Units In Denmark Research Articles

Healing architecture and Snoezelen in delivery room design: a qualitative study of women\u2019s birth experiences and patient-centeredness of care

BackgroundThe physical place and environment has a profound influence on experiences, health and wellbeing of birthing women. An alternatively designed delivery room, inspired by the principles of healing architecture and Snoezelen, was established in the Regional Hospital in Herning, Denmark. These principles provided knowledge of how building and interior design affects the senses, including users’ pain experience and stress levels. The aim of the study was to explore women’s experience of the environment and its ability to support the concept of patient-centeredness in the care of birthing women.MethodsApplying a hermeneutical-phenomenological methodology, fourteen semi-structured interviews with low-risk women giving birth in an alternative delivery room at an obstetric unit in Denmark were undertaken 3–7 weeks after birth.ResultsOverall, women’s experiences of given birth in the alternative delivery room were positive. Our analysis suggests that the environment was well adapted to the women’s needs, as it offered a stress- and anxiety-reducing transition to the hospital setting, at the same time as it helped them obtain physical comfort. The environment also signaled respect for the family’s needs as it supported physical and emotional interaction between the woman and her partner and helped relieve her concern for the partner’s well-being. The psychosocial support provided by the midwives appeared inseparable from the alternative delivery room, as both affected, amplified, and occasionally restricted the women’s experience of the physical environment.ConclusionOur findings support the use of principles of healing architecture and Snoezelen in birth environments and add to the evidence on how the physical design of hospital environments influence on both social and physical aspects of the well-being of patients. The environment appeared to encompass several dimensions of the concept of patient-centered care.

Parents' experiences of early discharge after a planned caesarean section: A qualitative interpretive study

ObjectiveThe birth rate in Denmark is increasing, and the rate of births by caesarean section has increased to more than 20%. Thus, the obstetric departments have been put under pressure to identify new solutions to optimize the maternity care system, in which early discharge might be considered. The aim of this study was to explore parents' experiences of the postnatal care after planned caesarean section with focus on factors that support or hinder early discharge. DesignAn interpretive, hermeneutic approach was chosen, using qualitative interviews with multiparous women and their partners. Data analysis was performed using thematic analysis. Participants and settingTwelve women and partners were recruited from two hospital-based maternity units in Denmark. The inclusion criteria were low-risk Danish-speaking multiparous women having a planned caesarean section with a singleton pregnancy (gestational age between 37+0 and 41+6 weeks). Seven sets of parents were discharged before 28 h and five were discharged after 48 h. FindingsThree main themes were identified as important for timing of discharge: (1) Setting for recovery (2) Views on length of stay, and (3) Preparation and individual planning. All parents valued the safe and supportive environment at the hospital, but several preferred early discharge as they felt more comfortable in their home environment and wanted to be together as a family with all siblings. When considering appropriate time of discharge, the main issues were that pain was manageable, that breastfeeding was initiated successfully and that professional support was available after discharge. Finally, early discharge required preparation and planning and the parents stressed the importance of knowing that they would not be discharged unless they felt ready. Conclusion and implication for practiceA clear link was observed between the care package the parents received and their views on the optimal time of discharge. Based on our findings it seems likely that a significant proportion of parents will accept and feel confident about early discharge if individual circumstances are taken into account in the antenatal planning of a caesarean section.

Risk of comorbidities in patients diagnosed with chronic urticaria: A nationwide registry-study

BackgroundThe autoimmune profile of Chronic Urticaria (CU) patients is an increasing topic of interest. Associated diseases suggest shared pathogenic pathways, and they may provide important knowledge on specific targets for future treatment models. In this study we examined the prevalence and risk of comorbidities in CU. MethodsThe Danish National Patient Registry was used to identify all CU patients from 1994 to 2015. Five of 5 specialized dermatological units in Denmark were covered. Analyses were conducted as a nested case control study and a matched cohort study. CSU patients were matched 1:10 on age and sex to an otherwise random group of people from the background population. ResultsA total of 12,185 CU patients were identified, with an overweight of female cases (69% versus 32%). There was an overrepresentation of mast cell mediated diseases including mastocytosis and anaphylaxis, as well as atopic diseases including type 1 allergies and atopic dermatitis. The prevalence of rheumatoid arthritis, systemic lupus erythematosus, thyroiditis and vitiligo was also increased, as was the prevalence of depression. CU patients who did not have any of the co-morbidities at the time of their CU diagnosis had an increased risk of developing both mast cell mediated diseases, atopic diseases, and autoimmune diseases excluding thyroiditis and diabetes. ConclusionThe autoimmune profile of the comorbidities of CU was demonstrated with an evident risk of developing rheumatoid arthritis. CU patients were also at increased risk of either having or achieving depression. Mast cell related diseases seemed to be overrepresented, although registry data within this disease category are questionable and similar to symptoms of CU to the untrained eye. Thus, CU patients constitute a multimorbid group of patients, which must be recognized among treating physicians.

Staphylococcus aureus Bacteremia Risk in Hemodialysis Patients Using the Buttonhole Cannulation Technique: A Prospective Multicenter Study

Rationale & ObjectiveArteriovenous fistulas are the preferred access type for hemodialysis. The buttonhole needling technique has become an alternative to stepladder or area puncture. However, an increased risk for infection has been described. The present study examined the risk for infectious complications with different needling techniques.Study DesignProspective multicenter observational cohort study with 5 years of follow-up.Setting & ParticipantsIn-center hemodialysis patients from 5 hemodialysis units in Denmark, dialyzed on a native arteriovenous fistula. 286 patients were included; 144 cannulated with the buttonhole technique.ExposureThe buttonhole cannulation technique was compared to the stepladder or area puncture technique.OutcomesPrimary end points: event rates of access-related Staphylococcus aureus bacteremia and the HR for first access-related S aureus bacteremia. Secondary end points: local infections and access-related S aureus bacteremia–related metastatic infections and mortality.Analytical ApproachTime-to-event analysis using Cox proportional hazards regression to estimate the HR of access-related S aureus bacteremia in buttonhole cannulation compared to stepladder/area puncture. Poisson regression was used for incidence rate ratio calculations.ResultsS aureus caused 48 access-related bacteremias; 43 (90%) in the buttonhole group compared with 5 (10%) in the stepladder/area group. The HR for first access-related S aureus bacteremia was significantly higher for buttonhole cannulation compared to stepladder/area needling (unadjusted, 6.8 [95% CI, 2.4-19.1]; adjusted, 8.4 [95% CI, 2.9-24.2]). The incidence rate ratio for access-related S aureus bacteremia was 6.8 (95% CI, 2.9-16.1), and the incidence rate ratio of local cannulation-site infection without access-related S aureus bacteremia was 3.8 (95% CI, 1.3-15.4) for buttonhole cannulation compared to stepladder/area needling.LimitationsNonrandomized observational design, prevalent hemodialysis patients.ConclusionsAccess-related S aureus bacteremia rates were very high for buttonhole cannulation compared to stepladder/area needling, questioning the use of buttonhole cannulation in routine clinical practice. A restrictive approach to buttonhole use is recommended, with buttonhole cannulation only being used as a second alternative to area technique when stepladder cannulation is not feasible.

Distributed water erosion modelling at fine spatial resolution across Denmark

Water erosion on agricultural land and sediment delivery to streams are a major threat to soil productivity and surface water quality. Climate change and different national and international societal drivers now require Denmark to take action to protect soil and water resources. In this study, we adapted the spatially distributed sediment transport model WaTEM using the best data available at national scale. To calibrate and validate the model, sediment yield data from 31 catchments and 189 slope units in Denmark were compared with the model output, which was produced at a fine spatial resolution of 10 × 10 m.Residual analysis and cross-validation were used to identify potential catchment outliers and assess model robustness. We obtained a median Nash & Sutcliffe model efficiency range of 0.06–0.6 for the Danish environment. Based on the equifinality concept, an ensemble of 100, NSE-weighted model realisations for acceptable transport capacity coefficients was used to assess model uncertainty. The comparison between rill survey data and predicted values indicates that although the model captures well the spatial variability in erosion, it may underestimate the long-term average of soil erosion. Based on the modelling, 71% of the agricultural land in Denmark is mapped as stable in terms of the amount of erosion and deposited material. Overall, 6.1% of the farmland is estimated to have unsustainable erosion and 0.9% of the farmland exceeds erosion rates of 7.5 t ha−1 a−1. Sediment export into surface water in Denmark equals 92,000 t a−1, corresponding to an average sediment yield of 2.7 t km−2.The performance of WaTEM is considered satisfactory in this study. Importantly, modelled water erosion exceeds the perceived erosion risk in Denmark. Strengthened by distributed uncertainty assessment at national scale, our study provides an important national knowledge base for engaging land users and regulators in the process of targeted erosion mitigation planning that is required to comply with national and EU regulation. Future investigations concerning the deviation between predicted and observed data and specific catchment parameters for the non-behavioural catchments are required as well as studies that include the establishment of catchment sediment budgets.

Do health care professionals worry about delirium? Relatives’ experience of delirium in the intensive care unit: A qualitative interview study

ObjectivesIn intensive care units, there is a high incidence of delirium, which relates to the risk of complications. Engagement of relatives is an acknowledged part of handling delirium, but knowledge of relatives’ perspectives is lacking. AimTo explore relatives’ experiences of delirium in the critically ill patient admitted to an intensive care unit. Research designA qualitative design with a phenomenological approach. Semi-structured interviews with eleven relatives of critically ill patients who had delirium during admission to the intensive care unit. SettingAn intensive care unit in Denmark. FindingsThree categories emerged: ‘Delirium is not the main concern’, ‘Communication with health-care professionals is crucial’, and ‘Delirium impacts on relatives’. Relatives had a lack of knowledge of delirium. Symptoms of delirium were thought of as a natural consequence of critical illness and seemed to be a secondary problem. Health-care professionals did not talk about delirium and information was requested. Delirium and the manifestation of it was experienced in different ways and brought different ways of coping. ConclusionFindings give a new insight into relatives’ experience of delirium in the intensive care unit. Relatives need more information to better understand delirium. Future research must investigate the potential in helping relatives to cope with delirium, to the benefit of both patient and relatives.

Negotiated mobilisation: An ethnographic exploration of nurse-patient interactions in an intensive care unit.

To explore nurse-patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse-patient interactions in relation to mobilisation between nurses (n=44) and mechanically ventilated patients (n=25). We conducted interviews with nurses (n=16) and patients (n=13) who had been mechanically ventilated for at least 3days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. We identified three themes: "Diverging perspectives on mobilisation" showed that nurses had a long-term and treatment-oriented perspective on mobilisation, while patients had a short-term perspective and regarded mobilisation as overwhelming in their present situation. "Negotiation about mobilisation" demonstrated how patients actively negotiated the terms of mobilisation with the nurse. "Inducing hope through mobilisation" captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. Exploring the nurse-patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse-patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit.

Reprint of Recovery programme for ICU survivors has no effect on relatives’ quality of life: Secondary analysis of the RAPIT-study

BackgroundRelatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain. AimTo determine whether relatives benefit from a recovery programme intended for intensive care survivors. Research designA randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94). SettingTen intensive care units in Denmark. Main outcome measuresPrimary outcome: health-related quality of life (HRQOL). Secondary outcomes: Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge. ResultsNo difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: −3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: −1.88; 5.59], p = 0.33). No differences were found in secondary outcomes. ConclusionThe recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.

Sudden vs Pressure Wean From Nasal Continuous Positive Airway Pressure in Infants Born Before 32 Weeks of Gestation

Nasal continuous positive airway pressure (nCPAP) is a well-established treatment of respiratory distress syndrome in preterm infants. Suboptimal weaning from nCPAP may be associated with lung injury, pulmonary morbidity, and infant weight gain. To our knowledge, the best weaning strategy from nCPAP is unknown. To compare the effect of sudden wean and pressure wean from nCPAP in very preterm infants. A randomized, clinical, open-label, multicenter trial was conducted at 6 neonatal intensive care units in Denmark from September 2012 to December 2016 and included infants born before 32 weeks of gestation. Sudden wean with discontinuation of nCPAP without a prior reduction in pressure. Pressure wean with gradual pressure reduction prior to the discontinuation of nCPAP. The primary outcome was weight gain velocity from randomization to postmenstrual age 40 weeks. Secondary outcomes included other measures of growth, nCPAP and the duration of oxygen supplementation, postmenstrual age at successful wean and at discharge, successful wean at the first attempt, the number of attempts to wean, and the length of the hospital stay. Prespecified subgroup analyses by gestational age were performed. Of the 372 randomized infants, 185 (49.7%) were randomized to sudden wean and 187 infants (50.3%) to pressure wean. A total of 177 infants in both groups completed the trial (median gestational age for sudden and pressure wean, 30 weeks [interquartile range, 29-31]; male: sudden wean, 89 [50%]; pressure wean, 96 [54%]). There was no difference in mean [SD] weight gain velocity from randomization to 40 weeks postmenstrual age between the 2 groups (22 [6] g/kg/day). No difference was found in any of the secondary outcomes. More infants born before 28 weeks of gestation were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group (risk difference, 31%; 95% CI, 13%-50%), but there was no difference in the duration of nCPAP and oxygen supplementation. Overall, we found no difference in weight gain velocity or any of the secondary outcomes between very preterm infants who were randomized to sudden wean or pressure wean from nCPAP. However, among infants born before 28 weeks' gestation, infants from the pressure wean group were more often successfully weaned during the first attempt without a longer total duration of nCPAP treatment. ClinicalTrials.gov Identifier: NCT01721629.

Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals.

BackgroundMonitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM) chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes.ObjectiveThe aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses.Materials and methodsWe used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations.ResultsAmong 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54). In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease.ConclusionThe presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most Danish hospitals. Together with descriptive analyses, it was possible to use an alarm from a risk-adjusted CUSUM chart to identify potential performance problems.

Recovery programme for ICU survivors has no effect on relatives’ quality of life: Secondary analysis of the RAPIT-study

BackgroundRelatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain. AimTo determine whether relatives benefit from a recovery programme intended for intensive care survivors. Research designA randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94). SettingTen intensive care units in Denmark. Main outcome measuresPrimary outcome: health-related quality of life (HRQOL). Secondary outcomes: Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge. ResultsNo difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: −3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: −1.88; 5.59], p = 0.33). No differences were found in secondary outcomes. ConclusionThe recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.

SuPAR is associated with risk of future acute surgery and post-operative mortality in acutely admitted medical patients

BackgroundAcutely admitted medical patients are often fragile and in risk of future surgery. The biomarker soluble urokinase plasminogen activator receptor (suPAR) is a predictor of readmission and mortality in the acute care setting. We aimed to investigate if suPAR also predicts acute surgery, which is associated with higher mortality than elective surgery, and if it predicts post-operative mortality.MethodsA retrospective registry-based cohort study of 17,312 patients admitted to an acute medical unit in Denmark, from 18 November 2013 until 30 September 2015. The first admission with available suPAR was defined as the index admission, and patients were followed via national registries until 1 January 2016. The risk of acute surgery during the entire follow-up period as well as the 90-day post-operative mortality risk was modeled by Cox regression analyses adjusted for sex, age, C-reactive protein, and Charlson Comorbidity Index (Charlson Score).ResultsAcute surgery was carried out on 2404 patients (13.9%) after a median of 45 days (interquartile range 5–186) following the index admission. Patients receiving acute surgery had higher baseline suPAR compared with patients receiving elective- or no surgery (p < 0.0001). The hazard ratio (HR) for acute surgery was 1.50 (95% confidence interval (CI): 1.42–1.59) for every doubling of the suPAR level in the adjusted Cox regression analysis. Death within 90 days occurred in 439 (18.3%) patients receiving acute surgery, and the adjusted HR for post-operative mortality was 1.73 (95% CI: 1.52–1.95).DiscussionElevated levels of suPAR in acutely admitted medical patients were independently associated with increased risk of future acute surgery as well as with 90-day post-operative mortality.Trial registrationThis retrospective registry-based cohort study was approved by the Danish Health and Medicines authority (reference no. 3–3013-1061/1). All processing of personal data followed national guidelines, and the project was approved by the Danish Data Protection Agency (reference no. HVH-2014-018, 02767).

Risk factors and between-hospital variation of caesarean section in Denmark: a cohort study

ObjectivesThe aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.DesignHistorical...

Life-and-Death Decisions in a Neonatal Intensive Care Unit in Denmark: The Discrete Authority of Origin Stories

ABSTRACTIn what ways are care and compassion implicated in efforts to establish lives worth living? Drawing on fieldwork in a Danish Neonatal Intensive Care Unit (NICU), in this article we investigate the role of family biographies in conducting life-and-death decisions around premature infants. Guided by a larger literature on citizenship, we view decisions in the NICU as political acts of assigning citizenship. We ask what bodies and biographies can generate and evoke care and compassion among NICU staff and forge entries or exits from the Danish Welfare State. We demonstrate that infants’ origin stories are appointed legitimate forms of suffering in contemporary Danish society and are thus granted an unnoticed form of authority in life-and-death decisions. In this way, we conclude that what comes to constitute a life worth living in the twenty-first-century Danish Welfare State is in fact the worth of the family.

Bowel Endometriosis Syndrome: a new scoring system for pelvic organ dysfunction and quality of life.

Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? The BENS score can be used to identify women with BENS and to monitor the effect of medical and surgical treatment of women suffering from bowel endometriosis. Endometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems are mainly based on anatomical and surgical findings. The score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark. Patients filled in questionnaires on pelvic pain, quality of life (QoL) and urinary, sexual and bowel function. Items were selected for the final score using clinical and statistical criteria. The chosen variables were included in a multivariate analysis. Individual score values were designated items to form the BENS score, which was divided into 'no BENS', 'minor BENS' and 'major BENS.' Internal and external validations were performed. The six most important items were 'pelvic pain', 'use of analgesics', 'dyschezia', 'straining to urinate', 'fecal urgency' and 'satisfaction with sexual life'. The range of the BENS score (0-28) was divided into 0-8 (no BENS), 9-16 (minor BENS) and 17-28 (major BENS). External validation showed a significant association between BENS score and QoL (P = 0.0001). The BENS scoring system is limited by the fact that it was developed from a single endometriosis unit in Denmark, making it susceptible to social, cultural and demographic bias. It is the first endometriosis classification system to be based directly on the symptomatology of the patient. Validation in other languages will promote comparison of treatments and results across borders. No external funding was either sought or obtained for this study. A.F. is an investigator for Bayer, outside this work.

Cardiotocography interpretation skills and the association with size of maternity unit, years of obstetric work experience and healthcare professional background: a national cross-sectional study.

We aimed to examine whether cardiotocography (CTG) knowledge, interpretation skills and decision-making measured by a written assessment were associated with size of maternity unit, years of obstetric work experience and healthcare professional background. A national cross-sectional study in the setting of a CTG teaching intervention involving all 24 maternity units in Denmark. Participants were midwives (n = 1260) and specialists (n = 269) and residents (n = 142) in obstetrics and gynecology who attended a 1-day CTG course and answered a 30-item multiple-choice question test. Associations between mean test score and work conditions were analyzed using multivariable robust regression, in which the three variables were mutually adjusted. Participants from units with > 3000 deliveries/year scored higher on the test than participants from units with < 1000 deliveries/year (3000-3999 deliveries/year: mean difference 0.8, p < 0.0001; > 4000 deliveries/year: mean difference 0.5, p = 0.006). Participants with < 15 years of work experience scored higher than participants with > 15 years of experience (15-20 years of experience: mean difference - 0.6, p = 0.007; > 20 years experience: mean difference - 0.9, p < 0.0001). No differences were detected concerning professional background. CTG knowledge, interpretation skills and decision-making measured by a written assessment were positively associated with working in large maternity units and having < 15 years of obstetric work experience. This might indicate a challenge in maintaining CTG skills in small units and among experienced staff but could also reflect different levels of motivation, test familiarity and learning culture. Whether the findings are transferable to the clinical setting was not examined.

Nurse-patient communication within the context of non-sedated mechanical ventilation: A hermeneutic-phenomenological study.

To explore non-sedated mechanically ventilated patients' communication with nurses in the intensive care unit. Mechanically ventilated patients are temporarily voiceless, making interpersonal communication complex. Both nurses and patients find communication challenging and may experience negative emotions when communication fails. In Nordic countries, sedation protocols have changed to light/non-sedation, resulting in more patients being conscious and more clinical practitioners experiencing communication difficulties. The study was qualitative with a phenomenological-hermeneutic approach. Data were collected at two intensive care units in Denmark from January to April 2015. Data collection consisted of interviews with patients, focus group interviews with nurses and field observations concerning nurse-patient communication. Data were analysed as one collective body of data using Ricoeur's theory of interpretation. The main theme showed that communication is a movement between the two opposite feelings of comprehension and frustration. Sub-themes showed (1) the dynamics of power change when the patient is voiceless; (2) consciousness and voicelessness make caring difficult; and (3) the process of interpreting and structuring communication is situational. These findings are important in nursing care and provide perspectives on the shift from communication towards comprehension and, thus, away from frustration. A non-sedation protocol is a major change in clinical practice in relation to communication. It requires a new way of thinking where communication becomes an integrated part of care, and the nurse has to be constantly alert and adjust his or her communication strategies to the patient's changing needs and communication ability. Some nursing interventions may optimize communication: (1) systematic assessment of patients' communication; (2) education of nurses in Augmentative and Alternative Communication; (3) using communication tools when possible; and (4) securing time, continuity, empathy and patience in nursing care.

Fathers' Needs and Masculinity Dilemmas in a Neonatal Intensive Care Unit in Denmark.

Background:Most healthcare professionals in neonatal intensive care units typically focus on the infants and mothers; fathers often feel powerless and find it difficult to establish a father-child relationship. In family-centered healthcare settings, exploring fathers' experiences and needs is important because men's roles in society, especially as fathers, are changing.Purpose:To describe fathers' needs when their infants are admitted to a neonatal intensive care unit and to discuss these needs within a theoretical framework of masculinity to advance understanding and generate meaningful knowledge for clinical practices.Methods:This qualitative study used participant observation, interviews, multiple sequential interviews, and a focus group discussion. Data were analyzed using grounded theory principles.Results:Analysis of the fathers' needs generated 2 primary themes: (1) Fathers as caregivers and breadwinners and (2) fathers and emotions. Fathers wished to be involved and to take care of their infants but have to balance cultural and social norms and expectations of being breadwinners with their wishes to be equal coparents.Implications for Practice/Research:Health professionals in neonatal intensive care units must be aware of fathers' need and desire to be equal coparents. Nurses should play a key role by, for example, showing that fathers are as important to their infants as are the mothers, helping them become involved in childcare, and ensuring that they are directly informed about their children's progress. Further research in other cultural settings would contribute to knowledge regarding fatherhood and the role of fathers in childcare.

Readmission and mortality in patients discharged with a diagnosis of medical observation and evaluation (Z03*-codes) from an acute admission unit in Denmark: a prospective cohort study

BackgroundWe assessed the 30-day risk of readmission and mortality among patients receiving an International Classification of Diseases 10th edition diagnosis of medical observation and evaluation (Z03*) following admission to an acute medical admission unit (AMAU), stratified on any further specification of diagnosis during hospital stay.MethodsWe used Central Denmark’s (Midt)-Electronic Patient Journal to identify patients with a Z03*-diagnosis among patients admitted to the AMAU, Aarhus University Hospital Nørrebrogade from April 2012 to March 2013, and noted any specification of diagnosis. Patients were followed from hospital discharge until death, emigration, or completion of 30 days follow-up.ResultsOf 409 patients with an initial Z03* diagnosis at the AMAU, 55% (n = 226) received a more specific discharge diagnosis after transferral to other departments. Among patients discharged to home with a Z03*-diagnosis, 30% were readmitted within 30 days, while the corresponding figure was 23% for patients receiving a specific diagnosis (p = 0.06). In contrast, corresponding figures for 30-day mortality were 3% for Z03*-diagnosed patients and 10% for those who obtained a specific diagnosis (p = 0.003).ConclusionsPatients diagnosed with Z03* at hospital discharge have a substantially lower 30-day mortality, but a higher readmission-rate, compared to patients who obtain a specific diagnosis during the entire hospital stay.

Mycobacterium chimaera in Heater–Cooler Units in Denmark Related to Isolates from the United States and United Kingdom

Mycobacterium chimaera was present at high rates (>80%) in heater–cooler units (HCUs) from all 5 thoracic surgery departments in Denmark. Isolates were clonal to HCU-associated isolates from the United States (including some from patients) and United Kingdom. However, M. chimaera from 2 brands of HCU were genetically distinct.