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  • 1.
    Adolfsson, Eva Thors
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Starrin, Bengt
    Smide, Bibbi
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Wikblad, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Type 2 diabetic patients' experiences of two different educational approaches: A qualitative study2008Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 7, nr 45, s. 986-994Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. Method: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. Findings: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance-care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. Conclusions: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.

  • 2.
    Ahlstedt, Carina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Eriksson Lindvall, Carin
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Företagsekonomiska institutionen.
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Muntlin Athlin, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; School of Nursing, University of Adelaide, Australia.
    What makes registered nurses remain in work? An ethnographic study2019Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, s. 32-38Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3.
    Arnetz, Judith
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Hasson, Henna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: Results of a prospective, non-randomized controlled intervention2007Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, nr 5, s. 723-735Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction. Objectives: The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction. Design: The study was a prospective, non-randomized, controlled intervention. Participants and settings: Nursing staff in two municipal elderly care organizations in western Sweden. Methods: In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced. Results: Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality. Conclusions: Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

  • 4. Bredesen, Ida Marie
    et al.
    Bjoro, Karen
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Hofoss, Dag
    The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: A cross-sectional study2015Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, nr 1, s. 149-156Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. Objective: To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. Design: A cross-sectional study. Setting: Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. Participants: Inpatients >= 18 years at 88 somatic hospital wards (N = 1209). Patients in paediatric and maternity wards and day surgery patients were excluded. Methods: The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. Results: The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. Conclusions: Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important. (C) 2014 Elsevier Ltd. All rights reserved.

  • 5.
    Charalambous, Andreas
    et al.
    Univ Technol, Limassol, Cyprus;DOCENT, Limassol, Cyprus;Univ Turku, Dept Nursing Studies, Turku, Finland.
    Wells, Mary
    Imperial Coll Healthcare NHS Trust, London, England.
    Campbell, Pauline
    Glasgow Caledonian Univ, NMAHP RU, Glasgow, Lanark, Scotland.
    Torrens, Claire
    Glasgow Caledonian Univ, NMAHP RU, Glasgow, Lanark, Scotland.
    Östlund, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Oldenmenger, Wendy
    Erasmus MC Canc Inst, Dept Med Oncol, Rotterdam, Netherlands.
    Patiraki, Elisabeth
    Univ Athens, Sch Hlth Sci, Nursing Fac, Athens, Greece.
    Sharp, Lena
    Reg Canc Ctr, Stockholm, Sweden;Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Nohavova, Iveta
    Charles Univ Prague, Fac Med 1, Inst Hyg & Epidemiol, Prague, Czech Republic.
    Domenech-Climent, Nuria
    Alicante Univ, Alicante, Spain.
    Eicher, Manuela
    Lausanne Univ Hosp, Inst Higher Educ & Res Healthcare, Lausanne, Switzerland;Lausanne Univ Hosp, Dept Oncol, Lausanne, Switzerland;Univ Lausanne, Lausanne, Switzerland.
    Farrell, Carole
    Univ Manchester, Fac Biol Med & Hlth, Sch Hlth Sci, Div Nursing Midwifery & Social Work, Manchester, Lancs, England.
    Larsson, Maria
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Karlstad, Sweden.
    Olsson, Cecilia
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Karlstad, Sweden.
    Simpson, Mhairi
    NHS Lanarkshire, Motherwell, Scotland.
    Wiseman, Theresa
    Univ Southampton, Royal Marsden NHS Fdn Trust, Appl Hlth Canc Care, Southampton, Hants, England;Univ Southampton, Royal Marsden NHS Fdn Trust, Hlth Serv Res, Southampton, Hants, England.
    Kelly, Daniel
    Cardiff Univ, Nursing Res, Cardiff, S Glam, Wales.
    A scoping review of trials of interventions led or delivered by cancer nurses2018Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 86, s. 36-43Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Advances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses. Objectives: To identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses. Data sources and review methods: A systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum. Results: The search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (n = 79) and USA (n = 74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment phase (n = 137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (n = 153) were nurse-led and delivered by specialist cancer nurses (n = 74) or advanced cancer nurses (n = 29), although the quality of reporting was poor. Conclusions: To the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future.

  • 6. Galvin, Kathleen
    et al.
    Emami, Azita
    Dahlberg, Karin
    Bach, Shirley
    Ekebergh, Margaretha
    Rosser, Elizabeth
    Powell, Jane
    Edlund, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Bondas, Terese
    Uhrenfeldt, Lisbeth
    Challenges for future caring science research: a response to Hallberg (2006)2008Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, nr 6, s. 971-974Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Giesbers, A. P. M. (Suzanne)
    et al.
    Canisius Wilhelmina Hosp, POB 9015, NL-6500 GS Nijmegen, Netherlands.;Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands..
    Schouteten, Roel L. J.
    Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands..
    Poutsma, Erik
    Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands..
    van der Heijden, Beatrice I. J. M.
    Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands.;Open Univ Netherlands, Sch Management, POB 2960, NL-6401 DL Heerlen, Netherlands.;Univ Kingston, Kingston Business Sch, Kingston Hill, Kingston Upon Thames KT2 7LB, Surrey, England..
    van Achterberg, Theo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Kapucijnenvoer 35, B-3000 Leuven, Belgium.;Radboud Univ Nijmegen, Med Ctr, Radboud Inst Hlth Sci, Sci Ctr Qual Healthcare, POB 9101, NL-6500 HB Nijmegen, Netherlands..
    Nurses' perceptions of feedback to nursing teams on quality measurements: An embedded case study design2016Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 64, s. 120-129Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Providing nursing teams with feedback on quality measurements is used as a quality improvement instrument in healthcare organizations worldwide. Previous research indicated contradictory results regarding the effect of such feedback on both nurses' well-being and performance. Objectives: Building on the Job Demands-Resources model this study explores: (1) whether and how nurses' perceptions of feedback on quality measurements (as a burdening job demand or rather as an intrinsically or extrinsically motivating job resource) are respectively related to nurses' well-being and performance; and (2) whether and how team reflection influences nurses' perceptions. Design: An embedded case study. Settings: Four surgical wards within three different acute teaching-hospital settings in the Netherlands. Methods: During a period of four months, the nurses on each ward were provided with similar feedback on quality measurements. After this period, interviews with eight nurses and the ward manager for each ward were conducted. Additionally, observational data were collected from three oral feedback moments on each of the participating wards. Results: The data revealed that individual nurses perceive the same feedback on quality measurements differently, leading to different effects on nurses' well-being and performance: 1) feedback can be perceived as a job demand that pressures nurses to improve the results on the quality measurements; 2) feedback can be perceived as an extrinsically motivating job resource, that is instrumental to improve the results on quality measurements; 3) feedback can be perceived as an intrinsically motivating job resource that stimulates nurses to improve the results on the quality measurements; and 4) feedback can be perceived neither as a job demand, nor as a job resource, and has no effect on nurses' well-being and performance. Additionally, this study indicates that team reflection after feedback seems to be very low in practice, while our data also provides evidence that nursing teams using the feedback to jointly reflect and analyse their performance and strategies will be able to better translate information about quality measurements into corrective behaviours, which may result in more positive perceptions of feedback on quality measurements among individual nurses. Conclusions: To better understand the impact of feedback to nursing teams on quality measurements, we should take nurses' individual perceptions of this feedback into account. Supporting nursing teams in team reflection after them having received feedback on quality measurements may help in eliciting positive perceptions among nurses, and therewith create positive effects of feedback on both their wellbeing and performance.

  • 8.
    Gunningberg, Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Sedin, Inga-Maj
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Andersson, Sara
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Pingel, Ronnie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial2017Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 72, s. 53-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Pressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking. Objective: To evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting. Design: Pragmatic randomised controlled trial. Setting: A geriatric/internal medical ward with 26 beds in a Swedish university hospital. Participants: 190 patients were recruited (intervention: n = 91; control: n = 99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4 pm and Friday 4 pm, and expected to stay in the ward >= 3 days. Intervention: The continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care. Results: No significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34-3.79). Conclusions: This study failed to demonstrate a beneficial effect of a pressure mapping system on pressure ulcer prevalence and incidence. However, the study could have increased staff awareness and focus on pressure ulcer prevention, thus affecting the prevalence and incidence of pressure ulcers in a positive way in both study groups. It is important to further investigate the experience of the multidisciplinary team and the patients regarding their use of the pressure mapping system, as well as strengths and weaknesses of the system.

  • 9.
    Hasson, Henna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Arnetz, Judith
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    The impact of an educational intervention for elderly care nurses on care recipients' and family relatives' ratings of quality of care: A prospective, controlled intervention study2008Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, nr 2, s. 166-179Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Low competence levels among nursing staff have been associated with lower quality of elderly care. However, interventions aimed at improving nursing staff competence have not always been evaluated for their possible impact on the quality of elderly care. An educational intervention in the form of a workplace "toolbox" was shown to have positive effects on nursing staff competence and work satisfaction. It was therefore of interest to investigate whether the intervention had any effect on residents' and/or their family members' ratings of the quality of elderly care. Objectives: The aim of this study was to evaluate the possible effects of an educational intervention for nursing staff on care recipients' and their relatives' ratings of the quality of elderly care. Design: The study was a prospective, non-randomized, controlled intervention. Participants and settings: Care recipients and their relatives in two elderly care organisations in Sweden. Methods: Practical instruments and educational materials for improving staff competence and work practices were collated in a workplace "toolbox", which was introduced in the intervention organisation in February of 2003. Care recipients and their relatives' ratings of the quality of care were measured pre and post-intervention by questionnaire and compared to quality ratings in a reference organisation, where no toolbox was introduced. Results: Neither care recipients' nor relatives' ratings of the quality of care changed significantly over time in the intervention organisation. Furthermore, there were no significant interaction effects over time between organisations for quality of care ratings. Methodological weaknesses, such as low response rates, may have influenced results. Conclusions: The results of this study raise questions regarding the alleged positive association between staff competence and work satisfaction and care recipients' perceptions of the quality of care.

  • 10. Hasson, Henna
    et al.
    Arnetz, Judith E
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    The impact of an educational intervention on nursing staff ratings of quality of older people care: a prospective, controlled intervention study2009Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, nr 4, s. 470-478Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Low competence levels among nursing staff have been associated with lower quality of older people care. However, interventions to improve staff competence have not always been evaluated for their impact on the quality of older people care. An educational intervention in the form of a workplace "toolbox" was shown to have positive effects on nursing staff competence and work satisfaction, but had no effects on care recipients' or their family members' ratings of quality of care. It was therefore of interest to investigate whether the intervention had any effect on nursing staff ratings of quality of care. OBJECTIVES: The aim of the study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of quality of care. DESIGN: A prospective, non-randomized, controlled intervention. PARTICIPANTS AND SETTINGS: Nursing staff in two municipal older people care organizations in Sweden. METHODS: Practical instruments and educational materials for improving staff competence and work practices were collated in a workplace "toolbox" and introduced in the intervention organization in February of 2003. Nursing staff ratings of quality of care were measured pre- and post-intervention by questionnaire and compared to nurses' quality ratings in a reference organization, where no toolbox was introduced. RESULTS: Nursing staff ratings of quality of care improved significantly over time in the intervention organization. No improvements were found in the reference organization. CONCLUSIONS: Compared to a reference municipality, nursing staff ratings of quality of care improved in the organization where the toolbox was introduced. Competence development measures may have a positive impact on nursing staff's ratings of quality, but not on the quality ratings of care recipients and their family members. Further research is needed to understand the differences in these stakeholders' perceptions.

  • 11.
    Jangland, Eva
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Sjuksköterskeutbildningar.
    Carlsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Lundgren, Ewa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    The impact of an intervention to improve patient participation in a surgical care unit: a quasi-experimental study2012Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, nr 5, s. 528-538Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Organizational changes in surgical care are requiring patients to become more responsible for their own care, both before and after surgery, and also during recovery. Involving patients in their care is vital to improving quality of care and patient safety.

    Objective: The aim of this study was to investigate the impact of the ‘Tell-us’ card on patients’ perceptions of quality of care, with a specific focus on patient participation. Another aim was to evaluate the use of the Tell-us card from the patients’ perspective.

    Design: A quasi-experimental design with an intervention group and control groups was used. The patient's self-written Tell-us card was introduced as the intervention.

    Setting: The study was conducted in two surgical care units at a Swedish university hospital.

    Participants: A consecutive sample of patients admitted from the waiting list and from the emergency department was included (n = 310). The inclusion criteria were surgical patients with a hospital stay of at least one day. Patients who were younger than 18 years, not able to speak or write in Swedish, or unable or unwilling to give informed consent to participate were excluded.

    Methods: Quality of care was assessed using the questionnaire ‘Quality from the Patient's Perspective’. The patients included in the intervention group were asked to write what was most important for them during the day or just before discharge on patient-written Tell-us cards.

    Results: The use of the Tell-us card resulted in significant improvements (5 out of 17 items) in patients’ abilities to participate in decisions about their nursing and medical care. The patients found the Tell-us card more useful in their interaction with registered nurses and assistant nurses than with physicians.

    Conclusions: The use of the Tell-us card improved patients’ participation in some areas of nursing and medical care in the surgical care units. The Tell-us card is an uncomplicated and inexpensive tool that could be an important step towards improved patient participation in the surgical care unit. More research is needed to evaluate the use of the Tell-us card in different hospital units and over a longer period of time.

  • 12. Karlsson, Agnetha
    et al.
    Arman, Maria
    Wikblad, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Medicin.
    Teenagers with type 1 diabetes: A phenomenological study of the transition towards autonomy in self-management2008Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, nr 4, s. 562-570Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Becoming autonomous is an important aspect of teenagers' psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support. Objective: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes. Design and method: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis. Participants: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes. Findings: The lived experiences of the transition towards autonomy in self-management were characterized by the overriding theme "hovering between individual actions and support of others". The findings indicate that individual selfreliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme "confirmation of others" showed that parental encouragement increased the certainty of teenagers' standpoints; peers! acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers' self-esteem. Conclusion: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

  • 13.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Dow, Clare
    Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
    Calabrese, Joseph D
    University College London, United Kingdom.
    Locock, Louise
    Health Experiences Research Group, Dept Primary Care Health Sciences, University of Oxford, United Kingdom; National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom.
    Muntlin Athlin, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Stroke survivors’ experiences of the fundamentals of care: A qualitative analysis2013Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, nr 3, s. 392-403Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Managing the fundamentals of care (e.g. elimination, personal hygiene, eating,) needs to be more explicitly addressed within the patient-centred care discourse. It is not possible to investigate issues of patient dignity and respect without acknowledging these basic physical needs. While the literature on caring for people with a stroke is extensive, no studies to date have described stroke survivors’ experiences of all of these fundamentals during the in-hospital phase of their care.

    Design

    Secondary analysis of qualitative data grounded in interpretative phenomenology Participants and settings: Fifteen stroke survivors with in-hospital experiences from multiple healthcare settings and healthcare professionals across the United Kingdom were included.

    Method

    A secondary thematic analysis of primary narrative interview data from stroke survivors.

    Results

    Survivors of strokes have vivid and often distressing recollections of their experiences of the fundamentals of care. For every description of a physical need (elimination, eating and drinking, personal hygiene) there where lucid accounts of the psychosocial and emotional impact (humiliation, distress, lack of dignity, recovery, confidence). Linked to the somatic and emotional dimensions were narratives around the relationship between the patient and the carer (nurse, doctor, allied health professional). Positive recollections of the fundamentals of care were less evident than more distressing experiences. Consistent features of positive experiences included: stroke survivors describing how the physical, psychosocial and relational dimensions of care were integrated and coordinated around their particular need. They reported feeling involved in setting achievable targets to regain control of their bodily functions and regain a sense of personal integrity and sense of self. Sociological constructs such as biographical disruption and loss of self were found to be relevant to stroke survivors’ experiences. Indeed, such constructs may be more linked to the disruption of such fundamental activities rather than the experience of the illness itself.

    Conclusions

    We recommend more practical and integrated approaches be taken around understanding and meeting the physical, psychosocial and relational needs of patients in hospital which could lead to more patient-centred care experiences. These three dimensions need to co-exist in every care episode. More exploration is required to identify the common fundamentals of care needs of patients regardless of illness experience.

  • 14.
    Lindberg, Magnus
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Ludvigsen, Mette Spliid
    Aarhus University Hospital.
    Ultrafiltration rate as a nursing-sensitive quality indicator in haemodialysis2012Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, nr 10, s. 1320-1324Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Nursing quality indicators are widely used to demonstrate nurses' contributions to health care. Some studies in nephrology settings have addressed nursing quality, but indicators reflecting the nursing process quality in haemodialysis are lacking. This paper argues for considering ultrafiltration rate as a nursing-sensitive quality indicator in haemodialysis. Strategies and qualifications for considering ultrafiltration rate as a nursing quality indicator are established and discussed. It is argued that the indicator is associated with nursing practice, linked to both morbidity and mortality, and is within the scope of the nurse's responsibility. It is also argued that the indicator could be influenced by other factors than nursing care. Thus, further studies are needed to investigate the association between ultrafiltration rate and patient safety. The introduction of the ultrafiltration rate as a duty specific quality indicator is a coveted measure of nursing care quality in haemodialysis settings.

  • 15.
    Lindberg, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Lindberg, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Skytt, Bernice
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study.2017Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 70, s. 38-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations.

    OBJECTIVE: The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections.

    DESIGN & SETTING: Unstructured nonparticipant observations were performed at three medical wards.

    PARTICIPANTS & METHODS: Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities.

    RESULTS: The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was.

    CONCLUSION: The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission.

  • 16.
    Muntlin, Åsa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Carlsson, Marianne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Säfwenberg, Urban
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department: a quasi-experimental study2011Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, nr 1, s. 13-23Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations.

    Objectives: The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: a) pain intensity, b) frequency of received analgesic, c) time to analgesic, d) transit time, and e) patients’ perceptions of the quality of care in pain management.

    Design: A quasi-experimental design with ABA phases was used.

    Setting: The study was conducted in an emergency department at a Swedish university hospital.

    Participants: Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10.

    Methods: The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic.

    Results: The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management.

    Conclusions: The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department.

  • 17.
    Nordgren, Lena
    et al.
    Mälardalens högskola.
    Asp, Margareta
    Fagerberg, Ingegerd
    Support as experienced by men living with heart failure in middle age: a phenomenological study.2008Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, nr 9, s. 1344-54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Men living with heart failure (HF) in middle-age experience restrictions limiting their work capacity and/or social activities. To adjust to the life-situation they need support. The meaning of the phenomenon of support is not well known. Thus, formal carers may find it problematic to know how to support patients.

    AIM: The aim of the current study was to uncover and describe the meaning of the phenomenon of support as experienced by men living with HF in middle age.

    DESIGN: The study used a caring science perspective and a reflective lifeworld approach based on phenomenological philosophy.

    PARTICIPANTS AND SETTINGS: Nine men, aged 49-64 years and diagnosed with HF, were recruited from two outpatient HF clinics in Sweden.

    METHODS: Interviews were used for data gathering. Data were analyzed by means of reflective lifeworld research.

    FINDINGS: The essence of support as experienced by men living with HF in middle age can be understood as security, and a sense of having control over body and situation. Support is realized in the men's relations to other people; there is however tension between what is supportive and what is not, meaning that even though intentions are good, intended support involves limitations, uncertainties or insecurity. The essence is illuminated by the following meaning constitutes: Support--a tenuous security; Medications--a support for life; Conditional support within the context of formal care; and, Information and knowledge.

    CONCLUSIONS: The meaning of support as experienced by men living with HF in middle age is multi-dimensional, qualitative and contextual. When the men are supported they gain a sense of security and control, giving them strength to handle their life-situation. A lifeworld-led approach in the context of formal care can help formal carers support men living with HF in middle age.

  • 18.
    Sving, Eva
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Idvall, Ewa
    Högberg, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study2014Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, nr 5, s. 717-725Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND

    Implementation of evidence-based care for pressure ulcer prevention is lacking. As the hospital organization is complex, more knowledge is needed to understand how nursing care in this area can be improved.

    OBJECTIVES

    The present study investigated the associations between variables on different levels in the healthcare setting (patient, unit, hospital) and the documentation of (1) risk assessment and (2) skin assessment within 24h of admission, the use of (3) pressure-reducing mattresses and (4) planned repositioning in bed.

    DESIGN

    A cross-sectional study.

    SETTINGS

    One university hospital and one general hospital.

    PARTICIPANTS

    Geriatric (n=8), medical (n=24) and surgical (n=19) units. All adult patients (>17 years), in total 825, were included.

    METHODS

    A one-day prevalence study was conducted using the methodology specified by the European Pressure Ulcer Advisory Panel, together with the established methods used by the Collaborative Alliance for Nursing Outcomes. Independent variables were patient characteristics, hospital type, unit type, nurse staffing and workload. Dependent variables were documented risk and skin assessment within 24h of admission, pressure-reducing mattresses and planned repositioning in bed. The data were analysed with Logistic regression using the Generalized Estimating Equation (GEE) approach.

    RESULTS

    Patients at risk of developing pressure ulcers (Braden<17) had higher odds of having risk assessment documented, and of receiving pressure-reducing mattresses and planned repositioning. Patients at the general hospital were less likely to have risk and skin assessment documented and to receive pressure-reducing mattresses. On the other hand, planned repositioning was more likely to be used at the general hospital. When total hours of nursing care was lower, patients had higher odds of having pressure-reducing mattresses but were less likely to have planned repositioning.

    CONCLUSION

    Patient characteristics (high age and risk score) and hospital type were associated with pressure ulcer prevention. Surprisingly, nurse staffing played only a minor role. Leaders in healthcare organizations should establish routines on different levels that support evidence-based pressure ulcer prevention, and registered nurses need to assume responsibility for bedside care.

  • 19.
    von Essen, Louise
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Sjödén, Per-Olow
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    The importance of nurse caring behaviors as perceived by Swedish hospital patients and nursing staff2003Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 40, nr 5, s. 487-497Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study identified patient (n=81) and nursing staff (n=105) perceptions of the most and least important nurse caring behaviors. Using a Swedish version of the CARE-Q instrument, patients ranked as most important competent clinical know-how, while the nursing staff ranked expressive/affective behaviors as most important to make patients feel cared for. The results show significant differences (p<0.05) between the two groups in the rating of 29 of the instrument's 50 specific behaviors and in five out of six subscales combining individual items. Thus, patient perceptions of important nurse caring behaviors differ from staff perceptions. These results are similar to those from other studies of hospitalized patients’ perceptions of caring. The staff's results are in accordance with studies of professional nurses’ perceptions of caring. The findings support conclusions by other authors.

  • 20.
    von Essen, Louise
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Sjödén, Per-Olow
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    The importance of nurse caring behaviors as perceived by Swedish hospital patients and nursing staff1991Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 28, nr 3, s. 267-281Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study identified patient (n = 81) and nursing staff (n = 105) perceptions of the most and least important nurse caring behaviors. Using a Swedish version of the CARE-Q instrument, patients ranked as most important competent clinical know-how, while the nursing staff ranked expressive/affective behaviors as most important to make patients feel cared for. The results show significant differences (p less than 0.05) between the two groups in the rating of 29 of the instrument's 50 specific behaviors and in five out of six subscales combining individual items. Thus, patient perceptions of important nurse caring behaviors differ from staff perceptions. These results are similar to those from other studies of hospitalized patients' perceptions of caring. The staff's results are in accordance with studies of professional nurses' perceptions of caring. The findings support conclusions by other authors.

  • 21.
    Wahlberg, Åsa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Department of Gynecology and Obstetrics, Skåne University Hospital, Malmö, Sweden.
    Andreen Sachs, Magna
    LIME/Medical Management Centre, Karolinska Institute, Sweden.
    Bergh Johannesson, Kerstin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hallberg, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Gynekologisk endokrinologi. Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden.
    Jonsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik. Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden.
    Skoog Svanberg, Agneta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.
    Högberg, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study2017Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 65, s. 8-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence).

    OBJECTIVE: To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints.

    DESIGN: Cross-sectional survey.

    PARTICIPANTS: Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG).

    METHODS: A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression.

    RESULTS: The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient.

    CONCLUSIONS: A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.

  • 22.
    Wahlberg, Åsa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Department of Obstetrics and Gynaecology, Ystad Hospital, Sweden.
    Högberg, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Emmelin, Maria
    Department of Social Medicine and Global Health, Lund University, Sweden.
    The erratic pathway to regaining a professional self-image after an obstetric work-related trauma: A grounded theory study2019Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 89, s. 53-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: It is known that healthcare providers might be affected by severe medical events in which patients are badly hurt. In birth care, escalating situations can result in death or injury to a mother or new-born child.

    Objective: To explore the process that Swedish midwives and obstetricians go through after a severe event in the maternity unit.

    Design: A modified Constructivist Grounded Theory analysis, based on fourteen in-depth interviews with birth care professionals.

    Participants: Seven midwives and seven obstetricians.

    Results: A core category, 'regaining of a professional self-image', was constructed and interpreted as being constituted of six main categories illustrating a frequently erratic pathway to the regaining of a professional self-image. The process included a search for external acceptance for the re-establishment of belongingness by obtaining corroboration from the woman, work colleagues and manager, and the medico-legal system.

    Media exposure was invariably seen as something negative. Internal processes involved coping with emotions of guilt and shame and the vulnerability that the work entails, as well as contemplating future work. The possibility to fully regain one's professional self-image depended on having a sense of confidence and an urge to support others in similar situations by sharing gained insights. However, the process could also result in reconsidering one's professional self-image by setting up boundaries, creating a better work-life balance, or creating mental back-up plans in case of similar recurrences. For others, the process led to a change of professional identity and a search for roles away from emergency obstetrics or the specialty as such.

    Conclusions: Many midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important. Growth as well as leaving birth care can be the results of the process following a severe event.

  • 23. Wiman, Elisabeth
    et al.
    Wikblad, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Idvall, Ewa
    Trauma patients' encounters with the team in the emergency department: A qualitative study2007Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, nr 5, s. 714-722Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Encounters in emergency departments have been described from different perspective and with different research approaches. On reviewing the literature, along with medical skills, interpersonal skills such as the ability to create a relationship with the patient was considered significant. Patients exposed to high-energy violence arrive at the emergency department in a vulnerable condition. Apart from their physical condition, they might be in shock and frightened by the experiences of the injury. The team at the emergency department is responsible for a complex situation and has to quickly establish rapport, gather information, assess the physical condition, and design a treatment plan. Aim: The aim of this study was to explore trauma patients' conceptions of the encounter with the trauma team. Design and method: A qualitative inductive design was used and data were collected by semi-structured interviews. The interviews were transcribed verbatim and analysed according to contextual analysis. Participants: Twenty-three trauma patients with minor injuries, 17 from a university hospital and six from a county hospital with minor injuries, were included in the study. Findings: The main findings were three main categories, labelled modes of being with the patients: the instrumental, the attentive and the uncommitted mode. All encounters contained the instrumental mode and mostly there were a combination of instrumental mode and attentive mode. The patients were satisfied with these modes, which created emotions of confidence, comfort and satisfaction. The uncommitted mode occurred in some encounters together and generated emotions of abandonment, dissatisfaction. Conclusion: The main conclusion is that a high-quality encounter in trauma care is likely to be received from caregivers who can shift their mode of being with the patient between the instrumental and the attentive mode as the patient/situation demands. That is, flexibility between the physical and psycho-social care.

  • 24.
    Östlund, Ulrika
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kidd, Lisa
    Institute for Applied Health Research/School of Health, Glasgow Caledonian University, United Kingdom.
    Wengström, Yvonne
    Division of Nursing, Department or Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Rowa-Dewar, Neneh
    Public Health Sciences, University of Edinburgh, United Kingdom.
    Combining qualitative and quantitative research within mixed method research designs: A methodological review2011Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, nr 3, s. 369-383Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research: This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses. Design: This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009. Results: In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided. Conclusion: A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory. (C) 2010 Elsevier Ltd. All rights reserved.

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