Virpi Hantikainen

Although fatigue affects over 75% of patients with advanced cancer, changes over time in symptoms and antecedents have not been described in the acute care setting. To determine the prevalence, in patients with advanced cancer, of fatigue and anaemia on admission, describe strategies used to treat anaemia, observe changes in fatigue over ten days, and determine factors associated with fatigue. Prospective, observational study. In two Swiss tertiary care hospitals, a convenience sample of patients (N=103) was recruited at admission and followed up at days six (n=76) and ten (n=53). Patients were admitted because of new and/or worsening symptoms, deteriorating health status, or complications. They received measures aimed at symptom control and disease modifying interventions. Clinical and sociodemographic data were collected on selected patients who were able to complete a test battery of validated measures. Assessment was undertaken on hospital admission and on days six and ten post-...

This study is the first part of a larger research project concerned with disruptive behaviour and the use of physical restraints on elderly nursing home residents. This paper is focused on the types and prevalence of disruptive behaviour among elderly residents, nurses' experiences and the types of nursing interventions employed. Data was collected from nurses of varying qualifications (n = 173) in seven Swiss nursing homes by using a questionnaire. The most frequent behavioural problems reported by nurses were mobility, incontinence, getting dressed, verbal communication, passivity, withdrawal and continual requests. Nurses found physical aggression, continual shouting and verbal abuse the most difficult to manage with. The results also indicated that experiences varied between nurses. In particular, nursing staff always considered disruptive behaviour more disruptive against other residents rather then against themselves. The most frequently used interventions against disrupti...

Care for cancer patients is often provided by family caregivers. The terminal care period is usually associated with restricted mobility. The aim of this literature review is to analyse the needs of caregivers concerning mobility support and encouragement in everyday care of a cancer patient at the end of life. Relevant articles were identified via electronic database searches in Cochrane, PubMed, PsychINFO, ERIC, and CINAHL. Studies examining needs concerning mobility support and encouragement for terminal cancer care provided by family caregivers at home, published in English or German, have been included. The methodological quality of the included studies was assessed by two authors. A total of eleven studies with various designs have been included. The results show a need for information, guidance and support regarding mobility in two areas: i) activities of daily living including personal hygiene and ii) usage of equipment including transport. The literature review indicates th...

The aim of this study was to identify and describe the existing observation instruments that are used to assess nurses' skills in patient mobilisation and to evaluate the psychometric properties of the included instruments. Structured knowledge about instruments for assessing nurses' skills in patient mobilisation is limited. Systematic review. Studies were identified via electronic database searches and reference lists and were included based on the eligibility criteria. Data regarding the type of instrument, the number of items/domains and the psychometric properties of the instruments were extracted, and the quality of the instruments were appraised according to Zwakhalen et al.'s (BMC Geriatrics, 2006) proposed criteria. A total of 26 studies, reporting on 16 instruments, were included in this review. The instruments differed in terms of: (1) type of patient-mobilisation task, (2) focus of the instrument, (3) level of structure and (4) use by the observer. Most of the instruments were developed and used in evaluation studies that measured nurses' mobilisation techniques as an outcome of an educational intervention. The total quality score of the included instruments varied between 6-11 points out of a maximum quality score of 19. Although patient mobilisation is part of nurses' everyday work, we suggest from the results of this review that no common consensus exists about the best way to perform patient-mobilisation tasks. The results from this study further show that no instrument measured all of the important aspects of effective patient mobilisation. Most of the instruments that were reviewed were able to detect differences in patient-mobilisation techniques. However, convincing evidence is lacking with regard to the content, psychometric properties and practicability of these instruments for use in clinical practice. We suggest the development and validation of a new comprehensive instrument.

Im Rahmen eines multiprofessionellen Qualitätsmanagement- und Forschungsprojektes wird im Zeitraum von November 2009 bis Dezember 2012 am Kantonsspital Aarau unter Beteiligung nachsorgender Institutionen die interdisziplinäre OPTIMA-Studie durchgeführt. OPTIMA steht für „Optimierter Patienten-Transfer durch innovatives multidisziplinäres Assessment“. Ziel der Studie ist neben der Optimierung von Patientenpfaden die Gewährleistung einer patientenzentrierten und gleichzeitig kosteneffizienten Behandlung und Betreuung hinsichtlich der bevorstehenden Einführung von Fallpauschalen (DRG) in der Schweiz in 2012.

Patient and visitor violence (PVV) is the most dangerous occupational hazard that health professionals must contend with. Staff training is recommended to prevent and manage PVV. There is minimal research focusing on risk factors associated with PVV in general hospital settings. Therefore, staff training is mostly based upon expert knowledge and knowledge from psychiatric and emergency settings. This study investigates health professionals' experiences with PVV in order to describe risk factors related to PVV that occur in general hospital settings. A retrospective cross-sectional survey was conducted in 2007. A university general hospital in Switzerland. 2495 out of 4845 health professionals participated (58.0% nurses & midwives, 19.2% medical doctors, 3.6% physical therapists, occupational therapists & nutritionists, 6.1% ward secretaries, medical & radiology assistants, 6.3% nursing assistants or less qualified nursing staff and 5.1% other staff). All had direct patient conta...

Prevalence of symptoms, with a focus on fatigue, and changes of symptoms were explored over three months in outpatients with lymphoma, lung, breast or colorectal cancer, receiving chemotherapy in the oncology outpatient clinic of a Swiss tertiary care hospital. Prospective, descriptive design; symptom prevalence was measured at start of chemotherapy (T1), and one week prior to the third and fourth cycle (T2, T3). Included were patients starting chemotherapy, with expected survival of >3 months, irrespective of stage of disease. The Memorial Symptom Assessment Scale was used to assess 32 symptoms; fatigue was measured with the FACIT-Fatigue Scale (negative scale). Data were analysed using descriptive statistics and random-intercept regression models. 77 patients participated at T1, 58 and 50 at T2 and T3. Patients experienced on average 9.8, 14.4, and 13.7 symptoms, showing a significant increase over time. Lack of energy and feeling drowsy were most frequent. Symptom scores for lack of energy, changes in skin, pain, and feeling drowsy remained >2 over time (scale 0-4, higher scores = more symptoms). Fatigue mean scores were 36.3, 30.2, and 31.3, showing a significant increase of fatigue over time. Individual symptom trajectories varied widely within and among patients. High symptom prevalence at start of chemotherapy as well as over time and great variability in symptom experience call for an individual, systematic symptom assessment and management that does not focus solely on side-effects of therapy but includes disease-related symptoms to achieve satisfactory control of symptoms in outpatients receiving chemotherapy.

Supporting the movement of older people is one among the daily duties of geriatric nurses. Nurses exhibit a high risk of developing musculoskeletal disorders. Nurses should also possess interaction skills to support active participation of older people in their own daily activities. Kinaesthetics movement competence training claims to be a recommendable approach that benefits both nurses and nursing home residents. However, implementing Kinaesthetics into daily practice is a challenging process. This study aimed to examine nurses' experiences with regard to the implementation of Kinaesthetics movement competence training into a nursing home. Qualitative descriptive design with focus groups' interviews. Thirty-two (three men) geriatric nurses from a Swiss nursing home who participated first time in Kinaesthetics training were interviewed in three focus groups (average 79 minutes). Interviews were analysed using inductive coding, categorisation and abstraction. The ethics committees of the cantons Basel-Stadt and Basel-Land (Switzerland) approved the study on 16 September 2010 (reference no. 224/10). Nurses' experiences with the implementation of Kinaesthetics were divided into two categories: nurses' attitudes with regard to the implementation of Kinaesthetics and nurses experience of Kinaesthetics with regard to integration into daily practice. Even though the participants showed a positive attitude towards the design and structure of the Kinaesthetics training, its implementation into daily practice initially posed a noticeable challenge for the participating nurses. The results indicate that various factors exist that may either promote or impede the implementation of Kinaesthetics in nursing. The successful implementation of Kinaesthetics can be promoted by the structural integration of the concept at various levels of nursing home as well as complementary supporting measures. Regular professional support and education after Kinaesthetics training appears to be a necessary approach to sustainably implement the concepts into daily nursing practice.

This prospective study described symptom prevalence and changes of symptoms over ten days in patients with advanced cancer admitted to two Swiss tertiary care hospitals because of symptoms, deterioration of health status, or complications. Prevalence, frequency, severity of and distress from 31 symptoms were assessed repeatedly with the Memorial Symptom Assessment Scale in 103 patients at admission, and on day six (n = 76) and ten (n = 53) of the hospital stay. Repeated measures regression models were used for analysis. The mean number of symptoms experienced was 13.0 (SD = 6.1) at admission, 9.7 (SD = 5.4) on day six, 9.3 (SD = 4.9) on day ten. Lack of energy was most prevalent (82% of patients) and most frequent, pain was most severe and distressing; symptom scores of all but 4 symptoms (weight loss, "I don't look like myself," vomiting, itching) were >2 on a scale from 0 to 4. Over time, the average number of symptoms decreased significantly for the whole group (P < .0001) and for patients discharged after day six (P = .006), but not for patients dropping out after day six due to worsening health status (P = .78). Individual trajectories showed that symptom prevalence varied greatly within and among patients. High symptom prevalence at admission, identification of areas in symptom management with the potential for improvement, and wide variability in symptom prevalence among patients call for comprehensive symptom assessment and individual treatment, especially in patients with a worsening health status.