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Muntlin Athlin, ÅsaORCID iD iconorcid.org/0000-0002-7221-2876
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Publications (10 of 30) Show all publications
Jeffs, L., Muntlin Athlin, Å., Needleman, J., Jackson, D. & Kitson, A. (2018). Building the Foundation to Generate a Fundamental Care Standardized Data Set. Journal of Clinical Nursing
Open this publication in new window or tab >>Building the Foundation to Generate a Fundamental Care Standardized Data Set
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2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Accepted
Abstract [en]

Considerable transformation is occurring in healthcare globally with organizations focusing on achieving the quadruple aim of improving the experience of care, the health of populations, and the experience of providing care while reducing per capita costs of health care. In response, health care organizations are employing performance measurement and quality improvement methods to achieve the quadruple aim. Despite the plethora of measures available to health managers, there is no standardized data set and virtually no indicators reflecting how patients actually experience the delivery of fundamental care, such as nutrition, hydration, mobility, respect, education, and psychosocial support. Given the linkages of fundamental care to safety and quality metrics, efforts to build the evidence base and knowledge that captures the impact of enacting fundamental care across the health care continuum and lifespan should include generating a routinely collected data set of relevant measures. This paper provides an overview of the current state of performance measurement, key trends, and a methodological approach to leverage in efforts to generate a standardized data set for fundamental care.

National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-342067 (URN)10.1111/jocn.14308 (DOI)29446500 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-03-08Bibliographically approved
Muntlin Athlin, Å., Brovall, M., Wengström, Y., Conroy, T. & Kitson, A. (2018). Descriptions of Fundamental Care needs in cancer care: an exploratory study. Journal of Clinical Nursing
Open this publication in new window or tab >>Descriptions of Fundamental Care needs in cancer care: an exploratory study
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2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims and objectives

To explore the experiences of the fundamentals of care for people with a cancer diagnosis, from diagnosis to after adjuvant treatment.

Background

More focus is needed on the experience of people living with cancer, as current cancer care more emphasises on independence and resilience without fully acknowledging that there will be moments in the cancer journey where patients will need ‘basic nursing care’ to manage their symptoms and care pathways.

Design

Secondary analysis of qualitative data.

Method

Secondary thematic analysis of interview data from 30 people with a diagnosis of breast (n=10), colorectal (n=10) or prostate (n=10) cancer was undertaken.

Results

The findings revealed vivid descriptions of the fundamentals of care (i.e. basic needs) and participants described physical, psychosocial and relational aspects of the delivery of care. Both positive (e.g. supportive and kind) and negative (e.g. humiliating) experiences related to the relationship with the healthcare professionals were re-counted and affected the participants’ experiences of the fundamentals of care. Participants’ accounts of their fundamental care needs were provided without them identifying who, within the health care system, was responsible for providing these needs. Specific nursing interventions were seldom described.

Conclusion

Some people with a cancer diagnosis have to strive for help and support from the nursing staff to manage to regain control over their recovery. Nurses in cancer care need to focus on the patients’ fundamental care needs to optimise their patients’ recovery.

National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-342064 (URN)10.1111/jocn.14251 (DOI)29292542 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-03-15Bibliographically approved
Muntlin Athlin, Å. (2018). Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care: A scoping literature review. Journal of Clinical Nursing
Open this publication in new window or tab >>Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care: A scoping literature review
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims and objectives

To examine and map research on minimum data sets linked to nursing practice and the fundamentals of care. Another aim was to identify gaps in the evidence to suggest future research questions to highlight the need for standardisation of terminology around nursing practice and fundamental care.

Background

Addressing fundamental care has been highlighted internationally as a response to missed nursing care. Systematic performance measurements are needed to capture nursing practice outcomes.

Design

Overview of the literature framed by the scoping study methodology.

Method

PubMed and CINAHL were searched using the following inclusion criteria: peer‐reviewed empirical quantitative and qualitative studies related to minimum data sets and nursing practice published in English. No time restrictions were set. Exclusion criteria were as follows: no available full text, reviews and methodological and discursive studies. Data were categorised into one of the fundamentals of care elements.

Results

The review included 20 studies published in 1999–2016. Settings were mainly nursing homes or hospitals. Of 14 elements of the fundamentals of care, 11 were identified as measures in the included studies, but their frequency varied. The most commonly identified elements concerned safety, prevention and medication (n = 11), comfort (n = 6) and eating and drinking (n = 5).

Conclusion

Studies have used minimum data sets and included variables linked to nursing practices and fundamentals of care. However, the relations of these variables to nursing practice were not always clearly described and the main purpose of the studies was seldom to measure the outcomes of nursing interventions. More robust studies focusing on nursing practice and patient outcomes are warranted.

National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-342058 (URN)10.1111/jocn.14155 (DOI)29119641 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-03-23Bibliographically approved
Feo, R., Conroy, T., Jangland, E., Muntlin Athlin, Å., Brovall, M., Parr, J., . . . Kitson, A. (2018). Towards a standardised definition for fundamental care: A modified Delphi study. Journal of Clinical Nursing
Open this publication in new window or tab >>Towards a standardised definition for fundamental care: A modified Delphi study
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2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS AND OBJECTIVES:

To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.

BACKGROUND:

There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.

DESIGN:

Modified Delphi study.

METHODS:

Three phases: (i) engaging stakeholders via an interactive workshop; (ii) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (iii) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n = 38; Round 2 n = 28).

RESULTS:

Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.

CONCLUSIONS:

This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users.

RELEVANCE TO CLINICAL PRACTICE:

The definition and elements, through ongoing refinement, will contribute to a robust evidence base that will underpin policy development and the systematic and effective teaching, delivery, measurement and evaluation of fundamental care.

National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-342060 (URN)10.1111/jocn.14247 (DOI)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-04-05Bibliographically approved
Athlin, Å. M., Juhlin, C. & Jangland, E. (2017). Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain. Journal of Evaluation In Clinical Practice, 23(1), 89-95
Open this publication in new window or tab >>Lack of existing guidelines for a large group of patients in Sweden: a national survey across the acute surgical care delivery chain
2017 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 1, p. 89-95Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectivesEvidence-informed healthcare is the fundament for prac-tice, whereby guidelines based on the best available evidence should assist health profes-sionals in managing patients. Patients seeking care for acute abdominal pain form acommon group in acute care settings worldwide, for whom decision-making and timelytreatment are of paramount importance. There is ambiguity about the existence, use andcontent of guidelines for patients with acute abdomen. The objective was to describe andcompare guidelines and management of patients with acute abdomen in different settingsacross the acute care delivery chain in Sweden.MethodA national cross-sectional design was used. Twenty-nine ambulance stations, 17emergency departments and 33 surgical wards covering all six Swedish health regions wereincluded, and 23 guidelines were quality appraised using the validated Appraisal of Guide-lines for Research & Evaluation II tool.ResultsThere is a lack of guidelines in use for the management of this large group of pa-tients between and within different healthcare areas across the acute care delivery chain.The quality appraisal identified that several guidelines were of poor quality, especiallythe in-hospital ones. Further, range orders for analgesics are common in the ambulance ser-vices and the surgical wards, but are seldom present in the emergency departments. Also,education in pain management is more common in the ambulance services. Thesefindingsare noteworthy as, hypothetically, the same patient could be treated in three different waysduring the same care episode.ConclusionsThere is an urgent need to develop high-quality evidence-based clinicalguidelines for this patient group, with the entire care process in focus

Keywords
abdominal pain, acute care delivery chain, ambulance, emergency care, guidelines, surgical care
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-304033 (URN)10.1111/jep.12607 (DOI)000395024900012 ()27491471 (PubMedID)
Available from: 2016-09-29 Created: 2016-09-29 Last updated: 2018-01-10Bibliographically approved
von Thiele Schwarz, U., Hasson, H. & Muntlin Athlin, Å. (2016). Efficiency in the emergency department: A complex relationship between throughput rates and staff perceptions. International Emergency Nursing, 29, 15-20
Open this publication in new window or tab >>Efficiency in the emergency department: A complex relationship between throughput rates and staff perceptions
2016 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, p. 15-20Article in journal (Refereed) Published
Abstract [en]

Introduction

It is well known that emergency departments (EDs) suffer from crowding and throughput challenges, which make the ED a challenging workplace. However, the interplay between the throughput of patients and how staff experience work is seldom studied. The aim of this study was to investigate whether staff experience of work (efficiency, work-related efforts and rewards, and quantity and quality of work) differs between days with low and high patient throughput rates.

Method

Throughput times were collected from electronic medical records and staff (n = 252 individuals, mainly nurses) ratings in daily questionnaires over a total of six weeks. Days were grouped into low and high throughput rate days for the orthopedic, surgical and internal medicine sections, respectively, and staff ratings were compared.

Results

On days with low throughput rates, employees rated their efficiency, effort, reward and quantity of work significantly higher than on days with high throughput rates. There was no difference in perceived quality of work.

Conclusions

There is a complex relationship between ED throughput rates and staff perceptions of efficiency and efforts/rewards with work, suggesting that whereas low throughput may be troublesome from a patient and organizational perspective, working conditions may still be perceived as more favorable.

Keywords
Efficiency, Emergency department, Multitasking, Registered nurse, Throughput rates, Working conditions, Work environment, Workflow
National Category
Nursing
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-301395 (URN)10.1016/j.ienj.2016.07.003 (DOI)000387779100004 ()27524106 (PubMedID)
Funder
AFA Insurance, 100249
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2017-11-28Bibliographically approved
Athlin, Å. M., Engström, M., Gunningberg, L. & Baath, C. (2016). Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action?: A descriptive and explorative study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24, Article ID 134.
Open this publication in new window or tab >>Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action?: A descriptive and explorative study
2016 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 134Article in journal (Refereed) Published
Abstract [en]

Background: Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Methods: Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. Results: A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47-64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. Discussion and Conclusions: In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.

Keywords
Acute care, Ambulance, Emergency department, Nursing intervention, Pressure ulcer, Prevention, Quality indicator
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-310750 (URN)10.1186/s13049-016-0326-0 (DOI)000388133000001 ()27842564 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-19 Last updated: 2017-11-29Bibliographically approved
Jangland, E., Kitson, A. & Muntlin Athlin, Å. (2016). Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study. Journal of Advanced Nursing, 72(4), 791-801
Open this publication in new window or tab >>Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study
2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 4, p. 791-801Article in journal (Refereed) Published
Abstract [en]

AIM: To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode.

BACKGROUND: Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge.

DESIGN: A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism.

METHODS: Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n = 14) were analysed using directed content analysis.

RESULTS: Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility.

CONCLUSION: Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas.

Keywords
acute abdominal pain; acute nursing; emergency care; fundamentals of care; person-centred care; qualitative; relationship; surgical care; surgical nursing
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-276537 (URN)10.1111/jan.12880 (DOI)000371738400009 ()26732990 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council
Available from: 2016-02-16 Created: 2016-02-15 Last updated: 2017-11-30Bibliographically approved
Bååth, C., Engström, M., Gunningberg, L. & Muntlin Athlin, Å. (2016). Prevention of heel pressure ulcers among older patients - from ambulance care to hospital discharge: A multi-centre randomized controlled trial.. Applied Nursing Research, 30, 170-175
Open this publication in new window or tab >>Prevention of heel pressure ulcers among older patients - from ambulance care to hospital discharge: A multi-centre randomized controlled trial.
2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 30, p. 170-175Article in journal (Refereed) Published
Abstract [en]

UNLABELLED: The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+).

BACKGROUND: Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used.

METHODS: A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards.

RESULTS: Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017).

CONCLUSIONS: Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-289119 (URN)10.1016/j.apnr.2015.10.003 (DOI)000375340300031 ()27091274 (PubMedID)
Note

Funding: The study was funded by the Uppsala-Orebro Regional Research Council, Uppsala County Council, County Council of Varmland, University of Gavle, Karlstad University, Uppsala University, and Uppsala University Hospital. An unrestricted grant from ETAC AB provided the heel pressure ulcer suspension device (Heelift (R) Standard), but played no role in the design and conduct of the study; the collection, management, analysis or interpretation of the data; or the preparation, review or approval of the manuscript.

Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2017-11-30Bibliographically approved
Kaisdotter Andersson, A., Kron, J., Castren, M., Muntlin Athlin, Å., Hök, B. & Wiklund, L. (2015). Assessment of the breath alcohol concentration in emergency care patients with different level of consciousness. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1), Article ID 11.
Open this publication in new window or tab >>Assessment of the breath alcohol concentration in emergency care patients with different level of consciousness
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2015 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 1, article id 11Article in journal (Refereed) Published
Abstract [en]

Background

Many patients seeking emergency care are under the influence of alcohol, which in many cases implies a differential diagnostic problem. For this reason early objective alcohol screening is of importance not to falsely assign the medical condition to intake of alcohol and thus secure a correct medical assessment.

Objective

At two emergency departments, demonstrate the feasibility of accurate breath alcohol testing in emergency patients with different levels of cooperation.

Method

Assessment of the correlation and ratio between the venous blood alcohol concentration (BAC) and the breath alcohol concentration (BrAC) measured in adult emergency care patients. The BrAC was measured with a breathalyzer prototype based on infrared spectroscopy, which uses the partial pressure of carbon dioxide (pCO2) in the exhaled air as a quality indicator.

Result

Eighty-eight patients enrolled (mean 45 years, 53 men, 35 women) performed 201 breath tests in total. For 51% of the patients intoxication from alcohol or tablets was considered to be the main reason for seeking medical care. Twenty-seven percent of the patients were found to have a BAC of <0.04 mg/g. With use of a common conversion factor of 2100:1 between BAC and BrAC an increased agreement with BAC was found when the level of pCO2 was used to estimate the end-expiratory BrAC (underestimation of 6%, r = 0.94), as compared to the BrAC measured in the expired breath (underestimation of 26%, r = 0.94). Performance of a forced or a non-forced expiration was not found to have a significant effect (p = 0.09) on the bias between the BAC and the BrAC estimated with use of the level of CO2. A variation corresponding to a BAC of 0.3 mg/g was found between two sequential breath tests, which is not considered to be of clinical significance.

Conclusion

With use of the expired pCO2 as a quality marker the BrAC can be reliably assessed in emergency care patients regardless of their cooperation, and type and length of the expiration.

National Category
Other Clinical Medicine
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-243624 (URN)10.1186/s13049-014-0082-y (DOI)000350846000001 ()
Available from: 2015-02-11 Created: 2015-02-11 Last updated: 2017-12-04Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-7221-2876

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