering/well-beinginhealth,
ill-healthanddisease.
27
Method/Tool
Result
Implementation
Reference
Contd.
Other
Tool
forassessmentofself-care
ability
IndirectlymeasuredviaHIin
dex
(generalwell-being).
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel6BjrvellH&
EngstrmB.
KatzADLindex
I
ndividuallyadaptedADLtraining.
Assessmentofindependenc
eor
dependencyonhelpbasedon
activitiesofdailyliving.
Hulter-
sbergK(1986).
Barth
elsADLindex
I
ndividuallyadaptedADLtraining.
AssessmentofADLabilityw
iththe
helpofatool.
MahoneyFI&BartehlDW(
1965).
MiniMentalStateExam
A
measureofdegreeofcognitive
d
ysfunction.
RagneskogH(2001).
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Table
2cExamplesofmethodsforpreventingill-healthand/ortreatingill-health.
28
Method/Tool
Result
Implementation
Reference
Usespecialmattresse.g.water,air
orfoammattress
P
reventionofpressureulcersor
p
romotionofhealingofpressure
u
lcers.
CullumN,etal.(1995).
Seclu
sionasacareenvironment
measure
GlenS&JownallyS(
1995).
Individualadaptationofexternal
stimu
liinneonatalcarebasedon
matu
ritylevel
R
educestressinprematurebabies.
Adaptationofsound,
lightan
dthe
immediateenvironmentinchild's
incubator.
AlsH(1986).
SymningtonA&PinelliJ(2002).
Dieta
rysupplementsfortheelderlyF
unctionalconditionispreserveda
nd
m
ortalitydecreased.
Individualsystematicadministrationof
dietarysupplement.
UnossonM(1993).
Oralcare
I
mprovednutritionalintake.
Interventionprogrammeincluding
screeningoforalcavity,con
sultation
withdentist,oralcaretechniquesand
patienttraining.
Grahametal.(1993).
Nordenrametal.(199
4).
Bathing
T
reatmentofdryskin.
AnderssonHardyM(1992.)
Touc
hingskin/massage
I
nfluenceonreleaseofhormonesand
p
ositiveeffectsonanxiety,pain,
g
eneralhealthandhealing.
Also
a
imedtoreducemusculartension
and
s
tressinjuries.
WeinrichS&WeinrichM(1990).
ConellMeehanT(1992).
FerellTorryA&Glick
O(1993).
Relaxationtraining
T
ohelppatientsbettercopewith
s
tressthroughincreasedself-control.
Scandrett-HibdonS&
UeckerS
(1992).
SnyderM(1994).
Contd.o
npage29
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Table
2cExamplesofmethodsforpreventingill-healthand/ortreatingill-health.
29
Method/Tool
Result
Implementatio
n
Reference
Methods
fortreatmentofulcers:
Compression
Cleaningwithwaterat
body-temperature
Vacuumtherapy
Honeyandmaggottherapy
Intensificationoffactors
promotinghealinginthear
ea
aroundthesore.
Speedinguphealingby
increasingthetemperature
in
thesoreto38degrees.
Treatmentofinfectedulcers.
Compressionofleg
sore
oedema
Cleaningofulcersw
ithwater
atbodytemperature
Vacuumtherapyn
egative
pressureinthesore
through
theapplicationofa
polyurethanespong
e
connectedtoasuctiondevice
Applicationofhoney
to
infectedulcers
Applicationofflyma
ggotsof
theLucilia
familyto
necrotic
ulcers.
AlvarezOM,etal.(1
983).
BriggsM&NelsonE
(2001).
BanwellP(1999).
CooperRA,etal.(1
999).
ThomasS,etal.(1998).
Metho
dfortheuseofmattresses
witha
preventivefunction
P
reventionofpressureulcers.
CullumN,
DeeksJ,SheldonTA,
Song
F,
FletcherAW(
2002).(Cochrane
Review)
Metho
dforprovidinganadequate
amountofnutritionalfood
P
reventionofpressureulcers.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel2EkA-C,etal.
Hipprotection
P
reventionofhipfracturesinfalls.
Individually-adaptedhipprotectorsin
cottonpants.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel3U
dnG.
Hipprotection
P
reventionofhipfracturesinfalls.
LauritzenJB,
PetersenMM,
LundB
(1993).
Metho
dforpre-operativeinstructions
Effectsonfearandanxiety
Postoperativebreathing
function
Useofanalgesics
Useoftranquillisingdrugs
Timeinrecoveryroom
Numberofin-patientdays
Post-operativecomplications
Earlierdischarge
SBU(1994).Rapportnr.123,
Kapitel3
BonairA.
Contd.on
page30
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Table
2cExamplesofmethodsforpreventingill-healthand/ortreatingill-health.
30
Meth
od/Tool
R
esult
Implementation
Reference
Metho
dof"guidedimagery"
N
on-pharmacologicaltreatmentof
p
ain.
BulechekGM&McC
loskeyJC(1992).
Metho
dsforpreventingcontractures
SBU(1994).Rapportnr.123.
Toilettrainingmethods
SBU(1994).Rapportnr.123.
Monito
ringmethods
SBU(1994).Rapportnr.123.
Lotion
E
liminationofheadlice.
PlastowLetal.(2001).
Combingincombinationwithhair
shamp
oo
E
liminationofheadlice.
PlastowLetal.(2001).
Tapw
ater
Sterile
saltsolution
C
leansore.
Bowlorshower.Evaluationof
municipalnursingorganisation.
SelimP,etal.(2001).
Massa
ge
P
ressuresoreprevention.
BussIC,etal.(1997
).
Compressionbandage
Improvedhealingofulcers.
NelsonEA,etal.(2001).
Individ
ualprogrammetotraineating
ability
T
hepatientsfeltitwaseasiertoea
t.
B
eforethetreatment,nooneate.A
fter
treatment,6patientsateand4
p
atientshadtheirtuberemoved.
Systematicfocuson,andtra
iningof,
functionsrequiredforeating
and
discussionswiththepatient.
JacobssonC,etal.(
1997).
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Table
2d.Examplesofmethodsforevaluatingplannedindividualc
are
31
Method/Tool
Result
Implementation
Reference
Toolsandmethodsforevaluating
preve
ntionandtreatmentofpatients
withhighriskoffallinjuries
S
afecareenvironment.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel3Ud
nG.
Tool
forsystematicevaluationof
patientsatisfactionwithtreatment.
TreatmentSatisfactionDTSQand
DTSQc
H
igherqualityinthecareofpatients
w
ithdiabetes.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel5WredlingR.
Meth
ods/toolsforevaluatingpatient
self-c
areandcopingabilityand
comp
liance(concordance)
Assessmentbasedonself-r
ated
copingstrategies,self-careabilityand
compliance.
Kvalitetsindikatorerinomomvrdnad,
(2001).Kapitel5WredlingR.
EORTCQLQ-C30(questionnaire)
M
easureofqualityoflife.
Patientswithcancer.
MaughanK&ClarkC
(2001).
Lasry
SexualFunctioningscaledataM
easureofeffectsofcanceron
s
exualfunctioning.
Originallydevelopedforpatientswith
breastcancer.
MaughanK&ClarkC
(2001).
CQO
LC(CaregiverQualityofLife
Index
-CancerScale)
M
easureofqualityoflifeincaregiv
ers
w
hoarecaringforacloserelative
w
ithcancerinthehome.
Questionnaire(five-pointLik
ertscale),
10minuteduration.
WeitznerMAetal.(1
999).
WeitznerMA&McMillanSC(1999).
SF-36(MedicalOutcomesStudy
ShortForm)
M
easureofhealthandhealth-relat
ed
q
ualityoflife.
Thepatientrateshis/herperceived
healthandvariousfunctioningby
completingaquestionnaire.
Ware&Sherbourne(1992)
Bowling(1997).
NHP-NottinghamHealthProfile
M
easureofhealthandhealth-relat
ed
q
ualityoflife.
Thepatientrateshis/herperceived
healthandvariousfunctioningby
completingaquestionnaire.
HuntSMetal.(1980)
HuntSM,
McKennaS
P,
WilliamsJ
(1981).
SIP-
SicknessImpactProfile
M
easureofhealthandhealth-relat
ed
q
ualityoflife.
Thepatientrateshis/herperceived
healthandvariousfunctioningby
completingaquestionnaire.
BergnerM,
BobittRA,
CarterWB,
GilsonBS(1981).
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Table
3
Examplesofmethodsforthe
organisationofindividualcare.
32
Method
Results
Implementation
Reference
Primarynursing
Enhancedqualityofnursin
g
Increasedpatientsatisfaction
Shorterin-patienttimes
Increasedcost-effectivene
ss.
Eachpatientislistedwitha
specific
nursewhoisresponsibleforthe
patient'soverallcareduring
hospitalisationincludingany
readmission.
ReedSE(1988).
GiovanettiP(1986).
JohnsonT&TahanH
(1997).
Grou
pcare
T
hegroupisdeemedtoprovidebetter
c
arethanasinglecarer
Alimitednumberofcarerstendingthe
patient.
SegerstenK(1996).
NursingCaseManagement
Acontrolledbalancebetween
costandquality.
Aresult-basedcareprocess.
Oneandthesamenursepla
ns,
organises,co-ordinates,
imp
lements,
documentsandevaluatesth
ecare.
Thisalsoincludesoverall
responsibilityforgoalattainm
ent
withintheframeworkofa
predeterminedcareperioda
ndthe
planneduseofresources.
ZanderK(1988a).
ZanderK(1988b).
Individualcareplanning
Writtendirectivesfornurses.
Facilitatescontinuityofcare
forthepatient.
Aidstheprioritisingofnurs
ing
interventions.
Documentedindividualplansforeach
patient.
CarpenitoLJ(2000).
Standardcareplans
Increasedcarequality.
Moretimeforpatientcare,
Increasedexchangeofskills,
Facilitatestheintroduction
of
newemployeesandstude
nts.
Preparationofgeneralcare
plans
basedonamedicaldiagnos
is,
treatmentornursingaspects.
RyanKA(1989).
HellgrenA&EdlundK
(1996).
EdlundK&Forsberg
A(1999).
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LIST OF APPENDICES
APPENDIX 1. LIST OF MEMBERS OF T HE ALERT ADVISORY COMMITTEE IN THE
YEAR 2002
APPENDIX 2.DESCRIPTION OF SCIENTIFIC JOURNALS EXAMINED WHEN
MAPPING NURSING METHODS
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34
APPENDIX 1. LIST OF MEMBERS OF THE ALERT ADV ISORY COMMITTEE IN THE
YEAR 2002
Thomas Ihre, Chair, MD, PhD, General Surgery, Chair of the Swedish Society of Medicine, Member of
the Board of SBU
Karin Axelsson, RNT, DMSc, Lule University of Technology
Marianne Boijsen Carlsson, MD, PhD, Consulting radiologist, Sahlgrenska University Hospital
Professor Mona Britton, MD, PhD, Internal medicine, SBU
Sussanne Brjesson, University Lecturer, Nursing Research, Health University, Linkping
Professor Jane Carlsson, RTP, PhD, Physiotherapy, Gothenburg University
Professor Bjrn-Erik Erlandson, PhD, Health technology, Uppsala University Hospital
Professor Jan-Erik Johanson, MD, PhD, Urology, rebro Regional Hospital
Professor Dick Killander, MD, PhD, Oncology, Lund University Hospital
Gran Maathz, MPolSc, Purchaser Network for County Councils and Regions
Professor Felix Mitelman, MD, PhD, Clinical genetics, Lund University Hospital
Professor Lars G Nilsson, PhD, Pharmacist, NEPI
Per Nilsson, MD, PhD, Internal medicine, Medical Products Agency
Cecilia Ryding, General Medicine Specialist, Kvartersakuten Surbrunnsgatan, Stockholm
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35
APPENDIX 2. DESCRIPTION OF THE JOURNA LS EXAMINED WHEN MAPPING
NURSING METHODS
Circulation is a medical journal in the field of cardiovascular disease containing some basic research aswell as basic and clinical research. Contains mainly RCT studies.
European Heart Journal is a medical journal in the cardiovascular field that contains some basic
research but also clinical research. Mainly contains RCT studies.
Heart is a medical journal in the cardiac field that contains both descriptive studies and RCT studies of
clinical problems.
Heart and Lung is a US journal aimed at contributing to the development of research and practice in
nursing and closely related disciplines in the heart and lung field.
International Journal of Nursing Studies contains both descriptive studies and RCT studies in all fields
of nursing research. It has the aim of contributing to the development of research and practice in nursing
and related disciplines. Contains articles on the subjects of nursing theories, research that is close to the
patient, training and care organisation.
Journal of Advanced Nursing contains both descriptive and RCT studies in all fields of nursing
research. Contains articles on the subjects of nursing theories, research that is close to the patient, training
and care organisation.
Journal of Clinical Nursing has the aim of spreading clinical knowledge and experience between nurses,
midwives and public health workers in various cultures and health care systems. The journal publishes
articles on evidence-based care, clinically relevant research and literature reviews. Includes mainly
descriptive articles, but also RCT studies.
Patient Education and Counselling is a multidisciplinary journal that publishes work in the fields of
patient education and health promotion measures. The journal aims to describe and illuminate models for
education, support and advice in health care and contains both descriptive and RCT studies.
Scandinavian Journal of Caring Sciences has the aim of disseminating research in the health field to
nurses, occupational therapists, physiotherapists, physicians and social workers. The journal contains
research articles on care, organisation and training.
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36
Theoria, Journal of Nursing Theory, focuses on theory development, theoretical understanding of
nursing practice, and implementation of theory and theoretical understanding in clinical practice.
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37
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