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Muntlin Athlin, Åsa, DocentORCID iD iconorcid.org/0000-0002-7221-2876
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Publications (10 of 33) Show all publications
Ahlstedt, C., Eriksson Lindvall, C., Holmström, I. & Muntlin Athlin, Å. (2019). What makes registered nurses remain in work? An ethnographic study. International Journal of Nursing Studies, 89, 32-38
Open this publication in new window or tab >>What makes registered nurses remain in work? An ethnographic study
2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, p. 32-38Article in journal (Refereed) Published
Abstract [en]

Background: Registered nurses' work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses' workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses' work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses' development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.

National Category
Other Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-364722 (URN)10.1016/j.ijnurstu.2018.09.008 (DOI)
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-11-12Bibliographically approved
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, 27(11-12), 2481-2488
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 1365-2702, Vol. 27, no 11-12, p. 2481-2488Article 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)000434127600025 ()29446500 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-08-24Bibliographically 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, 27(11/12), 2230-2247
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 1365-2702, Vol. 27, no 11/12, p. 2230-2247Article in journal (Refereed) Published
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)000434127600005 ()29119641 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-11-12Bibliographically approved
Avallin, T., Muntlin Athlin, Å., Elgaard Sörensen, E., Kitson, A., Björck, M. & Jangland, E. (2018). Person-centred pain management for the patient with acute abdominal pain: An ethnography informed by the Fundamentals of Care framework. Journal of Advanced Nursing, 74(11), 2596-2609
Open this publication in new window or tab >>Person-centred pain management for the patient with acute abdominal pain: An ethnography informed by the Fundamentals of Care framework
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2018 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 11, p. 2596-2609Article in journal (Refereed) Published
Abstract [en]

Aims: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway.

Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance.

Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework.

Methods: Participant observation and informal interviews (92hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged 18years seeking care for AAP at the ED and admitted to a surgical ward (N=31; aged 20-90years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N=198).

Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics.

Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.

National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-364720 (URN)10.1111/jan.13739 (DOI)000447551800013 ()29893491 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-12-13Bibliographically 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, 27(11-12), 2285-2299
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 1365-2702, Vol. 27, no 11-12, p. 2285-2299Article in journal (Refereed) Published
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)000434127600009 ()29278437 (PubMedID)
Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-08-24Bibliographically 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
Frykman, M., von Thiele Schwarz, U., Muntlin Athlin, Å., Hasson, H. & Mazzocato, P. (2017). The work is never ending: uncovering teamwork sustainability using realistic evaluation. Journal of Health Organisation & Management, 31(1), 64-81
Open this publication in new window or tab >>The work is never ending: uncovering teamwork sustainability using realistic evaluation
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2017 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 1, p. 64-81Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork.

Design/methodology/approach

Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used.

Findings

The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced.

Practical implications

The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period.

Originality/value

By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-326059 (URN)10.1108/JHOM-01-2016-0020 (DOI)000398487700006 ()28260412 (PubMedID)
Funder
AFA Insurance, 100249
Available from: 2017-06-30 Created: 2017-06-30 Last updated: 2018-09-05Bibliographically 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
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ORCID iD: ORCID iD iconorcid.org/0000-0002-7221-2876

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