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Kempen, T., Hedström, M., Olsson, H., Johansson, A., Ottosson, S., Al-Sammak, Y. & Gillespie, U. (2019). Assessment tool for hospital admissions related to medications: development and validation in older patients. International Journal of Clinical Pharmacy, 41(1), 198-206
Open this publication in new window or tab >>Assessment tool for hospital admissions related to medications: development and validation in older patients
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2019 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 41, no 1, p. 198-206Article in journal (Refereed) Published
Abstract [en]

Background: Medication-related hospital admissions (MRAs) are frequently used to measure outcomes in studies involving medication reviews. The process of identifying MRAs is subjective and time-consuming, and practical, validated alternatives are required.

Objective: The aim of this study was to develop and validate a practical tool to identify MRAs. Setting Uppsala University Hospital, Sweden.

Method: We reviewed existing literature on methods to identify MRAs. The tool AT-HARM10 was developed using an iterative process including content validity and feasibility testing. The tool's inter-rater reliability (IRR) and criterion-related validity (CRV) were assessed: four pairs of either final-year undergraduate or postgraduate pharmacy students applied the tool to one of two batches of 50 older patients' hospital admissions. Assessment of the same 100 admissions by two experienced clinicians acted as gold standard.

Main outcome: measure Cohen's and Fleiss' kappa for IRR, and sensitivity, specificity, and positive and negative predictive value for CRV. Results AT-HARM10 consists of ten closed questions to distinguish between admissions that are unlikely to be and those that are possibly medication-related. The IRR was moderate to substantial (Cohen's kappa values were 0.45-0.75 and Fleiss' kappa values were 0.46 and 0.58). The sensitivity and specificity values were 70/86% and 74/70%, positive and negative predictive values were 73/74% and 71/83% respectively. Both AT-HARM10 and the gold standard identified approximately 50% of the admissions as MRAs.

Conclusion: AT-HARM10 has been developed as a practical tool to identify MRAs and the tool is valid for use in older patients by final-year undergraduate and postgraduate pharmacy students.

Place, publisher, year, edition, pages
SPRINGER, 2019
Keywords
Assessment tool, Drug-related problems, Elderly, Hospital admissions, Medication-related admissions, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-378388 (URN)10.1007/s11096-018-0768-8 (DOI)000458652000027 ()30585296 (PubMedID)
Funder
Thuréus stiftelse för främjande av geriatrisk forskningThe Swedish Heart and Lung Association, FA 2017:38]
Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-03-05Bibliographically approved
Hedström, M., Carlsson, M., Ekman, A., Gillespie, U., Mörk, C. & Åsberg, K. H. (2018). Development of the PHASE-Proxy scale for rating drug-related signs and symptoms in severe cognitive impairment. Aging & Mental Health, 22(1), 53-60
Open this publication in new window or tab >>Development of the PHASE-Proxy scale for rating drug-related signs and symptoms in severe cognitive impairment
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2018 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 1, p. 53-60Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The need for assessment of possible drug-related signs and symptoms in older people with severe cognitive impairment has increased. In 2009, the PHASE-20 rating scale for identifying symptoms possibly related to medication was the first such scale to be found valid and reliable for use with elderly people. In this project, the aim was to develop and examine the psychometric properties and clinical utility of PHASE-Proxy, a similar scale for proxy use in assessing elderly people with cognitive impairment.

METHODS: Three expert groups revised PHASE-20 into a preliminary proxy version, which was then tested for inter-rater reliability, internal consistency, and content validity. Its clinical usefulness was investigated by pharmacist-led medication reviews. Group interviews and a study-specific questionnaire with nursing home staff were used to investigate the feasibility of use.

RESULTS: The PHASE-Proxy scale had satisfactory levels of inter-rater reliability (Spearman's rank correlation coefficient; rs = 0.8), and acceptable internal consistency (Cronbach's alpha coefficient; α = 0.73). The factor analysis resulted in a logical solution with seven factors, grouped into two dimensions: signs of emotional distress and signs of physical discomfort. The medication reviews, interviews, and questionnaires also found the proxy scale to be clinically useful, and feasible to use.

CONCLUSION: The PHASE-Proxy scale appears to be a valid instrument that enables proxies to reliably assess nursing home residents who cannot participate in the assessment, to identify possible drug-related signs and symptoms. It also appears to be clinically useful and feasible for use in this population.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-303839 (URN)10.1080/13607863.2016.1232364 (DOI)000417735800008 ()27657536 (PubMedID)
Funder
Swedish National Board of Health and Welfare, 6.2.4-42858/2011
Available from: 2016-09-25 Created: 2016-09-25 Last updated: 2018-01-17Bibliographically approved
Pettersson, M., Hedström, M. & Höglund, A. T. (2018). Ethical competence in DNR decisions: a qualitative study of Swedish physicians and nurses working in hematology and oncology care. BMC Medical Ethics, 19, Article ID 63.
Open this publication in new window or tab >>Ethical competence in DNR decisions: a qualitative study of Swedish physicians and nurses working in hematology and oncology care
2018 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 63Article in journal (Refereed) Published
Abstract [en]

Background

DNR decisions are frequently made in oncology and hematology care and physicians and nurses may face related ethical dilemmas. Ethics is considered a basic competence in health care and can be understood as a capacity to handle a task that involves an ethical dilemma in an adequate, ethically responsible manner. One model of ethical competence for healthcare staff includes three main aspects: being, doing and knowing, suggesting that ethical competence requires abilities of character, action and knowledge. Ethical competence can be developed through experience, communication and education, and a supportive environment is necessary for maintaining a high ethical competence. The aim of the present study was to investigate how nurses and physicians in oncology and hematology care understand the concept of ethical competence in order to make, or be involved in, DNR decisions and how such skills can be learned and developed. A further aim was to investigate the role of guidelines in relation to the development of ethical competence in DNR decisions.

Methods

Individual interviews were conducted with fifteen nurses and sixteen physicians. The interviews were analyzed using thematic content analysis.

Results

Physicians and nurses in the study reflected on their ethical competence in relation to DNR decisions, on what it should comprise and how it could be developed. The ethical competence described by the respondents related to the concepts being, doing and knowing.

Conclusions

In order to make ethically sound DNR decisions in oncology and hematology care, physicians and nurses need to develop appropriate virtues, improve their knowledge of ethical theories and relevant clinical guidelines. Ethical competence also includes the ability to act upon ethical judgements. Continued ethical education and discussions for further development of a common ethical language and a good ethical working climate can improve ethical competence and help nurses and physicians cooperate better with regard to patients in relation to DNR decisions, in their efforts to act in the best interest of the patient.

Keywords
Ethical competence; DNR decisions; Oncology; Hematology; Nurses; Physicians
National Category
Medical Ethics
Identifiers
urn:nbn:se:uu:diva-355087 (URN)10.1186/s12910-018-0300-7 (DOI)000435613900002 ()29914440 (PubMedID)
Funder
Swedish Cancer Society
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2018-10-03Bibliographically approved
Pettersson, M., Höglund, A. T. & Hedström, M. (2018). Perspectives on the DNR decisions process: a survey of nurses and physicians in hematology and oncology. PLoS ONE, 13(11), Article ID e0206550.
Open this publication in new window or tab >>Perspectives on the DNR decisions process: a survey of nurses and physicians in hematology and oncology
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0206550Article in journal (Refereed) Published
Abstract [en]

Introduction

In cancer care, do-not-resuscitate (DNR) decisions are made frequently; i.e., decisions not to start the heart in the event of a cardiac arrest. A DNR decision can be a complex process involving nurses and physicians with a wide variety of experiences and perspectives. Previous studies have shown different perceptions of the DNR decision process among nurses and physicians, e.g. concerning patient involvement and information. DNR decisions have also been reported to be unclear and documentation inconsistent.

Objective

The aim was to investigate how important and how likely to happen nurses and physicians considered various aspects of the DNR decision process, regarding participation, information and documentation, as well as which attributes they found most important in relation to DNR decisions.

Methods

A descriptive correlational study using a web survey was conducted, including 132 nurses and 84 physicians working in hematology and oncology.

Results

Almost half of the respondents reported it not likely that the patient would be involved in the decision on DNR, and 21% found it unimportant to inform patients of the DNR decision. Further, 57% reported that providing information to the patient was important, but only 21% stated that this was likely to happen. There were differences between nurses and physicians, especially regarding participation by and information to patients and relatives. The attributes deemed most important for both nurses and physicians pertained more to medical viewpoints than to ethical values, but a difference was found, as nurses chose patient autonomy as the most important value, while physicians rated non-maleficence as the most important value in relation to DNR decisions.

Conclusion

Nurses and physicians need to be able to talk openly about their different perspectives on DNR decisions, so that they can develop a deeper understanding of the decisions, especially in cases where they disagree. They should also be aware that what they think is important is not always likely to happen. The organization needs to support such discussions through providing an environment that allows ethical discussions on regular basis. Patients and relatives will also benefit from receiving the same information from all caregivers.

National Category
Medical Ethics
Identifiers
urn:nbn:se:uu:diva-361787 (URN)10.1371/journal.pone.0206550 (DOI)000451054800020 ()30462673 (PubMedID)
Note

Contributed equally to this work: Mona Pettersson, Anna T. Höglund, Mariann Hedström

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-01-18Bibliographically 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
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
Ander, M., Grönqvist, H., Cernvall, M., Engvall, G., Hedström, M., Ljungman, G., . . . von Essen, L. (2016). Development of health-related quality of life and symptoms of anxiety and depression among persons diagnosed with cancer during adolescence: a 10-year follow-up study. Psycho-Oncology, 25(5), 582-589
Open this publication in new window or tab >>Development of health-related quality of life and symptoms of anxiety and depression among persons diagnosed with cancer during adolescence: a 10-year follow-up study
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2016 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, no 5, p. 582-589Article in journal (Refereed) Published
Abstract [en]

Objective: The main aim was to investigate the development of health-related quality of life (HRQOL) and symptoms of anxiety and depression in a cohort diagnosed with cancer during adolescence from shortly after up to 10 years after diagnosis.

Methods: Participants (n = 61) completed the SF-36 and the HADS shortly; six, 12, and 18 months; and two, three, four, and 10 years (n = 28) after diagnosis. Polynomial change trajectories were used to model development.

Results: Polynomial change trajectories showed an initial increase which abated over time into a decrease which abated over time for the SF-36 subscales Mental Health and Vitality; an initial decline which abated over time into an increase for HADS anxiety; and an initial decline which abated over time into an increase which abated over time for HADS depression. The SF-36 mental component summary showed no change from two to 10 years after diagnosis whereas the SF-36 physical component summary showed an increase from two years after diagnosis which declined over time. Ten years after diagnosis 29% reported possible anxiety.

Conclusions: Development of HRQOL and symptoms of anxiety and depression appears to be nonlinear among persons diagnosed with cancer during adolescence. Well into permanent survivorship an increase in symptoms of anxiety is shown and approximately a third of the participants report possible anxiety. The findings indicate the need for: studies designed to pinpoint the times of highest psychological risk, clinical follow-up focusing on psychological problems, and development of effective psychological interventions for survivors of adolescent cancer

National Category
Cancer and Oncology Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-262514 (URN)10.1002/pon.3965 (DOI)000374494700014 ()26361085 (PubMedID)
External cooperation:
Funder
Swedish Cancer Society, 99 0347 01 0235 02 0690 03 0227 05 0189 10 0649 11 0649 12 0649Swedish Childhood Cancer Foundation, 1999/021 02/002 04/011 07/044 10/086
Available from: 2015-09-16 Created: 2015-09-16 Last updated: 2017-12-04Bibliographically 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
Pettersson, M., Hedström, M. & Höglund, A. T. (2014). Striving for good nursing care: Nurses' experiences of do not resuscitate orders within oncology and hematology care. Nursing Ethics, 21(8), 902-915
Open this publication in new window or tab >>Striving for good nursing care: Nurses' experiences of do not resuscitate orders within oncology and hematology care
2014 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 21, no 8, p. 902-915Article in journal (Refereed) Published
Abstract [en]

Background: Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce.

Objective: The aim of this study was to investigate hematology and oncology nurses’ experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses’ specific role in these decisions.

Research design: A qualitative, descriptive methodology with individual semi-structured interviews was used.

Participants and research context: A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually.

Ethical considerations: In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration.

Findings: The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties.

Conclusion: In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other’s opinions within the medical team, regular ethical discussions are required.

National Category
Medical Ethics
Identifiers
urn:nbn:se:uu:diva-239297 (URN)10.1177/0969733014533238 (DOI)
Available from: 2014-12-22 Created: 2014-12-22 Last updated: 2018-10-03
Kirsebom, M., Wadensten, B. & Hedström, M. (2013). Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement. Journal of Advanced Nursing, 69(4), 886-895
Open this publication in new window or tab >>Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement
2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 4, p. 886-895Article in journal (Refereed) Published
Abstract [en]

Aim:

To investigate registered hospital and nursing home nurses' experiencesof coordination and communication within and between care settings when olderpersons are transferred from nursing homes to hospital and vice versa.

Background:

It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon.

Design:

A descriptive study design with a qualitative approach was used.

Methods:

In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.

Results:

Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospitalregistered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursinghome registered nurses suggested increased collaboration to understand each other's work situation better.

Conclusion:

Communication and coordination among hospital andnursing home registered nurses need to be furthered improved. Registered nurses'coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursingcare and unnecessary transfer and admission to hospital.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-186141 (URN)10.1111/j.1365-2648.2012.06077.x (DOI)000316285400014 ()
Available from: 2012-11-28 Created: 2012-11-28 Last updated: 2017-12-07
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6296-0160

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