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By telephoning a healthcare call centre, individuals in Sweden can consult a nurse to discuss medical problems and health care accessibility, and to receive professional information on how to find their way about the health care system. The aim of the study was to identify problems, difficulties and disadvantages that telephone nurses with varying degrees of experience had met during their professional careers. The Delphi technique was used with three sets of questionnaires. Twenty-five nurses with varying experience of working with telephone advice from six 24-hours call centres participated in the study. The response rate was 100%. An open-ended question generated 154 statements. Comments were categorized into 24 different problem categories. Ten problem categories were mainly related to the nurse perspective, i.e. the problems experienced were associated with the qualities of the nurse, eight principally to the patient perspective, i.e. problems associated with caller characteristics and six mostly to the organizational perspective, i.e. problems linked to the organization of the national health service. 'Lack of health care resources' was rated as the biggest problem, 'second-hand consultations' as the second and 'always making a decision' as the third biggest problem. Decision-making seems to be the core of telephone advice nursing and problems related to the nurses, patients and organization seem to influence the telephone nurses' working situation. Training should focus on active listening and handling social conflicts.

This study aimed to evaluate the longitudinal effects of a nursing-documentation intervention on the quantity and quality of the nursing documentation in a sample of patient records at a university hospital in Stockholm, Sweden. In this quasi-experimental longitudinal study, two hospital wards participated in a 2-year intervention and a third ward was used for comparison. The intervention consisted of organizational changes and education regarding nursing documentation in accordance with the VIPS model, a model designed to structure nursing documentation. To evaluate the effect, patient records were audited at three different time points: before the intervention, directly after the intervention and 3 years after the intervention. A total of 269 patient records were used. The findings showed a significant score increase in quantity as well as in quality of the nursing documentation, in the intervention wards directly after the intervention, as compared with those from the comparison ward. The results suggests that a comprehensive intervention based on the VIPS model and including organizational support for registered nurses (RN) may improve nursing documentation in an acute care hospital setting.

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Objective The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A 1c), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Research design and methods Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A 1c measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Results Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, selfmonitoring) were significantly associated with FOH but R 2 increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetesrelated anxiety, hypoglycemia history, self-monitoring, and glycemic control. Conclusion There is a strong link between FOH and nondiabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions. Keywords Type 1 diabetes Á Hypoglycemia Á Fear of hypoglycemia Á Severe hypoglycemia Á Psychological factors It is well known that depression and anxiety are more prevalent in patients with type 1 diabetes compared to subject without diabetes [1-3] and that psychological Managed by Antonio Secchi.

This study identifies the frequency of severe hypoglycaemia as the most important factor associated with fear of hypoglycaemia. Moreover, for the first time, we document gender differences in fear of hypoglycaemia, suggesting that females are more affected by fear of hypoglycaemia than men.

Objectives-To develop, validate, and test the reliability of an audit instrument that measures the extent to which patient records describe important aspects of nursing care. Material-Twenty records from each of three hospital wards were collected and audited. The auditors were registered nurses with a knowledge of nursing documentation in accordance with the VIPS model-a model designed to structure nursing documentation. (VIPS is an acronym formed from the Swedish words for wellbeing, integrity, prevention, and security.) Methods-An audit instrument was developed by determining specific criteria to be met. The audit questions were aimed at revealing the content of the patient for nursing assessment, nursing diagnosis, planned interventions, and outcome. Each of the 60 records was reviewed by the three auditors independently and the reliability of the instrument was tested by calculating the inter-rater reliability coeYcient. Content validity was tested by using an expert panel and calculating the content validity ratio. The criterion related validity was estimated by the correlation between the score of the Cat-ch-Ing instrument and the score of an earlier developed and used audit instrument. The results were then tested by using Pearson's correlation coeYcient. The patient record is a principal source of information in which the nursing documentation of patient care is an essential part. Traditionally, nurses have written down their performance of the medical interventions or observations ordered by the physician. The rationale behind this was to show that the instructions had been adhered to and to inform other nurses or physicians. Results-TheRecently, the nursing profession has moved towards a more independent practice with a clear recognition of nursing care. With increasing recognition of these nursing components the documentation of nursing care must include not only timely and accurate recording of the performed interventions-medical and nursing-but also the decision process, explaining and evaluating why a specific nursing action was chosen.In 1967, Yura and Walsh first described the nursing process model (fig 1) as a structured, problem solving approach to nursing practice and its evaluation.1 This process originally contained four steps: assessment, planning, implementation, and evaluation. In a later version, the nursing diagnosis was included. The nursing process model is a central and widely accepted concept, 2 both for nursing practice and documentation. The nursing process model is based on the scientific approach of investigation and goal oriented action. The primary purpose of the model is to relate individualised nursing care to the individual patient rather than generalised care based on routines.The nursing care plan is an essential tool in the delivery of modern nursing care. The care plan is a document containing the three nuclear parts of the nursing process model: a nursing diagnosis, describing the problem or need; the aim of the nursing care; and the interventions that have be...

We suggest that the "qualities" identified by the study findings should be implemented in clinical care, and could facilitate active guidance and counseling for bereaved parents who have experienced a stillbirth.