Linköping University Medical Dissertation
No. 567

Quality of care and assessment of health among elderly in acute care


Inger Johansson

Akademisk avhandling som for avläggande av medicine doktorsexamen vid Linköpings Universitet offentligen försvaras i Berzeliussalen, Hälsouniversitetet, Linköping

Fredagen den 2 oktober 1998 kl. 9.00

Fakultetsopponent är docent Mona Kihlgren, Centrum för omvårdnadsvetenskap, Örebro


This thesis describes nursing staffs opinion of quality of care and work satisfaction and elderly patients' perception of health, functional capacity, quality of life and sense of coherence (SOC) from a prognostic point of view. The research was performed within several surgical and orthopaedic wards, and different instruments were developed and tested for reliability and validity. The study groups consisted of nursing staff (n=66), surgical patients clinically ready for discharge (n=53) and a consecutive sample of patients with hip fracture (n=73). All patients were 60+ years of age and living in their own homes before their stay in hospital.

The nursing staff answered questionnaires concerning work satisfaction and perceived quality of care before and one year after the introduction of modular nursing. Among the respondents considerable differences were noted in one ward one year after the intervention, particularly concerning their relationship with colleagues, identification and commitment, and quality of care. Key factors for this outcome could be related to the quality of the interpersonal relationships and the leadership of the ward.

Significant differences between subgroups were revealed when using a Swedish version of the Health Assessment Form (HAF) and a tool measuring Sense of Coherence (SOC) in personal interviews among elderly patients clinically ready for discharge. The patients who could return home showed less discomfort concerning physical variables such as breathing and elimination of urine and scored higher within emotional status and SOC than those who were referred to an institution or were deceased before the one month follow-up. The result indicated that the HAF as well as SOC had some prognostic value for further care as well as for survival/fatal outcome for patients clinically ready for discharge.

The Swedish version of the NEECHAM Confusion Scale was found to be reliable and valid for detecting and following up acute confusional states among patients with hip fracture. The part of the scale measuring vital function was found to have predictive power in relation to the Quality of Life Index (QLI) at the four-month follow-up. The parts reflecting cognitive function and urinary continence predicted significantly for function of daily living activities (I-ADL), measured with the Standardized Practical Equipment (SPE). Patients with a stronger SOC, compared with those with a weaker, were discharged earlier from the hospital, reported a higher score on the QLI and performed I-ADL better four months after discharge from the hospital.

The findings highlight the importance of having a broad range of valid and reliable instruments when following up organisational changes among nursing staff as well as for assessing the health and functional needs of elderly patients in acute care in order to predict future developments.

Key words: assessment, elderly, health, quality of life, sense of coherence, organisation of care.

Department of Medicine and Care, Division of Nursing Science,
Faculty of Health Sciences, Linköping University,
S-581 85 Linköping Sweden.

Linköping 1998

ISBN 91-7219-052-3      ISSN 0345-0082