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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
Hovén, E., Hagström, J., Pöder, U., Grönqvist, H. & von Essen, L. (2019). Parents' needs of support following the loss of a child to cancer: a Swedish, prospective, longitudinal, multi-centre study. Acta Oncologica
Open this publication in new window or tab >>Parents' needs of support following the loss of a child to cancer: a Swedish, prospective, longitudinal, multi-centre study
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2019 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226XArticle in journal (Refereed) Published
Abstract [en]

Introduction: Parents' needs of support following the loss of a child to cancer and whether these needs are met are not fully known. This study aimed to describe parents' needs, opportunity, and benefit of support from healthcare professionals and significant others from shortly after, up to five years after bereavement.

Material and methods: Data were collected at nine months (T5, n = 20), eighteen months (T6, n = 37), and five years after the child's death (T7, n = 38). Parents answered questions via telephone about need, opportunity, and benefit of talking to psychologists, social workers, partners, and friends. Needs were examined in relation to parent and child characteristics, including sex, age, and parent posttraumatic stress symptoms (PTSS).

Results: The proportion reporting a need of support from psychologists varied from 56% and 46% at T5 to 20% and 6% at T7 (mothers and fathers, respectively). All mothers and 90% of fathers reported a need of support from social workers at T5. At T7, the corresponding percentages were 30% and 6%. More mothers than fathers reported a need of support from friends at T7 (p = .001). The proportion reporting a need of support from psychologists, social workers, and friends decreased over time (all p <= .050). Parents reporting a higher level of PTSS were more likely to report a need of support from social workers at T6 (p = .040) and from psychologists (p = .011) and social workers (p = .012) at T7. Opportunities for support from healthcare professionals varied, most reported need of and opportunity for support from significant others. Almost all reported benefit from received support.

Conclusion: Bereaved parents need and benefit of support from healthcare professionals and significant others. Results show a need for improved access to psychosocial services, even at five years post bereavement. Large-scale studies are needed to better understand the associations between parent and child characteristics and support needs.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-397598 (URN)10.1080/0284186X.2019.1686535 (DOI)000495183800001 ()31702406 (PubMedID)
Funder
Swedish Research Council, K2008-70X-20836-01-3Swedish Research Council, K2011-70X-20836-04-4Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 2007/1015Swedish Cancer Society, 2010/726Swedish Cancer Society, 2013/580Swedish Cancer Society, 2014/613Swedish Childhood Cancer Foundation, PROJ08/010
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2020-02-20Bibliographically approved
Karlsson, A.-C., Gunningberg, L., Bäckström, J. & Pöder, U. (2019). Registered nurses' perspectives of work satisfaction, patient safety and intention to stay: A double-edged sword. Journal of Nursing Management, 27(7), 1359-1365
Open this publication in new window or tab >>Registered nurses' perspectives of work satisfaction, patient safety and intention to stay: A double-edged sword
2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 7, p. 1359-1365Article in journal (Refereed) Published
Abstract [en]

Aim

To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these.

Background

Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment.

Method

Descriptive design with 25 qualitative interviews.

Results

Five categories were identified: RNs feel satisfied when providing person‐centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal.

Conclusion

Registered nurses' job satisfaction could be described as a double‐edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety.

Implications for Nursing Management

Our findings suggest that nursing leadership can increase RNs’ intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.

Keywords
intention to stay, job satisfaction, nursing, patient safety, qualitative research
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-398834 (URN)10.1111/jonm.12816 (DOI)000481332800001 ()31211908 (PubMedID)
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2019-12-12Bibliographically 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 Sciences
Identifiers
urn:nbn:se:uu:diva-337410 (URN)10.1186/s12913-018-3629-1 (DOI)000449346000002 ()30400985 (PubMedID)
Available from: 2017-12-26 Created: 2017-12-26 Last updated: 2020-01-10Bibliographically 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: 2020-02-24Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2867-0490

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