Nordic Journal of Nursing Research

Parkinson's disease is a chronical neurological disease. The prevalence of Parkinson's disease is increasing as a result of the increasing number of elderly. The aim of this study was to investigate in what way the Parkinson's disease affects the person's with the disease and their next-of-kin and how they handle their situation. The method used has a qualitative approach. Data has been collected from seven persons with Parkinson's disease and six next-of-kin. The present study showed the time before the diagnose, the time for the diagnose, the time after the diagnose, the situation today and in the future. The patients and their next-of-kin experiences were expressed as denying or accepting, fear or relief, negative or positive self-esteem, dependence or independence, anxiety or confidence. The study also showed that the length and the phase of the Parkinson's disease influenced both the persons with Parkinson's disease and their next-of-kin experiences of the situations. It is important to understand the experiences of the affects in order to be able to meet their needs.

To assess the prevalence of alcohol consumption among Norwegian nursing students, nursing students for the mentally disabled and teaching students (NNT students), a questionnaire was distributed to each of the 4761 freshman students who started their basic college education in 1997. 1923 replies from the NNT sample could be used, giving a response rate of 40.4%. 93% of the total sample have ever consumed alcohol. Nursing students consumed 4.1 units each week, the nursing students for the mentally disabled 6.8 and the teaching students 5.9 per. week. The mean consumption in one week was 8.1 units for men and 4.2 units for women. The nursing students have their first experience with alcohol when they are older compared to the nursing students for the mentally disabled and the teaching students; the difference is significant. NNT students, upon commencement of their career, will have important roles in preventing alcohol abuse and reshaping alcohol consumption. Many will also be considered role models. Since no such previous studies have been performed in the Nordic countries, registering a baseline will make possible comparisons with studies of other populations as well as be a reference point for follow up studies of the NNT population.

The intention with the article is to elucidate some pedagogical challenges by using a method that emphasize self-directed learning. The article is based on a descriptive study wherein the students' anticipations and experiences with such a method are charted. The students were in their last semester, and they should prepare for studies in the clinical area. In the study a qualitative interview is used, and the data source in the study consists of statements from 15 students. The study shows that contact with a clinical area is important for motivation. The students are positive regarding the method, experiences with the method and clinical area are experienced as useful. The results show also that the method entails challenges in regard to responsibility and participation from both teachers and students. In order to secure diciplinal quality a balance between direction and control in preparation for learning situations is demanded. These are pedagogical challenges which need further elaboration.

Pain is common among elderly. Very sick elderly persons living in nursing homes often have communication problems because of dementia or stroke, which causes problem to judge pain and evaluate effects of pain treatment. The aim of this study was to describe the prevalence, localisation and expressions of pain and to evaluate the usefulness of some pain assessment methods for nursing home residents. The study included 66 elderly living in a nursing home of which 49% had dementia as main medical diagnosis. A specially trained registered nurse (RN) performed pain assessment by • presenting a set of pain assessment tools • interpreting the nursing home residents' reactions during activity and • interviewing the resident about perceived pain. Two physiotherapists (PTs) performed physical examination including assessment of joint motion and palpation of joints and muscles. Contractures and ambulating status were noted. Cognitive Performance Scale (CPS) assessed cognitive capacity. When assisted by the RN 61% of the residents used independent or by assistance a verbal rating scale. The RN made an estimation of pain in all the nursing home residents and the PTs examined 92% of the residents. Pain was identified in 88% of the residents, 42% of the residents were treated with analgesics and pain was documented in the nurses' daily notes in 27% of the patient records. All residents with contractures had pain in the engaged joint. This study indicates that it is possible to assess pain by combining interview and interpretation of the residents' reactions during activity. Detection of pain by physical examination is a valuable complement especially for persons with decreased ability to communicate.

Adequate nutrition is crucial for frail and ill elderly. In Sweden, poor nutritional status among elderly in hospitals and in community care has been reported in mass media and study reports. A retrospective study of hospital records and community acts is here presented. Notes on nutrition of 94 patients (80 years>) during their last stay in acute somatic medical care were analysed. Also, community acts for those who had received home-care after discharge. Prospectively in addition, focusing the need for nutrition, one elderly person was observed and interviewed after discharge from hospital to community care in own home as a case study. Three questions were asked: 1) What was documented on nutritional needs during the acute medical care episode? 2) In case of home-care after discharge, what was documented on nutritional needs in community acts? 3) What actions for meeting demands for adequate nutrition is planned by community home-care services for an elderly client discharged from hospital to own home? In this sample notes on nutrition were made in 87 percent of the acute medical care patient records. In the community services acts, notes on nutrition were rare. In the case study, needs of high-energy food intake and psychological support during meals were not adequately planned for and met in home care. The conclusion is, that in order to undertake caring responsibilities for elderly, knowledge of nutritional needs, psychological and social support as well as documentation skills is necessary within all levels of care and important indicators of quality of care. At the community level, in plans for home care and in individual care of elderly clients, explicit and planned assessment must be made for nutritional needs and meal situation. Also, for the continuity of care between hospital and community care and evaluation.

The purpose with this study was to investigate how students relate their own experience and conceptions to their understanding of a written task. Recent research show that some crucial concepts that students have about different phenomena's are hard to change if the new information contradicts their previous views. The study is a case-study where the case consists of a written study-task, read and understood by tree female nurse students. These three students were observed and videotaped when thinking aloud about the task. The results indicate three assimilating approaches to the interpretation of the study-task: ‘illuminating, «verifying», and «comparative’. Only the «comparative» approach one observes that he/she is critical to the text being read — for instance by testing the information read against own experience and conceptions and reverse. In the other two approaches the students use more of their own experience in order to confirm that what they already know. They are less critical to the content of the task.

When introduction to life becomes an introduction to death This article focuses on how midwifes experience the situation when babies die in connection with birth. There is little research and litterature to be found within this field. The objective of this descriptive study, which is based on in-depth inter-viewes with six midwifes working at a large hospital, is to describe what midwifes find to be difficult when facing stillbirth. The midwifes participating in this study categorise stillbirth both as expected and unexpected stillbirth. The respondents where uncertain as how to balance between closeness and distancing to the parents. Some of the midwifes try to do whatever feels right, but they do not discuss these situations with colleagues. Neither do they discuss what reactions can be expected in midwifes when faced with stillborn babies and their parentes. Almost all of the respondents find it hard to face these situations. The respondents miss formal channels for receiving help in dealing with their own reaction to what has happened, and for discussing thoughts and problems. The midwifes found it difficult to give meaning to the experiences concerning stillbirth, both for themselves and for the parents.

The aim of this article is to describe the role of the researcher in getting objective and valid data in ethnographic fieldwork in a foreign culture. The paper is based on an ethnographic research project, which dealt the cultural care among the Bena in the village of Ilembula in Tanzania. Cultural care refers to culturally learned activities aiming at assisting, supporting, facilitating or enabling the improvement of health condition. The data were collected through interviews, participant observation and personal working diaries. Sixty-one villagers were interviewed. The data was analyzed by inductive qualitative content analysis method. The article shows how significant for the researcher it is to build up the relationship with the key persons of the community in order to become accepted and find informants, who are capable to explain cultural beliefs and practices. Language barrier and the role of the research assistants are in focus when evaluating relevance of the data collection. The researcher has to be aware of her background and reflect her experience, feelings, thoughts and ideas throughout the fieldwork The final conclusion is that in cultural encounter the researcher is able to learn about other cultures to one degree or another. The purpose of the article is to encourage nurse researchers to cross cultural barriers.

Within the concept of PBL (Problem Based Learning,) which is the idea of pedagogy in The Faculty of Health Sciences in Linköping, integration of theory and practise is seen as prerequisite for the learning process. A project involving tutorial groups has been carried out in The Nursing Programme with the aim of integrating theoretical and clinical studies. These tutorial groups were made up of students and their clinical preceptors and a teacher from the programme acted as tutor. The aim of the project was to integrate theoretical and clinical studies at a higher education level in the practical part of the training. The tutorial group met once a week for a period of seven weeks. The work of the tutorial group had as its starting-point the result of an assessment made by one of the students, and the subsequent work was based on the problem- solving process. The resources of the clinic and the patient yielded useful information. Evaluation of group activities showed that all of the students as well as the preceptors reached the conclusion that tutorial groups should be included in clinical studies. Integrated tutorial groups create during clinical studies a basis for critical reflection regarding nursing care. The coming together of clinically active nurses, students and teachers creates the conditions for activity at a higher education level and leads to greater understanding of the various professional skill aeras.