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  • 1.
    Hrisanfow, Elisabet
    et al.
    Family Medicine Research Centre, Örebro University, Örebro.
    Hägglund, Doris
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 97-105Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care.

    Background. Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant.

    Design. A questionnaire survey.

    Method. The study included 391 women and 337 men, aged 5075 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results. Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality-of-life scores, women with incontinence had lower physical state scores (37.6 +/- 10.4 vs. 41.4 +/- 9.9; p < 0.001) and mental state scores (44.3 +/- 10.2 vs. 47.1 +/- 10.5; p < 0.007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality-of-life scores, men with incontinence had lower mental state scores than did men without incontinence (46.0 +/- 9.7 vs. 49.8 +/- 9.7; p < 0.001).

    Conclusion. The present results indicate that cough and urinary incontinence lead to poor quality of life in women and men with chronic obstructive pulmonary disease.

    Relevance to clinical practice. In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.

  • 2.
    Hrisanfow, Elisabeth
    et al.
    Örebro universitet, Hälsoakademin.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    The prevalence of urinary incontinence among women and med with chronic obstructive pulmonary disease in Sweden2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 13-14, p. 1895-1905Article in journal (Refereed)
    Abstract [en]

    Aim.  The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with chronic obstructive pulmonary disease in primary health care.

    Background.  Information on the prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease is scant. Such knowledge may be important to the development of care for patients with chronic obstructive pulmonary disease.

    Design.  A questionnaire survey.

    Method.  The study included 391 women and 337 men, aged 50–75 years, with chronic obstructive pulmonary disease. A self-administered, evidence-based questionnaire for incontinence was used. A response rate of 66% was obtained, of which 89·3% had spirometry-confirmed chronic obstructive pulmonary disease, and most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results.  The prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease was 49·6 and 30·3%, respectively. Women and men with urinary incontinence had a significantly higher body mass index than did women and men without urinary incontinence. The most common type of incontinence in women was stress incontinence (52·4%) and in men postmicturition dribbling (66·3%). Women with urinary incontinence had a higher presence of a symptomatic cough than did women without urinary incontinence (p < 0·001). On the whole, incontinence affected women more than men concerning experienced bothersomeness of incontinence (p < 0·001). More women than men with urinary incontinence refrained from activities (p < 0·021) and had sought help for incontinence (p < 0·012).

    Conclusion.  The present results indicate that urinary incontinence content should be included in care plans for patients living with chronic obstructive pulmonary disease. In addition, the results imply that nurses and physicians working in primary health care should ask patients with chronic obstructive pulmonary disease about urinary incontinence and then offer appropriate assessment and management of it.

  • 3.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    A systematic literature review of incontinence care for persons with dementia: the research evidence2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 303-312Article, review/survey (Refereed)
    Abstract [en]

    Backgroud. Urinary/faecal incontinence in persons with dementia is a potentially treatable condition. However, which type of incontinence care is most appropriate for persons with dementia remains undecided. Aim. The aim of this study was to perform a systematic review of literature on incontinence care in persons with dementia focusing on assessment/management and prevention. Design. A systematic search of the literature. Method. The search was performed in the CINAHL, PubMed and Cochrane Library databases. Results. Of the 48 papers analysed, two were systematic literature reviews of management of urinary incontinence including persons with dementia. These reviews showed that the best-documented effect of toilet assistance for urinary incontinence in elderly persons with/without dementia had prompted voiding. However, prompted voiding in persons with dementia raises ethical concerns related to the person's integrity and autonomy. Timed voiding in combination with additional interventions like incontinence aids, staff training on the technique of transferring participants from bed to commode and pharmacological treatment decreased the number of urinary incontinence episodes in older persons with/without dementia. There is good scientific evidence that prevention of urinary incontinence in elders with/without dementia decreases incontinence or maintains continence. However, the evidence is insufficient to describe the state of knowledge of faecal incontinence. Conclusions. Toilet assistance, including timed voiding in combination with additional interventions and prompted voiding, are the available evidence-based interventions; however, nursing incontinence care is an experience-based endeavour for persons with dementia. Relevance to clinical practice. There is a lack of evidence-based nursing interventions related to incontinence care for persons with dementia. More research is needed to show whether experience-based incontinence care is effective and which activities are most appropriate for persons with dementia. However, the practice of effective nursing will only be realised by using several sources of evidence, namely research, clinical experience and patient experience.

  • 4.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    District continence nurses' experiences of their continence service in primary health care2010In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 2, p. 225-233Article in journal (Refereed)
    Abstract [en]

    Aim The aim of the present study was to describe district continence nurses' experiences of providing continence services in primary care. Background It has been stated that there is too little research on the experiences of district care nurses who provide continence services. Method Twenty-two district continence nurses answered a written questionnaire containing three open-ended main questions. A qualitative content analysis method was used to analyse the texts. Results The district continence nurses' feelings of maintaining their professionalism were promoted by scheduled patient encounters, patients who participate in assessment of urinary incontinence (UI) and functioning teamwork. The opposite situation, nurses' feelings of having a lesser degree of professionalism, was associated with not having scheduled patient appointments, patients not participating in assessment of UI and lack of teamwork. Conclusions The district continence nurses lacked the authority to start nurse-led continence clinics because of the lack of collaborative teamwork, an organization that did not enable nurse-led scheduled appointments and nurses' limited view of their own profession. Implications for nursing management Primary health care managers and policy-makers need to provide an environment that enables interprofessional collaboration so that nurses' skills can be used to advance patient services; such initiatives could enable district continence nurses to reach their full potential.

  • 5.
    Hägglund, Doris
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mooney, Tiffany
    Vårdcentralen Leksand.
    Momats, Emma
    Akutavdelning Mora lasarett.
    Nursing staff´s experiences of providing toilet assistance to elderly nursing home residents with urinary incontinence.2017In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 7, no 2, p. 145-157Article in journal (Refereed)
  • 6.
    Hägglund, Doris
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Olai, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home2017In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 2, p. 109-116Article in journal (Refereed)
    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.

  • 7.
    Hägglund, Doris
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Olai, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Möjliggörande och hindrande faktorer som påverkat införandet av förändringsarbetet Toa-rätten vid urininkontinens, inom särskilt boende i äldreomsorgen2016Conference paper (Other academic)
  • 8.
    Hägglund, Doris
    et al.
    Örebro universitet, Hälsoakademin.
    Wadensten, Barbro
    Örebro universitet, Hälsoakademin.
    Andersson, Catarina
    Örebro universitet, Hälsoakademin.
    Aflarenko, Margareta
    Örebro universitet, Hälsoakademin.
    Effekten av tranbärsjuice och personalutbildning i vårdhygien för att förebygga urinvägsinfektioner inom särskilt boende2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, no 2, p. 28-32Article in journal (Refereed)
    Abstract [en]

    Cranberry juice is often given to elderly persons in nursing homes to prevent urinary tract infections; still there is little evidence to support its use. Basic hygiene routines are important for preventing urinary tract infections. The aim of this study was to investigate whether cranberry juice and staff education in hygiene care can prevent symptomatic urinary tract infections among elderly persons living in nursing homes. A quasiexperimental study with three intervention groups and one control group was conducted involving 257 elderly women and men. A total of 48 symptomatic urinary tract infections were documented over the six months of the study: 21 (43.7%) in the cranberry group, 11 (22.9%) in the control group, 9 (18.7%) in the cranberry/hygiene care group and 7 (14.5%) in the hygiene care group. These between-group differences were not statistic significant. Hence, our study showed no preventive effect from cranberry juice, alone or in combination with staff education in hygiene care, on the incidence of symptomatic urinary tract infections. However, more and better research with larger randomised trials or cranberry capsules is needed to study its potential use to prevent urinary tract infections in elderly persons.

  • 9.
    Wadensten, Barbro
    et al.
    Örebro universitet, Hälsoakademin.
    Engholm, Rosa
    Örebro universitet, Hälsoakademin.
    Fahlström, Gunilla
    Örebro universitet, Hälsoakademin.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    Nursing staff's description of a good encounter in nursing homes2009In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 3, p. 203-210Article in journal (Refereed)
    Abstract [en]

    Background. It has been stated that there is too little research on what constitutes good communication and good encounters in nursing homes.

    Aim and objectives. The aim of the present study was to examine nursing staff members’ views on what is important in caring encounters with older people living in nursing homes.

    Design. A qualitative descriptive study using focus group interviews with staff in a nursing home in Sweden.

    Method. Focus group interviews, analysed using qualitative content analysis.

    Results. Three main themes emerged describing nursing staff members’ opinions about the content of good encounters: ‘Caring encounters from the perspective of equality’, ‘Caring encounters from the perspective of integrity’ and ‘Caring encounters from the perspective of promoting security’.

    Conclusions. The nursing staff had theoretical knowledge of what constitutes a good caring encounter, but they seemed to need more supervision and training to develop their ways of encountering older people as well as to become stronger in their professional role. When performing such training with staff, the methodology of appreciative inquiry could be a powerful tool.

    Relevance to clinical practice. It is important to help staff become empowered and to help them develop and improve their encounters with older care recipients.

  • 10.
    Wätterbjörk, Inger
    et al.
    School of Health and Medical Sciences, Örebro University, and Family Medicine Research Center, Örebro, Sweden.
    Häggström-Nordin, Elisabet
    epartment of Women's and Children's Health, Uppsala University, Uppsala, and School of Health, Care and Social Welfare, Mälardalen University, Sweden.
    Hägglund, Doris
    Family Medicine Research Center, Örebro, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Provider strategies for contraceptive counselling among Swedish midwives2011In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 19, no 5, p. 296-301Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that in contraceptive counselling the provider sets the agenda. The aim of this study was to describe how a group of Swedish nurse-midwives think and act in their role as contraceptive counsellors. Semi-structured questions were put to a convenience sample of 16 nurse-midwives. Data were analysed using qualitative content analysis. Five categories were identified: exploring the woman's situation; providing information about contraceptive methods; performing medical evaluation; guiding the decision-making process; and following up on the counselling. Results showed that the providers had developed their own strategies and suggest the use of interventions which combine counselling methods to provide information, with a theory for decision-making, to help in giving advice. This study could contribute to personal reflection on contraceptive counselling in practice, both for experienced counsellors and those new to the task

  • 11.
    Zakrisson, Ann-Britt
    et al.
    Örebro universitet, Hälsoakademin.
    Engfeldt, Peter
    Örebro universitet, Hälsoakademin.
    Hägglund, Doris
    Örebro universitet, Hälsoakademin.
    Odencrants, Sigrid
    Örebro universitet, Hälsoakademin.
    Hasselgren, Mikael
    Centre for Assessment of Medical Technology in Örebro, Sweden ; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for Assessment of Medical Technology in Örebro, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden.
    Theander, Kersti
    epartment of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Sweden ; Primary Care Research Unit, County Council in Värmland, Karlstad, Sweden ; Department of Nursing, Karlstad University, Sweden.
    Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial2011In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, p. 427-433Article in journal (Refereed)
    Abstract [en]

    AIM:To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD).

    METHOD:A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records.

    RESULTS:No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009).

    CONCLUSIONS:The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

  • 12.
    Zakrisson, Ann-Britt
    et al.
    Family Medicine Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hägglund, Doris
    Family Medicine Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The asthma/COPD nurses’ experience of educating patients with chronic obstructive pulmonary disease in primary health care2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 147-155Article in journal (Refereed)
    Abstract [en]

    The number of patients with chronic obstructive pulmonary disease (COPD) is increasing. These patients need nursing care, including education in self-care, which has a positive effect on their physical and psychoemotional well-being. The aim of this study was to describe the experiences of asthma/COPD nurses' in primary health care (PHC) of educating patients with COPD. A descriptive, qualitative study was conducted, with interviews of 12 asthma/COPD nurses. The data were analysed using qualitative content analysis. The findings are presented in two themes: Theme 1, receiving support results in a feeling of security, which enables the development of patient education; and Theme 2, a lack of support results in a feeling of insecurity, which makes it difficult to develop patient education. The asthma/COPD nurses were individual orientated with individualization of care, but the patient's mood, the varying support of those around and the nurses' varying degrees of security affected the education. The conclusion is that the asthma/COPD nurses' experience of patient education fluctuated between insecurity and security. The nurses' feeling of insecurity in their patient education can be strengthened through support from colleagues and by increased knowledge in promoting the learning of others. Collaborative teamwork with a well-functioning asthma/COPD clinic in PHC can facilitate and improve patient services; these initiatives can enable the asthma/COPD nurses to reach their full potential.

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