uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Publications (10 of 30) Show all publications
Stenberg, J., Melin, J., Lindberg, M. & Furuland, H. (2019). Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients. Hemodialysis International, 23(3), 402-413
Open this publication in new window or tab >>Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients
2019 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 23, no 3, p. 402-413Article in journal (Refereed) Published
Abstract [en]

Introduction: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.

Methods: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.

Findings: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (r(s) = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).

Discussion: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
Fluid overload, brain natriuretic peptide (BNP), bioimpedance, hemodialysis, repeated measurements
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-391030 (URN)10.1111/hdi.12751 (DOI)000475503700025 ()30848066 (PubMedID)
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-08-19Bibliographically approved
Lindberg, M., Skytt, B. & Lindberg, M. (2019). Perceptions of Infection Control Practices and the use of Vignettes to Alter Infection Control Behavior: A Feasibility Study. FLORENCE NIGHTINGALE JOURNAL OF NURSING-FLORENCE NIGHTINGALE HEMSIRELIK DERGISI, 27(3), 231-240
Open this publication in new window or tab >>Perceptions of Infection Control Practices and the use of Vignettes to Alter Infection Control Behavior: A Feasibility Study
2019 (English)In: FLORENCE NIGHTINGALE JOURNAL OF NURSING-FLORENCE NIGHTINGALE HEMSIRELIK DERGISI, ISSN 2147-4923, Vol. 27, no 3, p. 231-240Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method: Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results: The mind-set to help one another and do one's best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion: Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.

Place, publisher, year, edition, pages
ISTANBUL UNIV-CERRAHAPASA, 2019
Keywords
Feasibility test, healthcare-associated infection, healthcare personnel behavior, infection control practices, qualitative research
National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-396946 (URN)10.5152/FNJN.2019.19005 (DOI)000492145700004 ()
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2020-01-23Bibliographically approved
Lindberg, M. (2019). Single-Case Experimental Designs: A Clinical Research Opportunity in Renal Care. Journal of Renal Care, 45(2), 72-73
Open this publication in new window or tab >>Single-Case Experimental Designs: A Clinical Research Opportunity in Renal Care
2019 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 45, no 2, p. 72-73Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-386371 (URN)10.1111/jorc.12278 (DOI)000468625600002 ()31115184 (PubMedID)
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-06-24Bibliographically approved
Lindberg, M. (2018). Evidence-Based Renal Care: Does It Matter?. Journal of Renal Care, 44(2), 63-64
Open this publication in new window or tab >>Evidence-Based Renal Care: Does It Matter?
2018 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 44, no 2, p. 63-64Article in journal, Editorial material (Other academic) Published
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-358103 (URN)10.1111/jorc.12244 (DOI)000431659600001 ()29722205 (PubMedID)
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically approved
Stenberg, J., Henriksson, C., Lindberg, M. & Furuland, H. (2018). Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals. BMC Nephrology, 19, Article ID 121.
Open this publication in new window or tab >>Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals
2018 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, article id 121Article in journal (Refereed) Published
Abstract [en]

Background

Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals’ perceived barriers and facilitators for use of bioimpedance in clinical practice.

Methods

Qualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants’ perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process.

Results

Several barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants.

Conclusions

Determinants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation’s attractiveness, advantages in practice, and collaboration. Motivation, team processes and organizational capacities appeared as both barriers and facilitators.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Barriers, Bioimpedance, Dry weight, Facilitators, Focus groups, Renal dialysis
National Category
Urology and Nephrology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-351359 (URN)10.1186/s12882-018-0907-4 (DOI)000433236500004 ()29792174 (PubMedID)
Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2019-01-21Bibliographically approved
Lindberg, M., Skytt, B., Wågström, B.-M., Arvidsson, L. & Lindberg, M. (2018). Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study. Journal of Hospital Infection, 100(3), e146-e150, Article ID S0195-6701(18)30406-7.
Open this publication in new window or tab >>Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study
Show others...
2018 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 100, no 3, p. e146-e150, article id S0195-6701(18)30406-7Article in journal (Refereed) Published
Abstract [en]

Background: To understand healthcare personnel's infection prevention behaviour has long been viewed as a key factor in preventing healthcare-associated infections. Suboptimal hand hygiene compliance and handling of materials, equipment, and surfaces present the main risks for potential organism transmission. Further exploration is needed regarding the role of context-specific conditions and the infection prevention behaviours of healthcare personnel. Such knowledge could enable the development of new intervention strategies for modifying behaviour.

Aim: To describe risk behaviours for organism transmission in daily care activities over time.

Methods: Unstructured observations of healthcare personnel carrying out patient-related activities were performed on 12 occasions over a period of 18 months.

Findings: Risk behaviours for organism transmission occur frequently in daily care activities and the results show that the occurrence is somewhat stable over time. Interruptions in care activities contribute to an increased risk for organism transmission that could lead to subsequent healthcare-associated infection.

Conclusion: Interventions aimed at reducing the risks of healthcare-associated infections need to focus on strategies that address: hand hygiene compliance; the handling of materials, equipment, work clothes and surfaces; the effects of interruptions in care activities if they are to alter healthcare personnel's infection prevention behaviour sufficiently.

Keywords
Hand hygiene, Healthcare-associated infection, Hygiene, Infection control, Interruptions, Observation of practice
National Category
Infectious Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-365806 (URN)10.1016/j.jhin.2018.07.041 (DOI)000448006000024 ()30081148 (PubMedID)
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2020-01-23Bibliographically approved
Lindberg, M., Lindberg, M. & Skytt, B. (2017). Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study.. International Journal of Nursing Studies, 70, 38-45
Open this publication in new window or tab >>Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study.
2017 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 70, p. 38-45Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations.

OBJECTIVE: The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections.

DESIGN & SETTING: Unstructured nonparticipant observations were performed at three medical wards.

PARTICIPANTS & METHODS: Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities.

RESULTS: The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was.

CONCLUSION: The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission.

Keywords
Hand hygiene, Healthcare-associated infections, Hygiene, Infection control
National Category
Nursing Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-317118 (URN)10.1016/j.ijnurstu.2017.02.016 (DOI)000399853700005 ()28231441 (PubMedID)
Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2020-01-23Bibliographically approved
Stenberg, J., Lindberg, M. & Furuland, H. (2016). Clinical praxis for assessment of dry weight in Sweden and Denmark: A mixed-methods study. Hemodialysis International, 20(1), 111-119
Open this publication in new window or tab >>Clinical praxis for assessment of dry weight in Sweden and Denmark: A mixed-methods study
2016 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 20, no 1, p. 111-119Article in journal (Refereed) Published
Abstract [en]

Overhydration is an independent predictor of mortality in hemodialysis (HD) patients. More than 30% of HD patients are overhydrated, motivating the development of new methods for assessing hydration status. This study surveyed clinical praxis and local guidelines for dry weight (DW) assessment in Swedish and Danish HD units, and examined if differences in routines and utilization of bioimpedance spectroscopy (BIS) and other assistive technology affected frequency of DW adjustments and blood pressure (BP) levels. Cross-sectional information on praxis, guidelines and routines, plus treatment-related data from 99 stratified patients were collected. Qualitative data were analyzed with content analysis and interpreted in convergence with statistical analysis of quantitative data in a mixed-methods design. Local guidelines concerning DW existed in 54% of the units. A BIS device was present in 52%, but only half of those units used it regularly, and no correlations to frequency of DW adjustments or BP were found. HD nurses were authorized to adjust DW in 60% of the units; in these units, the frequency of DW adjustments was 1.6 times higher and systolic BP pre-HD 8 mmHg lower. There is a wide variation in routines for DW determination, and there are indications that authorization of HD nurses to adjust DW may improve DW assessment. BIS is sparsely used; its implementation may have been delayed by uncertainty over how to manage the device and interpret measurements. Hence, better methods and guidelines for assessing DW and using BIS need to be developed.

Keywords
Hemodialysis, dry weight, bioimpedance spectroscopy, guidelines, blood pressure, mixed-methods design
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-264132 (URN)10.1111/hdi.12336 (DOI)000369304400022 ()26264888 (PubMedID)
Available from: 2015-10-06 Created: 2015-10-06 Last updated: 2017-09-18Bibliographically approved
Friberg, S., Jansson, J., Westergren, E. & Lindberg, M. (2016). Grundutbildade sjuksköterskors upplevelse att börja arbeta på en barnavdelning. Nordisk sygeplejeforskning, 6(1), 20-33
Open this publication in new window or tab >>Grundutbildade sjuksköterskors upplevelse att börja arbeta på en barnavdelning
2016 (Swedish)In: Nordisk sygeplejeforskning, ISSN 1892-2678, E-ISSN 1892-2686, Vol. 6, no 1, p. 20-33Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe nurses trained to a basic level experience of starting work on a children's ward. A qualitative study has been conducted with a purposively drawn sample of informants. Semi-structured interviews were conducted with eight basic trained nurses. Data were analyzed using qualitative content analysis. The results showed that respondents felt that the pediatrics course is not preparing for the professional work with children. Most felt that it was through real situations in the workplace that they gained necessary knowledge. Furthermore, it was found that only a few were satisfied with the induction. Spending time with many different supervisors was an important factor for experiencing dissatisfaction with the induction. Good support was received from employees; however the support of the organization was poor. Conclusion: Today's undergraduate education in nursing does not include enough pediatrics to prepare students for professional work with children and adolescents. Actions at individual and workplace levels are needed to increase knowledge of the basic trained nurse. Continuity and support during the induction is important for newly employed nurses to feel competent in their work.

Place, publisher, year, edition, pages
SCANDINAVIAN UNIV PRESS, 2016
Keywords
children, general nurses, knowledge, safety, supervision
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-400178 (URN)10.18261/issn.1892-2686-2016-01-03 (DOI)000436681800003 ()
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2019-12-19Bibliographically approved
Erlingmark, J., Hedström, M. & Lindberg, M. (2016). Nurse staffing and renal anaemia outcomes in haemodialysis care. Journal of Renal Care, 42(3), 185-189
Open this publication in new window or tab >>Nurse staffing and renal anaemia outcomes in haemodialysis care
2016 (English)In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 42, no 3, p. 185-189Article in journal (Refereed) Published
Abstract [en]

Background: Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes.

Objectives: To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management.

Design: Cross-sectional audit.

Participants: Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data.

Measurements: The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management.

Results: The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres.

Conclusions: These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation.

Keywords
Haemodialysis, Haemoglobin, Nurse staffing, Renal anaemia, Transferrin saturation
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-300760 (URN)10.1111/jorc.12167 (DOI)000391014900007 ()27364918 (PubMedID)
Available from: 2016-07-08 Created: 2016-08-12 Last updated: 2017-11-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1289-9896

Search in DiVA

Show all publications