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Karlsson, A., Lindeborg, P., Gunningberg, L. & Jangland, E. (2019). Evidence-based nursing-How is it understood by bedside nurses?: A phenomenographic study in surgical settings. Journal of Nursing Management, 27(6), 1216-1223
Open this publication in new window or tab >>Evidence-based nursing-How is it understood by bedside nurses?: A phenomenographic study in surgical settings
2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 6, p. 1216-1223Article in journal (Refereed) Published
Abstract [en]

Aim The aim was to identify and describe nurses' understanding of working with evidence-based nursing (EBN) in clinical practice. Background Evidence-based health care is recognized as fundamental to nursing practice, but it is challenging to implement. How nurses understand this part of their work can affect their practice. Methods Using a qualitative explorative design with a phenomenographic approach, we interviewed 21 nurses working in Swedish surgical wards. Results We identified three understandings of EBN among nurses in surgical care: A. a fragmentary and difficult concept that is not integrated or used in clinical practice; B. an important approach guided by knowledgeable colleagues and students; and C. a process that nurses are responsible for developing and leading. Conclusion Nurses' understandings of working with EBN in surgical wards vary widely. Nurse managers have an important task to create a common outlook among nurses about integrating research, patient experience and clinical experience in decision-making. Implication for nursing management These findings could inspire nurse managers to reflect on how to move nurses towards a more comprehensive understanding of EBN and how to identify nurses who could act as facilitators in quality improvement work.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
evidence-based nursing, nursing leader, phenomenography, qualitative, surgical nursing
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-395327 (URN)10.1111/jonm.12802 (DOI)000486018500020 ()31124261 (PubMedID)
Available from: 2019-10-17 Created: 2019-10-17 Last updated: 2019-10-17Bibliographically approved
Feo, R., Donnelly, F., Muntlin Athlin, Å. & Jangland, E. (2019). Providing high-quality fundamental care for patients with acute abdominal pain: A qualitative study of patients' experiences in acute care. Journal of Health Organisation & Management, 33(1), 110-123
Open this publication in new window or tab >>Providing high-quality fundamental care for patients with acute abdominal pain: A qualitative study of patients' experiences in acute care
2019 (English)In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 33, no 1, p. 110-123Article in journal (Refereed) Published
Abstract [en]

Purpose Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences. Design/methodology/approach A qualitative descriptive study, using repeated reflective interviews, was analysed thematically (n=10 patients). Findings Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one's care. Patients reported that health professionals established genuine professional-patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional-patient relationships were seen as inexcusable.

Place, publisher, year, edition, pages
EMERALD GROUP PUBLISHING LTD, 2019
Keywords
Healthcare, Hospitals, Patient care, Interviews, Qualitative research, Nursing
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-380438 (URN)10.1108/JHOM-02-2018-0037 (DOI)000460932000009 ()30859914 (PubMedID)
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-03-28Bibliographically approved
Donnelly, F., Feo, R., Jangland, E. & Muntlin Athlin, Å. (2019). The management of patients with acute abdominal pain in the emergency department: A qualitative study of nurse perceptions. AUSTRALASIAN EMERGENCY CARE, 22(2), 97-102
Open this publication in new window or tab >>The management of patients with acute abdominal pain in the emergency department: A qualitative study of nurse perceptions
2019 (English)In: AUSTRALASIAN EMERGENCY CARE, ISSN 2588-994X, Vol. 22, no 2, p. 97-102Article in journal (Refereed) Published
Abstract [en]

Background: Acute abdominal pain is a common reason for presentation to the emergency department. Understanding the role of nurses involved in management of acute abdominal pain is important for improving patient care and outcomes. The aim of this study was to understand the perceptions of emergency nurses in the management of acute abdominal pain. Methods: Using a qualitative design, a purposeful sample (n=9) of experienced registered nurses was recruited from the emergency department of a large tertiary public hospital in South Australia. Semi-structured interviews, informed by literature describing the management of acute abdominal pain, were used to identify the perceptions of emergency nurses when caring for patients with acute abdominal pain. Results: Thematic analysis of interviews identified four themes: Centrality of Diagnosis; Busyness and Patient Management; Systems Issues; and Communication Challenges. Of the four themes, the Centrality of Diagnosis was especially important to the nurses' sense of contribution to patient care. Care was also affected by the busyness of the environment, the systems and processes in place to manage patients and communication in the emergency department. Conclusions: The management of patients with acute abdominal pain is influenced by how nurses participate in the diagnostic process. Nurses identified their role in this process and described how this role impacted their delivery of fundamental care. Further studies of the nursing contribution to diagnosis, communication, and the systems that affect care delivery in the emergency department are required.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Abdominal pain, Diagnosis, Nursing, Emergency department, Hospital, Fundamentals of care
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-390030 (URN)10.1016/j.auec.2019.04.002 (DOI)000471239500006 ()31056349 (PubMedID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-07Bibliographically approved
Tegelberg, A., Jangland, E., Juhlin, C. & Muntlin Athlin, Å. (2019). Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain. Journal of Clinical Nursing, 28(19-20), 3641-3650
Open this publication in new window or tab >>Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 19-20, p. 3641-3650Article in journal (Refereed) Published
Abstract [en]

Aim and objectives: To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care.

Background: Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high‐quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high‐quality fundamental care across the acute care chain.

Design: Qualitative descriptive semi‐structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used.

Methods: Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro‐ and macrolevels across the acute care chain.

Results: The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models.

Conclusions: The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal.

Relevance to clinical practice: Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence‐based and high‐quality care.

Keywords
acute abdominal pain, ambulance care service, emergency department, interviews, managers, surgical department
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-393384 (URN)10.1111/jocn.14962 (DOI)000485989700028 ()31190406 (PubMedID)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-10-22Bibliographically approved
Jangland, E., Teodorsson, T., Molander, K. & Muntlin Athlin, Å. (2018). Inadequate environment, resources, and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework. Journal of Clinical Nursing, 27(11-12), 2311-2321
Open this publication in new window or tab >>Inadequate environment, resources, and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2311-2321Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: The purpose was to explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework.

BACKGROUND: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high- quality, person-centred care it is important to understand how these factors affect patients' experiences and care needs.

DESIGN: A focused ethnographic approach.

METHOD: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis.

RESULTS: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety.

CONCLUSION: Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership, and challenges to patients' safety. The findings highlight the crucial importance of prioritizing and valuing the patients' fundamental care needs for recovery.

RELEVANCE TO CLINICAL PRACTICE: Nursing leaders and nurses need to take the lead to re-conceptualize the value of fundamental care in the acute care setting. To improve clinical practice the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery.

Keywords
Fundamentals of Care, acute abdominal pain, acute care, focused ethnography, organization, surgical nursing
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-333982 (URN)10.1111/jocn.14095 (DOI)000434127600011 ()28960702 (PubMedID)
Funder
Swedish Research Council, 2013:1992Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2019-06-28Bibliographically approved
Kvarnström, S., Jangland, E. & Abrandt Dahlgren, M. (2018). Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice. Scandinavian Journal of Caring Sciences, 32(2), 765-771
Open this publication in new window or tab >>Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 765-771Article in journal (Refereed) Published
Abstract [en]

Aim: The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams.

Methods and results: The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward‐based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory‐led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229‐31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever‐present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice.

Conclusion: The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team.

Keywords
advanced practice nurse, ethnography, interdisciplinary, interprofessional collaboration, sociomaterial, teamwork
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-333979 (URN)10.1111/scs.12507 (DOI)000436254800033 ()28833414 (PubMedID)
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2018-08-24Bibliographically approved
Jangland, E., Mirza, N., Conroy, T., Merriman, C., Suzui, E., Nishimura, A. & Ewens, A. (2018). Nursing students' understanding of the Fundamentals of Care: A cross-sectional study in five countries. Journal of Clinical Nursing, 27(11-12), 2460-2472
Open this publication in new window or tab >>Nursing students' understanding of the Fundamentals of Care: A cross-sectional study in five countries
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2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2460-2472Article in journal (Refereed) Published
Abstract [en]

Aim and objectiveTo explore the accuracy with which nursing students can identify the fundamentals of care. BackgroundA challenge facing nursing is ensuring the fundamentals of care are provided with compassion and in a timely manner. How students perceive the importance of the fundamentals of care may be influenced by the content and delivery of their nursing curriculum. As the fundamentals of care play a vital role in ensuring patient safety and quality care, it is important to examine how nursing students identify these care needs. DesignCross-sectional descriptive design. MethodsA total of 398 nursing students (pre- and postregistration) from universities in Sweden, England, Japan, Canada and Australia participated. The Fundamentals of Care Framework guided this study. A questionnaire containing three care scenarios was developed and validated. Study participants identified the fundamentals of care for each of the scenarios. All responses were rated and analysed using ANOVA. ResultsThe data illustrate certain fundamentals of care were identified more frequently, including communication and education; comfort and elimination, whilst respecting choice, privacy and dignity were less frequently identified. The ability to identify all the correct care needs was low overall across the pre- and postregistration nursing programmes in the five universities. Significant differences in the number of correctly identified care needs between some of the groups were identified. ConclusionsNursing students are not correctly identifying all a patient's fundamental care needs when presented with different care scenarios. Students more frequently identifying physical care needs and less frequently psychosocial and relational needs. The findings suggest educators may need to emphasise and integrate all three dimensions. Relevance to clinical practiceTo promote students' ability to identify the integrated nature of the fundamentals of care, practising clinicians and nurse educators need to role model and incorporate all the fundamental care needs for their patients.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
Care scenarios, Fundamentals of Care, Nursing curriculum, Pre- and postregistration nursing students
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-358174 (URN)10.1111/jocn.14352 (DOI)000434127600023 ()29526052 (PubMedID)
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically 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
Jangland, E. & Gunningberg, L. (2017). Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project. Journal of Nursing Management, 25(4), 266-275
Open this publication in new window or tab >>Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project
2017 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 4, p. 266-275Article in journal (Refereed) Published
Abstract [en]

Aim

To evaluate an implementation project on patient participation.

Background

Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years.

Method

Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed.

Results

Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients’ involvement in their own care. Several barriers to change and sustainability were acknowledged.

Conclusions

Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement.

Implications for Nursing Management

A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-317309 (URN)10.1111/jonm.12459 (DOI)000400685900004 ()
Funder
The King Gustaf V's Jubilee Foundation
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2019-01-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6888-3792

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