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Gunningberg, Lena
Publications (10 of 47) Show all publications
Gunnarsson, A.-K., Gunningberg, L., Larsson, S. & Jonsson, K. B. (2017). Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter: a double-blind randomised trial. Clinical Interventions in Aging, 12, 137-143.
Open this publication in new window or tab >>Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter: a double-blind randomised trial
2017 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, p. 137-143Article in journal (Refereed) Published
Abstract [en]

Background

Urinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries (lat. Vaccinium macrocarpon Ait.)  are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters.

Aim

To investigate whether cranberry capsules given pre- and postoperatively are useful in preventing hospital-acquired UTIs in female patients with hip fracture and urinary catheter.

Design

Randomised, placebo-controlled double-blind trial.

Method

Female patients, age 60 years and older, with hip fracture were recruited (n=227). The patients were randomised to receive cranberry (n=113) or placebo (n=114) capsules daily, from admission to the ward, until five days postoperatively. Urine cultures were obtained at admission and at five and 14 days postoperatively. In addition, EQ-5D assessments were performed and patients were screened for UTI symptoms.

Result

There was no difference between the groups in the proportion of patients with postoperative positive urine cultures. When excluding patients with positive cultures at admission, patients with antibiotic treatment during follow-up, and patients that did not adhere to the protocol, there was a trend towards a protective effect of cranberry treatment against hospital-acquired UTIs ; e.g. 36% (n=33) in the control group vs. 22%  (n=41) in cranberry group (p=0.17) at 5 days postoperatively.

Conclusion

Cranberry concentrate does not seem to have an effect in preventing UTI in female patients with hip fracture and indwelling urinary catheter.

 

Keyword
Urinary tract infection, cranberry, hip fracture, elderly, randomised
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:uu:diva-232824 (URN)10.2147/CIA.S113597 (DOI)000391844900001 ()28144131 (PubMedID)
Note

The manuscript version of this article is part of the thesis "Patients with Hip Fracture: Various aspects of patient safety" http://uu.diva-portal.org/smash/record.jsf?pid=diva2:751476

Available from: 2014-10-01 Created: 2014-09-25 Last updated: 2017-12-05Bibliographically approved
Sving, E., Fredriksson, L., Gunningberg, L. & Mamhidir, A.-G. (2017). Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting. Journal of Clinical Nursing, 26(19-20), 3200-3211.
Open this publication in new window or tab >>Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 19-20, p. 3200-3211Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multifaceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention.

Background: Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes.

Design: A descriptive qualitative approach.

Method: Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used.

Result: The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements.

Conclusion: The multifaceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feedback discussions among the staff regarding the results of the care provided also appear to be vital.

Relevance to clinical practice. It is crucial that dedicated facilitators are involved to promote the implementation process. A preventative mindset should be strived for. Creating an implementation plan with an outcome and a process evaluation should be emphasised. It is important to give the staff regular feedback on the quality of care and on those occasions allocate time for discussion and reflection.

Place, publisher, year, edition, pages
WILEY, 2017
Keyword
hospital, implementation, pressure ulcer prevention, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-335125 (URN)10.1111/jocn.13668 (DOI)000410546400035 ()27875015 (PubMedID)
Available from: 2017-11-30 Created: 2017-11-30 Last updated: 2017-11-30Bibliographically approved
Jangland, E. & Gunningberg, L. (2017). Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project. Journal of Nursing Management, 25(4), 266-275.
Open this publication in new window or tab >>Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project
2017 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 4, p. 266-275Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim

To evaluate an implementation project on patient participation.

Background

Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years.

Method

Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed.

Results

Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients’ involvement in their own care. Several barriers to change and sustainability were acknowledged.

Conclusions

Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement.

Implications for Nursing Management

A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-317309 (URN)10.1111/jonm.12459 (DOI)000400685900004 ()
Funder
The King Gustaf V's Jubilee Foundation
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2017-07-06Bibliographically approved
Schoeps, L. N., Tallberg, A.-B. & Gunningberg, L. (2017). Patients' knowledge of and participation in preventing pressure ulcers: an intervention study. International Wound Journal, 14(2), 344-348.
Open this publication in new window or tab >>Patients' knowledge of and participation in preventing pressure ulcers: an intervention study
2017 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 14, no 2, p. 344-348Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate a patient information pamphlet on pressure ulcer (PU) prevention using a descriptive, comparative pre- and post-test study design. The patient information pamphlet 'How can you help to stop pressure ulcers?' developed by the European PU Advisory Panel in 2012 was implemented in two surgical wards in a university hospital. A total of 61 patients answered pre- and post-test questionnaires. Patients assessed their knowledge of the risks, causes and ways to prevent PUs significantly higher after the intervention than before. Twenty-eight patients (46%) reported that they had participated in PU prevention during the last 24 hours. The patients assessed the content of the PU pamphlet as useful, its language as quite easy to understand and its layout as good. Patients with a PU pamphlet during their hospital stay were more knowledgeable about and more active in their own care. It is important that nurses invite patients to be active partners in preventing PUs but also that they identify patients who need to have a more passive role. The PU pamphlet could be updated to increase its comprehensibility, meaningfulness and manageability for patients.

National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-300969 (URN)10.1111/iwj.12606 (DOI)000398068200008 ()27112492 (PubMedID)
Available from: 2016-08-16 Created: 2016-08-16 Last updated: 2017-05-30Bibliographically approved
Carlsson, M. E. & Gunningberg, L. (2017). Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study. Journal of Palliative Medicine, 20(1), 53-58.
Open this publication in new window or tab >>Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study
2017 (English)In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 20, no 1, p. 53-58Article in journal (Refereed) Published
Abstract [en]

Background: The scientific knowledge about pressure ulcers (PUs) is growing, but there is a shortage of studies of PUs at end of life. The recommendations regarding PU prevention in palliative care (PC) are based on consensus documents. Aim: To use data from a national register to identify predictors for development of PUs at the end of life. Design: A retrospective, descriptive, and comparative study design was used. Setting/Participants: All deceased patients over 17 years old (n = 60,319) and registered in the Swedish Register of Palliative Care (SRPC) during 2014 were included. Statistical Analysis: Logistic regression. Results: In the full model, all health units except general palliative home care had a significantly higher incidence of PUs than did the nursing homes. The well-known predictors of PUs in general, diabetes, post-fracture state, infections, and multiple sicknesses, are predictors even in dying patients. Dementia was significantly associated with lower likelihood of PUs, while pain was associated with more PUs. Intravenous drip or enteral feeding was associated with a significantly decreased likelihood of developing PUs. Conclusions: The SRPC could be a unique resource for quality improvement and research. The present study cannot prove causation, but it can report correlations between background variables and PU prevalence. More studies, with different designs, are warranted to establish the roles of risk factors for PU in end-of-life care.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-315843 (URN)10.1089/jpm.2016.0166 (DOI)000391749800013 ()27657349 (PubMedID)
Funder
Swedish National Board of Health and Welfare
Available from: 2017-02-21 Created: 2017-02-21 Last updated: 2017-11-29Bibliographically approved
Hultin, L., Olsson, E., Carli, C. & Gunningberg, L. (2017). Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff. Journal of Wound, Ostomy and Continence Nursing (WOCN), 44(2), Article ID 142-47.
Open this publication in new window or tab >>Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff
2017 (English)In: Journal of Wound, Ostomy and Continence Nursing (WOCN), ISSN 1071-5754, E-ISSN 1528-3976, Vol. 44, no 2, article id 142-47Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this study was to evaluate the use of a pressure mapping system with real-time feedback of pressure points in elderly care, with specific focus on pressure injury (PI) knowledge/attitudes (staff), interface pressure, and PI prevention activities (residents). DESIGN: Descriptive, 1-group pretest/posttest study. SUBJECTS AND SETTING: A convenience sample of 40 assistant nurses and aides participated in the study; staff members were recruited at daytime, and 1 nighttime meeting was held at the facility. A convenience sample of 12 residents with risk for PI were recruited, 4 from each ward. Inclusion criteria were participants older than 65 years, Modified Norton Scale score 20 or less, and in need of help with turning in order to prevent PI. The study setting was a care facility for the elderly in Uppsala, Sweden. METHODS: A descriptive, comparative pretest/posttest study design was used. The intervention consisted of the use of a pressure mapping system, combined with theoretical and practical teaching. Theoretical and practical information related to PI prevention and the pressure mapping system was presented to the staff. The staff (n = 40) completed the Pressure Ulcer Knowledge and Assessment Tool (PUKAT) and Attitudes towards Pressure Ulcer (APuP) before and following study intervention. Residents' beds were equipped with a pressure mapping system during 7 consecutive days. Peak pressures and preventive interventions were registered 3 times a day by trained study nurses, assistant nurses, and aides. RESULTS: Staff members' PUKAT scores increased significantly (P = .002), while their attitude scores, which were high pretest, remained unchanged. Peak interface pressures were significantly reduced (P = .016), and more preventive interventions (n = 0.012) were implemented when the staff repositioned residents after feedback from the pressure mapping system. CONCLUSIONS: A limited educational intervention, combined with the use of a pressure mapping system, was successful as it improved staff members' knowledge about PI prevention, reduced interface pressure, and increased PI prevention activities. As many of the staff members lacked formal education in PI prevention and management, opportunities for teaching sessions and reflection upon PI prevention should be incorporated into the workplace. More research is needed to evaluate the effect of continuous pressure mapping on the incidence of PI.

Keyword
elderly care, knowledge and attitudes, pressure mapping, pressure ulcer/injury, prevention
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-317308 (URN)10.1097/WON.0000000000000301 (DOI)000395945800007 ()28267120 (PubMedID)
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2017-04-27Bibliographically approved
Gunningberg, L., Sedin, I.-M., Andersson, S. & Pingel, R. (2017). Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. International Journal of Nursing Studies, 72, 53-59.
Open this publication in new window or tab >>Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial
2017 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 72, p. 53-59Article in journal (Refereed) Published
Abstract [en]

Background: Pressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking. Objective: To evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting. Design: Pragmatic randomised controlled trial. Setting: A geriatric/internal medical ward with 26 beds in a Swedish university hospital. Participants: 190 patients were recruited (intervention: n = 91; control: n = 99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4 pm and Friday 4 pm, and expected to stay in the ward >= 3 days. Intervention: The continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care. Results: No significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34-3.79). Conclusions: This study failed to demonstrate a beneficial effect of a pressure mapping system on pressure ulcer prevalence and incidence. However, the study could have increased staff awareness and focus on pressure ulcer prevention, thus affecting the prevalence and incidence of pressure ulcers in a positive way in both study groups. It is important to further investigate the experience of the multidisciplinary team and the patients regarding their use of the pressure mapping system, as well as strengths and weaknesses of the system.

Keyword
Hospital, Prevention, Pressure mapping, Pressure ulcer, RCT
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-330007 (URN)10.1016/j.ijnurstu.2017.04.007 (DOI)000405156300007 ()28460263 (PubMedID)
Available from: 2017-10-11 Created: 2017-10-11 Last updated: 2017-10-11Bibliographically approved
Hommel, A., Gunningberg, L., Idvall, E. & Bååth, C. (2017). Sucessful factors to prevent pressure ulcers - An interview study. Journal of Clinical Nursing, 26(1-2), 182-189.
Open this publication in new window or tab >>Sucessful factors to prevent pressure ulcers - An interview study
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 1-2, p. 182-189Article in journal (Refereed) Published
Abstract [en]

AIM AND OBJECTIVES: The aim of present study was to explore successful factors to prevent pressure ulcers (PU) in hospital settings.

BACKGROUND: PU prevalence has been recognized as a quality indicator for both patient safety and quality of care in hospital and community settings. Most PU can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions (SALAR) initiated nationwide PU prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of PU in the spring of 2014 was 14% in hospital settings with a range from 2.7% to 36.4%.

DESIGN: Qualitative semi-structured interviews were conducted.

METHODS: A qualitative content analysis, in addition to PARIHS frameworks was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014.

RESULTS: Three main categories were identified as successful factors to prevent PU in hospitals: creating a good organization, maintaining persistent awareness, and realising the benefits for patients.

CONCLUSION: The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of PU is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organization in prevention work.

RELEVANCE TO CLINICAL PRACTICE: The nurse managers' attitude and crucial to enable the personnel to work actively with PU prevention. Strategies are proposed to advance clinical leadership, knowledge, skills, and abilities for the crucial implementation of PU prevention.

Keyword
evidence-based practice, leadership, nurse's responsibilities, pressure ulcer, qualitative study, quality and safety, work organisation
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-300968 (URN)10.1111/jocn.13465 (DOI)000396472700017 ()27378536 (PubMedID)
Available from: 2016-08-16 Created: 2016-08-16 Last updated: 2017-11-28Bibliographically approved
Florin, J., Bååth, C., Gunningberg, L. & Mårtensson, G. (2016). Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument. International Wound Journal, 13(5), 655-662.
Open this publication in new window or tab >>Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument
2016 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 5, p. 655-662Article in journal (Refereed) Published
Abstract [en]

The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-236909 (URN)10.1111/iwj.12338 (DOI)000387667600061 ()25124833 (PubMedID)
Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-02-23Bibliographically approved
Bredesen, I. M., Bjoro, K., Gunningberg, L. & Hofoss, D. (2016). Effect of e-learning program on risk assessment and pressure ulcer classification: A randomized study. Nurse Education Today, 40, 191-197.
Open this publication in new window or tab >>Effect of e-learning program on risk assessment and pressure ulcer classification: A randomized study
2016 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 40, p. 191-197Article in journal (Refereed) Published
Abstract [en]

Background: Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian. Objectives: Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. Methods: Design, participants and setting: Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012. Analysis: Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables. Results: An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. Conclusion: An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected.

Keyword
E-leaming, Classroom learning, Braden scale, Pressure ulcer classification
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-298244 (URN)10.1016/j.nedt.2016.03.008 (DOI)000376051200031 ()27125172 (PubMedID)
Available from: 2016-07-01 Created: 2016-07-01 Last updated: 2017-11-28Bibliographically approved
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