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  • 1.
    Lagerin, Annica
    et al.
    Karolinska institutet.
    Carlsson, Axel C
    Karolinska institutet, Uppsala universitet.
    Nilsson, Gunnar
    Karolinska institutet.
    Westman, Jeanette
    Karolinska institutet.
    Törnkvist, Lena
    Karolinska institutet.
    District nurses' preventive home visits to 75-year-olds: an opportunity to identify factors related to unsafe medication management.2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 8, p. 786-794Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate factors related to unsafe medication management among 75-year-olds during preventive home visits, and to describe the interventions district nurses used.

    METHODS: An explorative study. During a 9- to 12-month period, 36 DNs used the Safe Medication Assessment (SMA) tool during preventive home visits to 75-year-olds who used at least one drug (n=113).

    RESULTS: One or more factors related to unsafe medication management were identified in 84% of the 75-year-olds. More than 40% used five or more drugs, and 34.5% reported symptoms potentially indicative of adverse effects of their drugs. Nearly 30% had prescribers from more than two medical units, and 7.1% of the older persons were appraised as having reduced cognitive ability. DNs intervened in more than two-thirds of the cases and used a variety of nursing care interventions to improve the safety of medication management.

    CONCLUSIONS: Preventive home visits seem to provide a unique opportunity to promote safe medication management. Several factors related to unsafe medication management were identified, and several different nursing care interventions were carried out to ensure safe medication management. Use of the SMA tool in preventive home visits seems to be advantageous in improving the safety of medication management among older persons.

  • 2.
    Lagerin, Annica
    et al.
    Karolinska institutet.
    Hylander, Ingrid
    Karolinska institutet.
    Törnkvist, Lena
    Karolinska institutet.
    District nurses' experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study.2017In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, no 1, article id 1355213Article in journal (Refereed)
    Abstract [en]

    This qualitative study used the grounded theory method to investigate district nurses' experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centres in Stockholm, Sweden. Group interviews were conducted with 30 nurses. The results describe how district nurses strive to stay on track in order to follow clinical guidelines and remain motivated despite prolonged wound treatment and feelings of hopelessness. Three main obstacles to following the guidelines were found. District nurses used compensating strategies so the obstacles would not lead to negative consequences. If the compensating strategies were insufficient, perceived prolonged wound treatment and feelings of hopelessness could result. District nurses then used motivating strategies to overcome these feelings of hopelessness. Sometimes, despite the motivating strategies, treatment in accordance with guidelines could not be achieved. With some patients, district nurses had to compromise and follow the guidelines as far as possible.

  • 3.
    Lagerin, Annica
    et al.
    Karolinska institutet.
    Nilsson, G
    Karolinska institutet.
    Törnkvist, L
    Karolinska institutet.
    An educational intervention for district nurses: use of electronic records in leg ulcer management.2007In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 16, no 1, p. 29-32Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate district nurses' management of leg ulcer patients and the effects of an in-service education programme led by district nurses as local educators at primary health-care centres.

    METHOD: Data were collected from electronic patient records (EPRs), both before and after the educational intervention. Nineteen district nurses undertook a one-day course focusing on four themes: Doppler assessment and measurement of ankle brachial pressure index; compression treatment; patient education; nursing documentation. Fourteen acted as in-service educators; 12 educators completed the intervention. The EPRs were scrutinised with an audit tool.

    RESULTS: The documentation on the selected key areas for the management of patients with leg ulcers was generally sparse, although the educational intervention resulted in statistically significant effects on documentation in three areas.

    CONCLUSION: Further improvements in care are necessary, as are qualitative and quantitative studies to explore the large discrepancies between guidelines and everyday clinical practice in this field.

  • 4.
    Lagerin, Annica
    et al.
    Karolinska institutet.
    Törnkvist, Lena
    Karolinska institutet.
    Hylander, Ingrid
    Karolinska institutet.
    District nurses' experiences of preventive home visits to 75-year-olds in Stockholm: a qualitative study.2016In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 17, no 5, p. 464-78Article in journal (Refereed)
    Abstract [en]

    UNLABELLED: Aims This study had two aims: to describe the dialogue between district nurses (DNs) and older people in preventive home visits (PHVs) from the perspective of the DNs, and to identify barriers to and facilitators of this dialogue as perceived by the DNs.

    BACKGROUND: The number of older people is rapidly increasing in all western countries, and as people's age increases, the probability that they will have multiple diseases also increases. Planned actions are therefore needed to promote health and prevent diseases among older people so they can remain in good health and live in their homes for as long as possible. In Sweden, PHVs to 75-year-olds by DNs are one such action.

    METHODS: This qualitative study included five group interviews with 20 DNs. Data were analysed with qualitative content analysis. Findings DNs' experiences of barriers to and facilitators of a successful health dialogue were sorted into five domains. Together, these domains provided a systematic description of the interaction between the DN and the older person in the PHV. The domains included: establishing trustful contact, conducting a structured interview, making an overall assessment, proposing health-promoting activities and offering follow-up. The barriers and facilitators could be related to the older person, the DN or the home environment. The latent content of the interviews was evident in three themes that were related to the DNs' experiences of barriers and facilitators. These themes illustrated professional dilemmas that the DNs had to resolve to achieve the purpose of the PHV. The study demonstrates that the interaction between a DN and an older person in a PHV can be described as a complex social process in which the DN balances a personal and professional approach, combines a person-oriented and a task-oriented approach and employs both a salutogenic and pathogenic perspective.

  • 5.
    Lagerin, Annica
    et al.
    Karolinska institutet, Stockholm läns landsting.
    Törnkvist, Lena
    Karolinska institutet, Stockholm läns landsting.
    Nilsson, Gunnar
    Karolinska institutet, Stockholm läns landsting.
    Johnell, Kristina
    Karolinska institutet, Stockholms universitet.
    Fastbom, Johan
    Karolinska institutet, Stockholms universitet.
    Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study.2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494817744101Article in journal (Refereed)
    Abstract [en]

    AIMS: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups.

    METHODS: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare.

    RESULTS: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs.

    CONCLUSIONS: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.

1 - 5 of 5
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