uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Muntlin, Åsa
Alternative names
Publications (10 of 26) Show all publications
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, 89-95 p.Article 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

Keyword
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, 15-20 p.Article 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.

Keyword
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, 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.

Keyword
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, 791-801 p.Article 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.

Keyword
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, 170-175 p.Article 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
Show others...
2015 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 1, 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
Hvitfeldt Forsberg, H., Muntlin Athlin, Å. & von Thiele Schwarz, U. (2015). Nurses' perceptions of multitasking in the emergency department: Effective, fun and unproblematic (at least for me): a qualitative study. International Emergency Nursing, 23(2), 59-64.
Open this publication in new window or tab >>Nurses' perceptions of multitasking in the emergency department: Effective, fun and unproblematic (at least for me): a qualitative study
2015 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, 59-64 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

The aim was to understand how multitasking is experienced by registered nurses and how it relates to their everyday practice in the emergency department.

METHOD:

Interviews with open-ended questions were conducted with registered nurses (n = 9) working in one of two included emergency departments in Sweden. Data were analyzed using Schilling's structured model for qualitative content analysis.

RESULTS:

Three core concepts related to multitasking emerged from the interviews: 'multitasking - an attractive prerequisite for ED care'; 'multitasking implies efficiency' and 'multitasking is not stressful'. From these core concepts an additional theme emerged: '… and does not cause errors - at least for me', related to patient safety.

DISCUSSION:

This study shows how the patient load and the unreflected multitasking that follows relate to nurses' perceived efficiency and job satisfaction. It also shows that the relationship between multitasking and errors is perceived to be mediated by whom the actor is, and his or her level of experience. Findings from this study add value to the discourse on multitasking and the emergency department context, as few studies go beyond examining the quantitative aspect of interruptions and multitasking and how it is experienced by the staff in their everyday practice.

National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-230759 (URN)10.1016/j.ienj.2014.05.002 (DOI)000354139000004 ()24953441 (PubMedID)
Projects
TEPPP
Available from: 2014-08-28 Created: 2014-08-28 Last updated: 2017-12-05Bibliographically approved
Gunningberg, L., Mårtensson, G., Mamhidir, A.-G., Florin, J., Muntlin Athlin, Å. & Bååth, C. (2015). Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. International Wound Journal, 12(4), 462-468.
Open this publication in new window or tab >>Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden
Show others...
2015 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 12, no 4, 462-468 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.

Keyword
Hospital, Knowledge, Nurse, Pressure ulcer, Student nurse
National Category
Dermatology and Venereal Diseases
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-207599 (URN)10.1111/iwj.12138 (DOI)000357520400016 ()23919728 (PubMedID)
Projects
PUP - Pressure Ulcer Prevention (Regional Network)
Available from: 2013-09-17 Created: 2013-09-17 Last updated: 2017-12-06Bibliographically approved
Muntlin Athlin, Å., Carlsson, M. & Gunningberg, L. (2015). To Receive or Not to Receive Analgesics in the Emergency Department: The Importance of the Pain Intensity Assessment and Initial Nursing Assessment. Pain Management Nursing, 16(5), 743-750.
Open this publication in new window or tab >>To Receive or Not to Receive Analgesics in the Emergency Department: The Importance of the Pain Intensity Assessment and Initial Nursing Assessment
2015 (English)In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 16, no 5, 743-750 p.Article in journal (Refereed) Published
Abstract [en]

Patients seeking emergency care for abdominal pain still experience poor pain management. Pain intensity is not always seen as a mandatory parameter in the initial nurse assessment. Despite the development of nurse-initiated analgesic protocols, many patients do not receive analgesics in the emergency department. The aim of this study was to describe initial nursing assessment related to pain management and to identify predictors for receiving or not receiving analgesics in the emergency department. The sample consists of 100 patients from an intervention group in a previously undertaken Swedish intervention study. The main findings were that the registered nurses assessed 62 patients as being in need of analgesics, and that 52 of these obtained analgesics. The majority of the patients assessed as not being in need of analgesics did not receive analgesics because they did not want medication. Median value for pain intensity at initial assessment was 6 on the numerical rating scale. The results for the logistic regression (n = 80) showed significant differences between receiving analgesics/not receiving analgesics and the predictor pain intensity (measured at initial nurse assessment). Nurses in emergency departments play a crucial role, in that their initial assessment is of specific importance for the patient's further care and whether the patient may or may not receive analgesics. However, more attention has to be paid to patients' experiences and their expectations regarding the pain management in the emergency department. These complex questions have to be studied further in a more systematic way.

National Category
Other Medical Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-267376 (URN)10.1016/j.pmn.2015.04.004 (DOI)000363359600014 ()
Available from: 2015-11-20 Created: 2015-11-20 Last updated: 2017-12-01Bibliographically approved
Kitson, A., Muntlin Athlin, Å. & Conroy, T. (2014). Anything but basic: Nursing’s challenge in meeting patients' fundamental care needs. Journal of Nursing Scholarship, 46(5), 331-339.
Open this publication in new window or tab >>Anything but basic: Nursing’s challenge in meeting patients' fundamental care needs
2014 (English)In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 46, no 5, 331-339 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

Nursing has not explored the fundamental aspects of patient care in a systematic, conceptually coherent, scientific way, and this has created a number of ongoing challenges.

Organizing Construct

Each challenge is identified and addressed in the form of a proposition, with evidence provided to support the arguments put forward and defend the proposed actions.

Findings

The challenges include: the need for an integrated way of thinking about the fundamentals of care from a conceptual, methodological, and practical perspective; the ongoing and unresolved tension in nursing practice between a depersonalized and mechanistic approach (termed a “task and time” driven culture) and the need for consistency around understanding and managing the dynamics of the nurse–patient relationship or encounter (termed a “thinking and linking” approach); and the need for a systematic approach to the fundamentals or basics of care that combines the physical, psychosocial, and relational dimensions of the care encounter within the wider context of the care environment. Pragmatic and practical frameworks are needed to ensure that the basic physical and psychosocial needs of patients are embedded not only in the practice but also in the thinking, reflection, and assessment processes of the nurse.

Conclusions

Nursing's challenge to meet patients’ basic or fundamental needs is complex. Developing a knowledge base will include identifying researchable questions, using rigorous methodologies, ensuring the relational dimensions are not lost, and ensuring the new knowledge is applied in practice. This requires collaboration on an international scale to achieve improvements in care.

Clinical Relevance

To work collaboratively to generate, test, and implement meaningful ways of capturing nursing practice around basic or fundamental care in order to ensure more integrated, holistic patient care nursing practices.

National Category
Nursing
Research subject
Caring Sciences in Medical Sciences
Identifiers
urn:nbn:se:uu:diva-220944 (URN)10.1111/jnu.12081 (DOI)000341637500005 ()
Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2017-12-05Bibliographically approved
Organisations

Search in DiVA

Show all publications