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Wadensten, Barbro
Publications (10 of 57) Show all publications
Umb-Carlsson, Õ. & Wadensten, B. (2018). Professional practice‐related training and organizational readiness for change facilitate implementation of projects on the national core value system in care of older people. Nursing Open, 5(4), 593-600
Open this publication in new window or tab >>Professional practice‐related training and organizational readiness for change facilitate implementation of projects on the national core value system in care of older people
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 4, p. 593-600Article in journal (Refereed) Published
Abstract [en]

Aim: To explore whether professional training contributed to implementation of the national core value system in practice in care of older people and to identify course participants' perceptions about factors that facilitated or obstructed them in implementing their projects. To identify participants' perceptions concerning factors that facilitate or obstruct implementation.

Design: Descriptive and cross‐sectional.

Methods: Data were retrieved from 451 participants who had completed the course “Understanding and providing leadership based on the national core value system for older people” at Uppsala University during spring semester and autumn semester of 2018. Quantitative and qualitative data were obtained using a web‐based questionnaire.

Results: The results showed that the majority (73%) of project plans were initiated, although not always completed and sometimes interrupted. Organizational readiness in terms of management supporting and prioritizing these plans were two principle facilitators chosen by half of the respondents and consequently the absence of these factors was an obstacle. In addition, successful implementation required dedicated co‐workers and certain resources, such as time and funds. Surprisingly, factors related to the project leader were reported to be of limited importance.

Keywords
elder care, nurses, nursing, older people, Sweden
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-358070 (URN)10.1002/nop2.185 (DOI)000446838700016 ()30338105 (PubMedID)
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-12-10Bibliographically approved
Bjurling-Sjöberg, P., Wadensten, B., Pöder, U., Jansson, I. & Nordgren, L. (2018). Struggling for a feasible tool - the process of implementing a clinical pathway in intensive care: A grounded theory study. BMC Health Services Research, 18, Article ID 831.
Open this publication in new window or tab >>Struggling for a feasible tool - the process of implementing a clinical pathway in intensive care: A grounded theory study
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 831Article in journal (Refereed) Published
Abstract [en]

Background: Clinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.

Methods: The setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.

Results: A conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as 'Struggling for a feasible tool,' was the core category that linked all categories. The phenomenon evolved from the 'Triggers' ('Perceiving suboptimal practice' and 'Receiving external inspiration and support'), pervaded the 'Implementation process' ('Contextual circumstances,' 'Processual circumstances' and 'Negotiating to achieve progress'), and led to the process 'Output' ('Varying utilization' and 'Improvements in understanding and practice'). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.

Conclusions: The findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-364675 (URN)10.1186/s12913-018-3629-1 (DOI)000449346000002 ()30400985 (PubMedID)
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2019-01-04Bibliographically approved
Bjurling-Sjöberg, P., Wadensten, B., Pöder, U., Jansson, I. & Nordgren, L. (2017). Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice. Journal of Interprofessional Care, 31(2), 233-244
Open this publication in new window or tab >>Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice
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2017 (English)In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 31, no 2, p. 233-244Article in journal (Refereed) Published
Abstract [en]

This study aimed to describe and explain teamwork and factors that influence team processes in everyday practice in an intensive care unit (ICU) from a staff perspective. The setting was a Swedish ICU. Data were collected from 38 ICU staff in focus groups with registered nurses, assistant nurses, and anaesthetists, and in one individual interview with a physiotherapist. Constant comparative analysis according to grounded theory was conducted, and to identify the relations between the emerged categories, the paradigm model was applied. The core category to emerge from the data was balancing intertwined responsibilities. In addition, eleven categories that related to the core category emerged. These categories described and explained the phenomenon's contextual conditions, causal conditions, and intervening conditions, as well as the staff actions/interactions and the consequences that arose. The findings indicated that the type of teamwork fluctuated due to circumstantial factors. Based on the findings and on current literature, strategies that can optimise interprofessional teamwork are presented. The analysis generated a conceptual model, which aims to contribute to existing frameworks by adding new dimensions about perceptions of team processes within an ICU related to staff actions/interactions. This model may be utilised to enhance the understanding of existing contexts and processes when designing and implementing interventions to facilitate teamwork in the pursuit of improving healthcare quality and patient safety.

Keywords
Grounded theory, intensive care unit, interprofessional care, interviews, practice, roles, teamwork
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-317286 (URN)10.1080/13561820.2016.1255184 (DOI)000395098400017 ()28140715 (PubMedID)
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2018-01-29Bibliographically approved
Hagerman, H., Högberg, H., Skytt, B., Wadensten, B. & Engström, M. (2017). Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study. Journal of Nursing Management, 25(8), 647-656
Open this publication in new window or tab >>Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study
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2017 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 8, p. 647-656Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Keywords
first-line manager, leadership-management performance, linear mixed model, structural and psychological empowerment, subordinate
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-331770 (URN)10.1111/jonm.12504 (DOI)000414511300009 ()28714218 (PubMedID)
Funder
AFA Insurance
Available from: 2017-10-17 Created: 2017-10-17 Last updated: 2019-03-15Bibliographically approved
Kirsebom, M., Hedström, M., Pöder, U. & Wadensten, B. (2017). General practitioners' experiences as nursing home medical consultants. Scandinavian Journal of Caring Sciences, 31(1), 37-44
Open this publication in new window or tab >>General practitioners' experiences as nursing home medical consultants
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 37-44Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To describe general practitioners' experiences of being the principal physician responsible for a nursing home.

METHOD:

Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation.

RESULT:

Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

CONCLUSION:

The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems.

Keywords
Advance care planning, general practitioners
National Category
Nursing
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-300896 (URN)10.1111/scs.12310 (DOI)000394988700004 ()
Available from: 2016-08-15 Created: 2016-08-15 Last updated: 2017-04-19Bibliographically approved
Carlsson, T., Melander, M. U., Wadensten, B., Bergman, G., Axelsson, O. & Mattsson, E. (2017). Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis. Interactive Journal of Medical Research, 6(2), Article ID e15.
Open this publication in new window or tab >>Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis
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2017 (English)In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 6, no 2, article id e15Article in journal (Refereed) Published
Abstract [en]

Background: When a heart defect is prenatally diagnosed in the fetus, expectant parents experience a great need for information about various topics. After the diagnosis, the Web is used for supplemental information, and the scarcity of research calls attention to the need to explore patient information websites from the perspectives of the intended consumers.

Objective: The overarching aim of this study was to explore the quality of Swedish patient information websites about congenital heart defects, from the perspectives of individuals with experience of a prenatal diagnosis of congenital heart defect in the fetus.

Methods: This was a mixed-methods study of websites identified through systematic searches in the two most used Web-based search engines. Of the total 80 screened hits, 10 hits led to patient information websites about congenital heart defects. A quality assessment tool inspired by a previous study was used to evaluate each website’s appearance, details, relevance, suitability, information about treatment choices, and overall quality. Answers were given on a 5-point Likert scale, ranging from 1, representing the lowest score, to 5, representing the highest score. Each website was assessed individually by persons with experience of continued (n=4) and terminated (n=5) pregnancy following a prenatal diagnosis. Assessments were analyzed with Kendall’s coefficient of concordance W, Mann-Whitney U test, Friedman’s test, and a Wilcoxon-Nemenyi-McDonald-Thompson test. In addition, each assessor submitted written responses to open-ended questions in the quality assessment tool, and two joint focus group discussions were conducted with each group of assessors. The qualitative data were analyzed with inductive manifest content analysis.

Results: Assessments represented a low score (median=2.0) for treatment choices and moderate scores (median=3.0) for appearance, details, relevance, suitability, and overall quality. No website had a median of the highest achievable score for any of the questions in the quality assessment tool. Medians of the lowest achievable score were found in questions about treatment choices (n=4 websites), details (n=2 websites), suitability (n=1 website), and overall quality (n=1 website). Websites had significantly different scores for appearance (P=.01), details (P<.001), relevance (P<.001), suitability (P<.001), treatment choices (P=.04), and overall quality (P<.001). The content analysis of the qualitative data generated six categories: (1) advertisements, (2) comprehensiveness, (3) design, (4) illustrations and pictures, (5) language, and (6) trustworthiness. Various issues with the included websites were highlighted, including the use of inappropriate advertisements, biased information, poor illustrations, complex language, and poor trustworthiness.

Conclusions: From the perspectives of the intended consumers, patient information websites about congenital heart defects are, to a large extent, inadequate tools for supplemental information following a prenatal diagnosis. Health professionals should initiate discussions with patients about their intentions to use the Web, inform them about the varied quality in the Web-based landscape, and offer recommendations for appropriate Web-based sources.

Keywords
congenital heart defects, consumer health information, information literacy, Internet, popular works, pregnancy, prenatal diagnosis
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-328480 (URN)10.2196/ijmr.7844 (DOI)000415945500008 ()28899846 (PubMedID)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2017-12-19Bibliographically approved
Kirsebom, M., Hedström, M., Pöder, U. & Wadensten, B. (2017). Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates. Nursing Open, 4(1), 41-48
Open this publication in new window or tab >>Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates
2017 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 1, p. 41-48Article in journal (Refereed) Published
Abstract [en]

Aim: To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department.

Design: Explorative.

Method: In a single municipality, qualitative and quantitative data were collected from documents and through semi-structured interviews with 11 RNs from five nursing homes identified as having the highest vs. six identified as having the lowest transfer rates to emergency department. Data were analysed by non-parametric tests and basic content analysis.

Results: All nursing homes in the highest transfer rate group and one in the lowest transfer rate group were run by private for-profit providers. Compared with the low group, the high group had fewer updated advance care plans and the RNs interviewed had less work experience in care of older people and less training in care of persons with dementia. There was no difference in nursing home size or staff/resident ratio. The RNs described similar possibilities to provide palliative care, medical equipment and perceived medical support from GPs.

Keywords
advance care planning, avoidable hospitalization, geriatric nursing, hospital admission, nursing homes, organization and administration
National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:uu:diva-259340 (URN)10.1002/nop2.68 (DOI)000390566200005 ()
Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04Bibliographically approved
Hagerman, H., Skytt, B., Wadensten, B., Högberg, H. & Engström, M. (2016). A longitudinal study of working life among first-line managers in the care of older adults. Applied Nursing Research, 32, 7-13
Open this publication in new window or tab >>A longitudinal study of working life among first-line managers in the care of older adults
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2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 7-13Article in journal (Refereed) Published
Abstract [en]

Aim: To study whether the number of subordinates plays a role in first-line managers' and subordinates' ratings of empowerment, stress symptoms, and leadership-management performance. The aim was also to study relationships between managers' empowerment and stress symptoms and leadership-management performance. Methods: A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached. Results: With fewer (<= 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with >= 31 subordinates. Furthermore, structural empowerment was related to the managers' stress symptoms and leadership management performance, mediated through psychological empowerment Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms. Conclusion: The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership-management performance they rated over time.

Keywords
First-line manager, Leadership-management performance, Number of subordinates, Stress symptoms, Structural and psychological empowerment
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-310763 (URN)10.1016/j.apnr.2016.03.003 (DOI)000388057100002 ()27969055 (PubMedID)
Funder
AFA Insurance
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2019-03-15Bibliographically approved
Carlsson, T., Bergman, G., Wadensten, B. & Mattsson, E. (2016). Experiences of Informational Needs and Received Information Following a Prenatal Diagnosis of Congenital Heart Defect. Prenatal Diagnosis, 36(6), 515-522
Open this publication in new window or tab >>Experiences of Informational Needs and Received Information Following a Prenatal Diagnosis of Congenital Heart Defect
2016 (English)In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 36, no 6, p. 515-522Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore the need for information and what information was actually received following a prenatal diagnosis of a congenital heart defect, in a country where termination of pregnancy beyond 22 weeks of gestation is not clinically performed.

METHODS: Twenty-six Swedish-speaking pregnant women (n = 14) and partners (n = 12) were consecutively recruited for semi-structured telephone interviews following the prenatal diagnosis of congenital heart defect. Data was analyzed using content analysis.

RESULTS: Although high satisfaction with the specialist information was described, the information was considered overwhelming and complex. Objective, honest and detailed information about multiple subjects were needed, delivered repeatedly and supplemented by written information/illustrations. Eighteen respondents had used the Internet to search for information and found issues involving searching difficulties, low quality, and that it was too complex, insufficient or unspecific. Those who terminated the pregnancy criticized that there was a lack of information about termination of pregnancy, both from health professionals and online sources, resulting in unanswered questions and unpreparedness.

CONCLUSION: Individuals faced with a prenatal diagnosis of a congenital heart defect need individualized and repeated information. These needs are not all adequately met, as individuals are satisfied with the specialist consultation but left with unanswered questions regarding pregnancy termination.

National Category
Medical and Health Sciences Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-281384 (URN)10.1002/pd.4815 (DOI)000378541100003 ()26991536 (PubMedID)
Available from: 2016-03-23 Created: 2016-03-23 Last updated: 2017-11-30Bibliographically approved
Carlsson, T., Bergman, G., Karlsson, A.-M., Wadensten, B. & Mattsson, E. (2016). Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages. Midwifery, 41, 54-60
Open this publication in new window or tab >>Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages
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2016 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 41, p. 54-60Article in journal (Refereed) Published
Abstract [en]

Objective: to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly.

Design: cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis.

Setting: two large and active Swedish virtual communities.

Sample: 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination).

Measurements and findings: before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child.

Key conclusions: spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences.

Implications for practice: information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies. 

Keywords
Antenatal diagnosis; Induced abortion; Life change events; Prenatal diagnosis; Social media; Reproductive behaviour
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-301105 (URN)10.1016/j.midw.2016.08.001 (DOI)000385927800008 ()27543968 (PubMedID)
Funder
Swedish Society of Medicine
Available from: 2016-08-18 Created: 2016-08-18 Last updated: 2017-11-28Bibliographically approved
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