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Pöder, Ulrika
Publications (10 of 28) Show all publications
Hedman, M., Häggström, E., Mamhidir, A.-G. & Pöder, U. (2019). Caring in nursing homes to promote autonomy and participation. Nursing Ethics, 26(1), 280-292
Open this publication in new window or tab >>Caring in nursing homes to promote autonomy and participation
2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 1, p. 280-292Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care.

OBJECTIVE: The purpose was to describe registered nurses' experience of caring for older people in nursing homes to promote autonomy and participation.

RESEARCH DESIGN: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was inspired by Giorgi's method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed.

FINDINGS: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses' awareness of older people's frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons' wishes were aspects that relied on registered nurses' trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people's right to autonomy and participation in nursing homes. Registered nurses' strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people.

DISCUSSION AND CONCLUSION: Awareness of older people's frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people's and healthcare personnel's perspectives, to promote autonomy and participation for residents in nursing homes.

Keywords
Autonomy, nursing home, older people, participation, phenomenology, registered nurse
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-342895 (URN)10.1177/0969733017703698 (DOI)000458874900027 ()28425315 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2019-08-01Bibliographically 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
Viktorisson, A., Sunnerhagen, K. S., Pöder, U., Herlitz, J. & Axelsson, Å. B. (2018). Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden. BMJ Open, 8(6), Article ID e021729.
Open this publication in new window or tab >>Well-being among survivors of out-of-hospital cardiac arrest: a cross-sectional retrospective study in Sweden
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e021729Article in journal (Refereed) Published
Abstract [en]

Objectives The psychological outcome of out-of-hospital cardiac arrest (OHCA) has been studied more extensively in recent years. Still, not much is known about the well-being among OHCA survivors. In this retrospective cross-sectional study, we aim to investigate post-OHCA well-being among patients with a good neurological outcome, 3 months after the cardiac event. To assess well-being, we analyse the frequency of anxiety, depression, post-traumatic stress disorder (PTSD) and health within this group. Further, we aim to evaluate the importance of five prognostic factors for post-OHCA well-being. Methods Data collection took place between 2008 and 2012, and every OHCA survivor within one region of Sweden, with a cerebral performance category (CPC) score of <= 2 at discharge, was asked to participate. Survivors were identified through the Swedish Cardiopulmonary Resuscitation Registry, and postal questionnaires were sent out 3 months after the OHCA. The survey included Hospital Anxiety and Depression scale (HADS), PTSD Checklist Civilian version (PCL-C) and European Quality of Life 5 Dimensions 3 level (EQ-5D-3L). Results Of 298 survivors, 150 were eligible for this study and 94 responded. The mean time from OHCA to follow-up was 88 days. There was no significant difference between respondents and non-respondents in terms of sex, age, cardiac arrest circumstances or in-hospital interventions. 48 participants reported reduced well-being, and young age was the only factor significantly correlated to this outcome (p=0.02). Women reported significantly higher scores in HADS (p=0.001) and PCL-C (p<0.001). Women also reported significantly lower EQ-5D index values (p=0.002) and EQ-visual analogue scale scores (p=0.002) compared with men. Conclusion Reduced well-being is experienced by half of OHCA survivors with a CPC score <= 2, and young age is negatively correlated to this outcome. The frequency of anxiety and PTSD is higher among women, who also report worse health.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-360545 (URN)10.1136/bmjopen-2018-021729 (DOI)000435567900095 ()29880571 (PubMedID)
Funder
Region Västra Götaland, VGFOUREG-78031
Available from: 2018-09-20 Created: 2018-09-20 Last updated: 2018-09-20Bibliographically 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
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
Knudsen, K., Pöder, U., Nilsson, U., Högman, M., Larsson, A. & Larsson, J. (2017). How anaesthesiologists understand difficult airway guidelines: an interview study. Upsala Journal of Medical Sciences, 122(4), 243-248
Open this publication in new window or tab >>How anaesthesiologists understand difficult airway guidelines: an interview study
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2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 243-248Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms.

METHODS: A qualitative phenomenographic design was chosen to explore anaesthesiologists' views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted.

RESULTS: Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts' consensus, a set of scientifically based guidelines for handling the difficult airway.

CONCLUSIONS: The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Airway guidelines, algorithms, qualitative study
National Category
Medical and Health Sciences Work Sciences
Identifiers
urn:nbn:se:uu:diva-342931 (URN)10.1080/03009734.2017.1406020 (DOI)000423294800006 ()29299973 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-03-15Bibliographically approved
Hovén, E., Grönqvist, H., Pöder, U., von Essen, L. & Lindahl Norberg, A. (2017). Impact of a child’s cancer disease on parents’ everyday life: A longitudinal study from Sweden. Acta Oncologica, 56(1), 93-100
Open this publication in new window or tab >>Impact of a child’s cancer disease on parents’ everyday life: A longitudinal study from Sweden
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2017 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 56, no 1, p. 93-100Article in journal (Refereed) Published
Abstract [en]

Background: A child's cancer disease may disrupt the daily life of the affected family for a long period. The aim was to describe restrictions on parents' leisure activities and work/studies during and after the child's treatment. Methods: This study used data from a cohort of mothers and fathers (n = 246) of children diagnosed with cancer. Data was collected five times from two months after diagnosis to one year after end of treatment. Reports of restrictions were evaluated over time, between mothers and fathers, and in relation to parent-reported child symptom burden (The Memorial Symptom Assessment Scale) and partial post-traumatic stress disorder (PTSD) (The PTSD Checklist-Civilian Version). Results: Two (51%) and four (45%) months after diagnosis, about half reported that their leisure activities were restricted at least some of the time. Corresponding percentages for restrictions on work/ studies were 84% and 77%. One year after end of treatment, the great majority reported that their leisure activities (91%) and/or work/studies (76%) were never/seldom restricted. During treatment, more mothers than fathers reported restrictions on work/studies all/most of the time. After end of treatment, gender was only related to reports of restrictions among parents not reporting partial PTSD. More parents who reported being restricted all/most of the time also reported partial PTSD and/or a greater symptom burden for the child. Conclusion: Parents report frequent restrictions on everyday life during treatment. One year after end of treatment, parents report only a limited impact of the child's cancer on their leisure activities and work/studies. More parents who report restrictions also report partial PTSD and/or a greater child symptom burden. The effect of gender on restrictions varies depending on reports of partial PTSD. Future studies of gender differences regarding the impact of a child's cancer on parents' everyday life should thus consider mothers' and fathers' level of psychological distress.

National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology Psychology
Identifiers
urn:nbn:se:uu:diva-306725 (URN)10.1080/0284186X.2016.1250945 (DOI)000392819600015 ()27834555 (PubMedID)
Funder
Swedish Childhood Cancer Foundation, PROJ08/010Swedish Research Council, K2008-70X-20836-01-3 K2011-70X-20836-04-4 K2015-99X-20836-08-4Swedish Cancer Society, 2007/1015 2010/726
Available from: 2016-11-03 Created: 2016-11-03 Last updated: 2018-02-28Bibliographically 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
Knudsen, K., Nilsson, U., Högman, M. & Pöder, U. (2016). Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study. BMC Anesthesiology, 16, Article ID 71.
Open this publication in new window or tab >>Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study
2016 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, article id 71Article in journal (Refereed) Published
Abstract [en]

Background Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. Methods A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories. Results From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself. Conclusions Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

Keywords
Awake fiberoptic intubation, Anaesthesia care, Qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-281381 (URN)10.1186/s12871-016-0240-z (DOI)000382199100004 ()27576876 (PubMedID)
Available from: 2016-03-30 Created: 2016-03-23 Last updated: 2017-11-30Bibliographically approved
Gunningberg, L., Pöder, U. & Carli, C. (2016). Facilitating student nurses' learning by real time feedback of positioning to avoid pressure ulcers--Evaluation of clinical simulation. Journal of Nursing Education and Practice, 6(1)
Open this publication in new window or tab >>Facilitating student nurses' learning by real time feedback of positioning to avoid pressure ulcers--Evaluation of clinical simulation
2016 (English)In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 6, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Reduction of pressure and shear is recognised as the single most important intervention in order to prevent pressure ulcers (PU). Recently, an objective way to measure and receive feedback about the amount of pressure at the body-mattress interface has become available.  Using such feedback in a simulated scenario in which there is a hypothetical risk for pressure ulcer development may prepare students in a safe and controlled environment for clinical placements. The aim of the study was to assess whether student nurses’ learning about optimal repositioning could be facilitated by real-time feedback in a simulated PU prevention scenario.

Methods: A quantitative study was performed in the Clinical Training Center using a descriptive, comparative design. Student nurses from the second (n = 24) and last (n = 32) semesters worked in pairs. Their task was to place two volunteers (69 and 70 years) in the best pressure-reducing position (lateral and supine), initially without access to the pressure mapping monitor and then again after feedback. In total 232 positionings were conducted.

Results: Despite the controlled environment, there was considerable variation in peak-pressure readings between student pairs Mean peak pressures were consistently higher in the lateral position compared with the supine, both before and after feedback. After feedback from the pressure mapping monitor, most peak pressure readings were significantly reduced and the number of preventive interventions and patients’ comfort had increased.

Conclusions: Including simulation of PU prevention in the nursing curriculum provides the possibility for students to train repositioning in a safe environment. The immediate feedback from the pressure monitoring system may strengthen students’ confidence and competence on clinical placements.

National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-269051 (URN)10.5430/jnep.v6n1p1 (DOI)
Available from: 2015-12-13 Created: 2015-12-13 Last updated: 2017-12-01Bibliographically approved
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