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Eldh, A. C., Olai, L., Jönsson, B., Wallin, L., Denti, L. & Elf, M. (2018). Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study. Nordic journal of nursing research (2), 87-95
Open this publication in new window or tab >>Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study
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2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, no 2, p. 87-95Article in journal (Refereed) Published
Abstract [en]

This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.

Keywords
context, frail older people, knowledge implementation, leadership, nursing home, oral care
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26788 (URN)10.1177/2057158517713379 (DOI)
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-06-08Bibliographically approved
Hägglund, D. & Olai, L. (2017). Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home. Nordic journal of nursing research, 37(2), 109-116
Open this publication in new window or tab >>Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home
2017 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 2, p. 109-116Article in journal (Refereed) Published
Abstract [en]

The aim of the present follow-up study was to describe staff perceptions of enabling and inhibitory factors that influenced implementation of evidence-based practice (EBP) for urinary incontinence in a nursing home. Focus group interviews were carried out and the text was deductively analyzed using the PARIHS framework and qualitative content analysis.  Factors believed to be most enabling for implementation were the EBP being considered as relevant and as a social process and visiting the lavatory being considered as a right for all. One determinant of successful implementation was having clear and involved leaders who had a continuous positive attitude toward the EBP and demanded results. Staffs who were given the role of continence agents were important facilitators. The factor believed to inhibit implementation most was staff having to carry out pad-weight tests before prescribing individual incontinence aids. The EBP offers a successful concept for caring for older persons with urinary incontinence in nursing homes. The EBP should be spread, both local and more widely.

Keywords
Implementation, nursing home, staff, urinary incontinence
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23358 (URN)10.1177/2057158516667644 (DOI)
Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2017-06-05Bibliographically approved
Hägglund, P., Olai, L., Ståhlnacke, K., Persenius, M., Hägg, M., Andersson, M., . . . Carlsson, E. (2017). Study protocol for the SOFIA project: Swallowing function, oral health, and food intake in old age. BMC Geriatrics, 17(1), Article ID 78.
Open this publication in new window or tab >>Study protocol for the SOFIA project: Swallowing function, oral health, and food intake in old age
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2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, no 1, article id 78Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia).

METHODS/DESIGN: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT <10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups.

DISCUSSION: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

TRIAL REGISTRATION: This trial was retrospectively registered at ClinicalTrials.gov, on July 4, 2016, identifier: NCT02825927 .

Keywords
Aged, Deglutition, Eating, Oral health, Oral screen, Quality of health care, Quality of life, Short-term care, Swallowing disorders
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24672 (URN)10.1186/s12877-017-0466-8 (DOI)28335729 (PubMedID)
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2017-11-29Bibliographically approved
Persenius, M., Stålnacke, K., Olai, L., Hägg, M. & Carlsson, E. (2016). Methodological issues in studying frail older people in short-term care. In: : . Paper presented at Nordic Conference in Nursing Research 2016. Methods and networks for the future. Stockholm 15-16 juni 2016.
Open this publication in new window or tab >>Methodological issues in studying frail older people in short-term care
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2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-22653 (URN)
Conference
Nordic Conference in Nursing Research 2016. Methods and networks for the future. Stockholm 15-16 juni 2016
Available from: 2016-08-01 Created: 2016-08-01 Last updated: 2016-11-17Bibliographically approved
Hägglund, D. & Olai, L. (2016). Möjliggörande och hindrande faktorer som påverkat införandet av förändringsarbetet Toa-rätten vid urininkontinens, inom särskilt boende i äldreomsorgen. In: : . Paper presented at Svensk Sjuksköterskeförening (SSF), Sjuksköterskedagarna, Kvalitet i omvårdnad-sjuksköterskans ansvar. 22-23 nov 2016, Stockholm..
Open this publication in new window or tab >>Möjliggörande och hindrande faktorer som påverkat införandet av förändringsarbetet Toa-rätten vid urininkontinens, inom särskilt boende i äldreomsorgen
2016 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
Keywords
Implementering, särskilt boende, personal, urininkontinens
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23362 (URN)
Conference
Svensk Sjuksköterskeförening (SSF), Sjuksköterskedagarna, Kvalitet i omvårdnad-sjuksköterskans ansvar. 22-23 nov 2016, Stockholm.
Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2016-11-16Bibliographically approved
Olai, L., Hägg, M., Stålnacke, K., Carlsson, E. & Persenius, M. (2015). Effects of swallowing training on eating, oral health and quality of care among elderly people in short-term care units: preliminary findings. In: : . Paper presented at The 21st IAGG European Congress of Gerontology and Geriatrics (IAGG-ER), Dublin, 23-26 April, 2015.
Open this publication in new window or tab >>Effects of swallowing training on eating, oral health and quality of care among elderly people in short-term care units: preliminary findings
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2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Lately, oral health-related quality of life (OHRQoL) and nutrition in elderly people living in special accommodations have been placed in focus. It has been shown that dysphagia, malnutrition and poor oral care are frequent in frail elderly people. Swallowing training, using an oral screen, has been successfully tested on stroke-afflicted patients with dysphagia. To what extent dysphagia will have an impact on oral health, and nutrition in elderly is poorly evaluated.  The aims are to study (1) oral health and OHRQoL together with eating, (2) to compare elderly people and nursing staffs’ perceptions of quality of care, and (3) to evaluate the effect of swallowing training on dysphagia. Early detection and intervention of quality of care related to oral hygiene, dysphagia, and eating, may lead to better care and quality of life for the elderly.

Methods:  In this prospective study 400 older people are examined with validated instruments measuring OHRQoL (OHIP14), perception of care quality (QPP), swallowing capacity (SCT) and eating ability (MEONF-II). Patients with dysphagia (n = 40), are included in a swallowing training program (IQoro®), another 40 patients with dysphagia serves as controls.

Results: Preliminary results from 219 patients, (mean age 82 years, 57 % women) shows that 53% are considered to have poor oral hygiene, 75% get no help with oral hygiene, 25% show clinical signs of malnutrition.

Conclusion:Safe eating, swallowing and good oral health for older people is a multidisciplinary responsibility, possible to influence. Key factors of importance for this process will be identified.

National Category
Health Sciences
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-19118 (URN)
Conference
The 21st IAGG European Congress of Gerontology and Geriatrics (IAGG-ER), Dublin, 23-26 April, 2015
Projects
Aspekter av ätande och vårdkvalitet bland äldre som vårdas på korttidsboende - före och efter en intervention
Available from: 2015-08-26 Created: 2015-08-26 Last updated: 2015-08-26Bibliographically approved
Olai, L., Elf, M., Eldh, A. C., Wallin, L. & Jönsson, B. (2015). Implementing oral health-care guidelines in long-term-care: the role and support of managers. In: : . Paper presented at 20th Congress of the European Association of Dental Public Health, Turkey, 17th-19th Sept. 2015.
Open this publication in new window or tab >>Implementing oral health-care guidelines in long-term-care: the role and support of managers
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2015 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Aim: There is an essential need to bridge the know-do gap in terms of oral-health-care for frail older people; while there are evidence based guidelines readily available, these guidelines are not altogether implemented in long-term-care (LTC) for older people. Facilitating knowledge translation has been found a complex undertaking, encompassing for example tailoring of evidence in relation to the specific context, considering the barriers and strengths of each setting. While managers and leaders have been found to influence implementation, studies focusing strategies to support the managers have only recently been launched. The aim of this pilot study in Swedish LTC is to support managers in facilitating implementation of evidence-based oral-care guidelines. Methods: Oral-health and knowledge translation experts provided a three month support programme for five managers in four LTC units, including knowledge of national guidelines tailored to LTC, and guidance for the managers on how to collate and execute guideline implementation plans, considering their behaviours, attitudes and actions as leaders in facilitating guideline implementation, underpinned by Gifford’s Model of Leadership. Oral-health measures were collected before and after the intervention, along with managers and staff experience. Results: Although the older people residing in the LTC units mainly had individual care plans for their oral care, and these aligned with the national guidelines, the oral care routines applied varied considerably. The managers were eager to support guideline implementation, and suggested that the intervention programme sustained their ambition. However, unclear roles and urgent everyday issues took its toll, leaving limited opportunities for managers to engage. Conclusions: Implementation of evidence based oral health-care guidelines requires support from primary leaders. Yet, they themselves need to be supported by the context, including top level management as well as staff, and all stakeholders involved in oral care issues need to be engaged.

National Category
Health Sciences Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19053 (URN)
Conference
20th Congress of the European Association of Dental Public Health, Turkey, 17th-19th Sept. 2015
Available from: 2015-08-26 Created: 2015-08-19 Last updated: 2015-11-24Bibliographically approved
Olai, L., Svärdsudd, K. & Borgquist, L. (2015). Life situations and the care burden for stroke pa­tients and their informal caregivers in a prospective cohort study. Upsala Journal of Medical Sciences, Supplement, 120(4), 290-298
Open this publication in new window or tab >>Life situations and the care burden for stroke pa­tients and their informal caregivers in a prospective cohort study
2015 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 120, no 4, p. 290-298Article in journal (Refereed) Published
Abstract [en]

Background. The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective.

Methods. A total of 377 Swedish stroke patients, aged ‡65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score.

Results. Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patient’s functional ability, low received municipal social service support, closeness of patient–caregiver relation, and short distance to patient’s home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient’s age, sex, functional ability, and patient–caregiver relationship. CB score increased with amount of informal caregiver support, patient’s age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time.

Conclusions. There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.

Keywords
Caregiver burden, dyad, elderly, informal caregiver, stroke
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19116 (URN)10.3109/03009734.2015.1049388 (DOI)000365684900009 ()26074171 (PubMedID)
Available from: 2015-08-26 Created: 2015-08-26 Last updated: 2017-12-04Bibliographically approved
Österlund Efraimsson, E., Ehrenberg, A., Fossum, B., Larsson, K., Klang, B. & Olai, L. (2015). Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care. European Clinical Respiratory Journal, 2, Article ID 27915.
Open this publication in new window or tab >>Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care
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2015 (English)In: European Clinical Respiratory Journal, ISSN 1399-3003, Vol. 2, article id 27915Article in journal (Refereed) Published
Abstract [en]

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.

Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.

Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.

Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.

Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.

Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

Keywords
change talk, chronic obstructive pulmonary disease, motivational interviewing, nurse-led clinics, smoking cessation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19117 (URN)10.3402/ecrj.v2.27915 (DOI)26672958 (PubMedID)
Available from: 2015-08-26 Created: 2015-08-26 Last updated: 2015-12-23Bibliographically approved
Stålnacke, K., Carlsson, E., Olai, L., Hägg, M. & Persenius, M. (2015). OHRQoL, oral-health/care, eating and swallowing among elderly people in short-term accommodations in Sweden. In: : . Paper presented at 20th Congress of the European Association of Dental Public Health, Turkey, 17th-19th Sept. 2015.
Open this publication in new window or tab >>OHRQoL, oral-health/care, eating and swallowing among elderly people in short-term accommodations in Sweden
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2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

It has been shown that poor oral health, lack of oral care, dysphagia and malnutrition are common among elderly persons living in special accommodations. All these factors are inter-related and have important impact on quality of life. Aims: The aims of the present study were to (1) describe oral health and oral health related quality of  life (OHRQoL) as well as  the prevalence of dysphagia and eating difficulties among elderly people in short-term accommodations (2) describe perceived care quality related to oral health and eating, (3) evaluate a training program for dysphagia. Methods: In four Swedish counties 320 patients in 30 short-term accommodations were studied by specially trained dental hygienists (RDH), after giving informed consent. Ethical approval has been given. Instruments measuring OHRQoL, oral health, perception of care quality, swallowing capacity and eating ability (OHIP-14, ROAG, QPP, SCT, MEONF-II, SWAL-QoL) were used. Patients with dysphagia were either invited to a 5 weeks training program using an oral screen, IQoro®, or to a control group (40 in each group), comprising follow-up at 5 weeks and 6 months. Results: Data collection is still ongoing for the 6-month follow-up. Preliminary results shows that mean age for the 320 patients was 82 years, 180 women (57%). 294 (91%) were native Swedes and 24 (8%) came from another European country. Physical condition was perceived good or fairly good by 155 (48%) participants, oral health was perceived good or fairly good by 212 (66%), oral hygiene was assessed by RDH as being poor for 156 (49%). 87 (27%) had swollen and bleeding gums, 53 (17%) had red and blistered oral mucosa. 210 (66%) participants perceived that they were given the support they needed at mealtimes but only 68 (22%) received support with daily oral care. Clinical signs of  nutritional risk was identified in 80 (25%) participants and 167 (54%) had a swallowing capacity less than 10 ml/sec. Mean value for OHRQoL measured by OHIP-14 was 7.66, no gender differences were observed. Having dysphagia affected OHRQoL to the worse, p<0.00. Conclusion: There was a discrepancy between participant’s perceptions and the assessments made by RDH, with the latter showing worse results. While being in a state of dependency almost half of the participants perceived their physical condition as good or fairly good and the same applies with regard to oral health. Although half of the study group had poor oral hygiene, the majority managed their oral hygiene by themselves.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-19134 (URN)
Conference
20th Congress of the European Association of Dental Public Health, Turkey, 17th-19th Sept. 2015
Available from: 2015-08-27 Created: 2015-08-27 Last updated: 2015-11-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5499-2055

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