Logo: to the web site of the Swedish Defence University

Nursing staff identified postoperative urinary tract infection (UTI) in patients with hip fracture as an increasing problem. A quality improvement project was carried out to investigate the problem and to reduce the incidence. The aim of the study was to describe the occurrence of UTI among patients with hip fracture before and after surgery, to assess whether the decision to use intermittent catheters instead of indwelling catheters was adopted and to test the hypothesis that hospital stay is significantly longer for patients with UTI than for those without infection. One hundred and forty-four patients were investigated for bacteriuria before the first catheterization and 1 week after the last catheterization. Positive urine cultures on admission to hospital were found in 38% of patients. Among those free from bacteria on admission, 61% had a positive urine culture after indwelling catheterization compared with 32% in the group treated with intermittent catetherization. A significantly longer hospital stay (P less than or equal to 0.05) was found among patients with UTI. The reason for using an indwelling catheter was not found in any medical or nursing documentation for 29% of the patients. The study points to the necessity for systematic assessment to detect and prevent UTI among older patients with hip fracture.

Aim.

To develop a patient questionnaire specific to intrapartal care, based on the theoretical foundation of the general instrument Quality from the Patient's Perspective (QPP).

Background.

Existing general patient questionnaires do not take intrapartal care aspects fully into account, and available intrapartal-specific patient questionnaires tend to have a weak theoretical foundation.

Design.

A cross-sectional, nationwide study carried out during a two-week period in 2007 at Swedish maternity units.

Method.

An intrapartal-specific QPP-questionnaire (QPP-I) was developed by combining a selection of 22 items from the short and long versions of the QPP with 10 newly constructed items. Responses were obtained from 739 women (63% response rate). The dimensionality of the QPP-I was assessed using structural equation modelling (a nested factor model). Non-parametric statistics were used for subgroup comparisons.

Results.

A nested model with a general factor including all 32 items and 10 subordinate factors was developed. Most scales had acceptable reliability coefficients (0 center dot 73-0 center dot 93), and a meaningful pattern of subgroup differences was obtained.

Conclusions.

The QPP-I is theory based and has its roots in a patient perspective. It was developed using a nationwide sample of Swedish women receiving intrapartal care, and an advanced statistical method was used. The outcome of this initial empirical trial was promising but needs to be tested in different countries and cultures.

Relevance to clinical practice.

By combining womens' responses on perceived reality and subjective importance ascribed to the various aspects of care measured, the QPP-I offers the care provider better guidelines on which elements to focus quality improvement work on, than would be the case if only a rank order of perceived reality ratings was available.

• Patients' views on the quality of care are important and it is desirable that these can be assessed using short, yet valid and reliable instruments.

• The aim of the work reported here was to develop and test a short version of an established questionnaire: Quality from the Patient's Perspective (QPP).

• Patients (n=162, 79% response rate) receiving care at medical and surgical departments in two Swedish hospitals responded to the original QPP as well as to a newly developed short version. An ethical research committee approved the study.

• Pearson correlations were computed between the long and short forms and differences between means were analysed with t-tests. Reliability was estimated by computing Cronbach alpha coefficients.

• Correlations of acceptable size were found between the short form and the original QPP. The short form also had acceptable reliability coefficients.

• The strengths of the work are that the items in the short version are derived from a patient perspective and are formulated in words used by patients; the items still have a theoretical foundation, which makes the interpretation of results more meaningful; global formulations such as `What do you think about your care?' have been avoided; the short format should make the questionnaire more attractive for many patients to respond to.

• Limitations are that results indicate that the short form does not fully measure what the long form does. Therefore, when the short form is used in practice, a two-step procedure is suggested, where a follow-up is done with a selection of items from the original long form. This selection could be restricted to areas where problems may be suspected, based on the results from the short form.

Background.  Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients’ opinions congruent with those of family members?

Aim.  To explore and compare the relationship between patients’ perception of the quality of care and close family members’ perception of this care as well as their perception of the patients’ perception.

Methods.  Sixty-seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care.

Results.  A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members’ own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern.

Conclusion.  Patients’ views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care-related experiences. The results can be understood in the light of empathic accuracy theory.

Relevance to clinical practice.  The findings of this study have important implications for clinical nursing practice. Family members’ perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care-related experiences, otherwise family members’ perception tend to be more critical than those of the patients themselves.

Aim. The aim was to explore the relationships between the feelings of women who give birth and several birth-related care conditions, the womens' socio-demographic background, personality and perceptions of the quality of intrapartum care. Background. Childbirth is a highly significant emotional event for women and it is an explicit goal that each woman should have a positive childbirth experience. Design. The nationwide study is cross-sectional and was conducted at Swedish maternity units over two months in 2007. Methods. The study group consisted of 739 women (63% response rate). A dimensionality analysis of six emotion items was performed using structural equation modelling (SEM). Non-parametric tests and generalised linear mixed effects model analyses were used to study relationships and to make subgroup comparisons. Results. In the SEM analysis, a positive and a negative feeling factor were identified. Strong associations between the feeling factors and the womens' perceptions of the quality of care were found, particularly in regard to the so-called identity-oriented approach of the midwives and other health professionals. In addition, a higher intensity of negative feelings was associated with a personality pattern characterised by extraversion, emotional instability and lower degree of conscientiousness, a lower level of education and having had delivery through Caesarean section. Conclusions. The positive and negative feelings of women who give birth strongly covary with the women's perception of the quality of their intrapartum care. This pertains in particular to information issues, the midwives showing commitment, empathy and respect, being present during labour and allowing the women to actively participate as much as they want to. Relevance to clinical practice. Subgroup differences indicate that midwives should pay increased attention to childbearing women who have primary school education only, a lower emotional stability and/or deliver through Caesarean section.