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BACKGROUND: Stress can originate from many different unsatisfying work situations. Registered nurses working in municipal care have experience of work-related stress in different ways.

AIM: The purpose of this study was to describe the work-related stress experienced by registered nurses caring for older people at municipal aged care facilities.

METHODS: Qualitative semi-structured interviews according to Polit and Beck were carried out in clinical work at six different municipal aged care facilities in Sweden. Twelve registered nurses participated in the study.

RESULTS: The results outlined in one main central theme: Feelings of inadequacy and dissatisfaction contribute to work-related stress and three categories: Difficulty coping with work tasks, Insufficient support, Work-related stress affects private lives. Areas identified were lack of time, staff shortages, high number of patients, lack of communication and teamwork in the working group, showing that inadequacy and dissatisfaction can contribute to work-related stress. This can contribute to work-related stress, and it can be a result of problems in the organizational and social work environment.

CONCLUSION: This study showed the everyday experiences of registered nurses' stress at work. The reasons that registered nurses experience a heavy workload were found to be similar in several municipal care facilities. Future interventions should consider the areas of stress found in this study to reduce the risk of further increasing the work-related stress experienced by registered nurses working in municipal aged care.

BACKGROUND: With the increased demand for health care services and with simultaneous staff shortages, new work models are needed in primary health care. In November 2015, a Swedish primary health care centre introduced a work model consisting of a structured patient sorting system with triage and Nurse on Call. The aim of this study was to describe the staff's experiences of introducing the triage and Nurse on Call model at the primary health care centre.

METHODS: Five focus group discussions with staff (n = 39) were conducted 4 years after the introduction of the work model. Groups were divided by profession: medical secretaries, nursing assistants, physicians, primary health care nurses, and registered nurses. The transcribed text from the discussions was analysed using qualitative inductive content analysis.

RESULTS: The analysis generated one overarching theme: The introduction of triage and Nurse on Call addresses changed preconditions in primary health care, but the work culture, organization, and acquisition of new knowledge are lagging behind. The overarching theme had five categories: (1) Changed preconditions in primary health care motivate new work models; (2) The triage and Nurse on Call model improves teamwork and may increase the quality of care; (3) Unclear purpose and vague leadership make introducing the work model difficult; (4) Difficulties to adopt the work model as it challenges professional autonomy; and (5) The triage and Nurse on Call model requires more knowledge and competence from nurses in primary health care.

CONCLUSIONS: This study contributes with knowledge about implications of a new work model in primary health care from the perspective of health care staff. The work model using triage and Nurse on Call in primary health care was perceived by participants to increase availability and optimize the use of resources. However, before introduction of new work models, it is important to identify barriers to and facilitators for successful improvements in the local health care context. Additional education for the health care staff is important if the transition is to be successful. Complementary skills and teamwork, supported by a facilitator seems important to ensure a well-prepared workforce.

Introduction Older patients with hip fractures are among the frailest and sickest groups of patients in the hospital. In addition to complex medical problems and comorbidities, they have to overcome the additional physiological challenges posed by the hip-fracture, as the subsequent surgery. The recovery process is complicated, and support of both physical, psychological and psychosocial challenges is highly needed. However, people with hip fracture is not a homogeneous group; although some of them are healthy people. It is essential to integrate the patient´s perspective into the healthcare process, and therefore we performed two studies that together bring forth a longitudinal qualitative study.

Objectives To explore how previously independently living older adults perceive their capacity to regain pre-fracture functions in the acute phase following hip fracture surgery and how they adapted to daily life four months later.

Methods An exploratory inductive qualitative longitudinal design. Individual interviews were conducted two to five days’ post hip surgery and follow-up interviews four months later. Inclusion criteria: 65 years or older, Swedish speaking, independent living at the time of injury, and with no cognitive impairment. Data were analysed using manifest inductive content analysis.

Results One main category describes the informants’ perception of their capacity to regain pre-fracture function in the acute phase: Ending up in a new situation with or without control. From being convinced of regaining recovery at admission, this changed into having no faith in regaining pre-fracture function and independent living. This transition occurred as they adapted to the routines in the acute hospital setting and became passive. At four months, one overarching category describes how the informants adapted to daily life: Hip-fracture, an interruption that has consequences for everyday life. Physical restraints affected the informants psychologically and, as a consequence, the psychological effects influenced their physical recovery. Some informants had given up, and some described they vacillated between to continue fighting for independence or to surrender. Some handled the situation to regain everyday life with self-esteem and power. Generating a strong driving force and determination was seen as a necessary basis for recovery.

Conclusion Findings imply that the ward-culture entails passivity and insecurity in the recovery process. It is essential to retain patients’ inner driving force to maintain pre-fracture functions. Sustaining a hip fracture affects self-image in physical, psychological, and psychosocial aspects. Thus, it is most urgent to prevent or delay disability in pre-frail older people. These studies contribute knowledge as to why previously healthy independently living older adults do or do not recover after hip fracture surgery.

Introduction:  Patient Reported Outcome Measures explore the view from the individuals´ perspective

Aim: The aim was to identify self-assessed factors that predict how patients recover after hip fracture surgery

Methods: A descriptive quality register-questionnaire study included 188 previous healthy, independent living adults aged 65 years and older stricken by a hip fracture in Sweden.  Data collection consisted of demographic data using the Swedish National Hip Fracture Register and Patient-reported assessment at the acute hospital, 2-5 days after surgery, and follow-up 4 months later. Following questionnaires were used: - EQ-5D, for assess health status - Falls Efficacy Scale, Swedish version (FES(S)), for assess perceived ability to perform common everyday tasks without fear of falling - Postoperative Recovery Profile (PRP), for assess patient-reported postoperative recovery including multidimensional items after surgical treatment.

Results: Based on patient reported assessment scores 21 percent reported themselves as fully or almost fully recovered at 4 months follow-up. In addition, 39 percent reported themselves slightly or not recovered at all. Different age groups experienced different challenges at different phases of the recovery process.

Discussion: Previously healthy adults who sustain a hip fracture are heterogeneous, and this heterogeneity means that their recovery process will likely differ. Using patient reported assessment provide improvement and integrated care. It is important to gain more knowledge from the individuals´ perspective of the difficulties when recover after a hip fracture. 

Implication for practice: Previous healthy, independently living older adults should be able to recover to the previous standard of everyday life after a hip fracture. The recovery process includes the entire continuum of fundamentals of care. The promotion of patient-valued outcomes for shaping clinical practice could be compatible with the outcomes that the patients value highest: to regain previous function capability and to regain independence after a hip fracture.

Background: Effects following a hip fracture often lead to functional disabilities and increased dependence on others. Although persons sustaining a hip fracture constitute a heterogeneous group in Swedish health care, they tend to be treated as a homogenous one.

Aim: The aim of this study was to reveal how previously healthy people, aged 65 years and older, described how they had adapted to daily life four months after a hip fracture.

Method: The follow-up interviews were performed by the first author four months after the hip fracture. Data were analysed using conventional inductive content analysis.

Findings: The results from the interviews highlight that sustaining a hip fracture, even four months later, was seen by the participants as an interruption leading to lasting consequences for everyday life. The recovery process during this period was complex and consisted of both physical and psychological strain. Some were resigned, some strived in order to regain independence and some handled the situation by means of self-confidence and self-efficacy.

Conclusion: Previous healthy and independently-living participants described, in different ways that the hip fracture was an interruption that still affected everyday life. The absence of psychological support may be one of the reasons for dependency after four months

Aims and objectives

To explore healthy older patients' perceptions of their own capacity to regain pre-fracture function in the acute phase following hip fracture surgery.

Background

The incidence of hip fractures is expected to increase. In Sweden, of the patients who sustain a hip fracture, 40 per cent are healthy and lived independently pre fracture. However, a hip fracture often results in declined functional outcomes for 40 per cent of these patients.

Design

The study had an explorative inductive qualitative design.

Methods

Semi-structured interviews (n = 30) were conducted two to five days after hip fracture surgery. Data were analysed using manifest inductive content analysis.

Results

As a description of patients' perception of their own capacity to regain pre-fracture function after a hip fracture, one main category emerged: To end up in a new situation with or without control. Patients expressed that they believed in recovery and thought nothing would be altered. However, since they had to adapt to the ward culture at the acute hospital, they became passive and became insecure about their future life situation.

Conclusion

The attitudes of staff at the acute hospital can influence the outcome for hip fracture patients. Patients believe in recovery but do not receive psychological support to regain physical capacity.

Introduction: The large and increasing number of hip fracture patients, in combination with the large impact that this is having on daily living activities, is emphasizing the importance of identifying factors that have a detrimental impact on post-operative outcomes. There are benefits to planning the ward in a way that prevents a steep decline in recovery after hip fracture surgery. Adding the patient`s perspective into the healthcare assessment, via shared healthcare decision-making, allows the patient’s needs and preferences to be taken fully into account. The aim of this study was to identify factors that predict how patients recover after hip fracture surgery.

Methods: A descriptive quality register/questionnaire study in acute orthopaedic wards, 2 to 5 days after surgery, with a follow-up 4 months later. The patients included were ≥65 years of age and had been previously healthy and living independently before the hip fracture.

Results: The participants in this study had returned to their own homes after 4 months, but only 21% reported themselves as being fully or almost fully recovered. In several domains of recovery, all 3 age groups (65-74, 75-84 and 85-97) reported different challenges both during their acute hospital stay and at the 4 months follow-up. The recovery phase is heterogeneous and requires individual care. The way that this is planned has an influence on patient outcome.

Conclusion: Patients sustaining a hip fracture are heterogeneous and different age groups experience different challenges. At 4 months follow-up, one fifth of the participants reported themselves fully or almost fully recovered and most of them had returned to their own homes. The Swedish National Hip Fracture Register and the patient-reported questionnaires employed in this study are appropriate tools to audit further development of healthcare to improve quality of life after hip fracture surgery.