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  • 1.
    Andersson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Pettersson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sidenvall, Birgitta
    Daily life after moving into a care home - experiences from older people, relatives and contact persons2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 9, p. 1712-1718Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To describe older people's experiences of daily life at the care home after admittance with respect to their perceptions of participation in the decision to move. Furthermore, the aim was to study the experiences of their relatives and contact persons with respect to the daily life of the same residents. Background. When older persons move into a care home, the whole family often play an important part. Thus, it is interesting to study how newly admitted older people, their relatives and staff members experience daily life in a modern care home. Methods. Qualitative design. The participants comprised a purposive sample of 13 residents, recently admitted to a care home, 69-90 years old, both single living and married, both moving from their own homes and from different institutions. Interviews were carried out with the older people (n = 13), their relatives (n = 10) and contact persons (n = 11). Results. The majority of the residents reported satisfaction with care home living. The relatives were also satisfied, secure and appreciated the privacy and homely atmosphere of the flat. The disadvantage of one-room flats was that the residents might have felt lonely. The relatives felt that the residents were bored, but few residents desired more activities, even if some of them longed for people to socialize with. For many older people, perhaps talking is the most important 'activity' at care homes. Concerning self-determination, some residents did not find it satisfactory. Relevance to clincial practice. Staff members must pay attention to residents' need to talk with people. For many older people, talking is perhaps the most important 'activity' at care homes. Nurses must safeguard residents' self-determination. When residents are in control of their lives, they may become satisfied with time.

  • 2.
    Andreae, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden..
    Strömberg, Anna
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.;Fac Med & Hlth Sci, Dept Cardiol, Linkoping, Sweden..
    Arestedt, Kristofer
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.;Linnaeus Univ, Ctr Collaborat Palliat Care, Kalmar, Sweden..
    Prevalence and associated factors for decreased appetite among patients with stable heart failure2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, p. 1703-1712Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure. BackgroundDecreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group. DesignObservational, cross-sectional study. MethodsA total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite. ResultsSeventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance. ConclusionIn this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Relevance to clinical practiceLoss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs.

  • 3.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Swenne, Christine Leo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Lindberg, Susan
    Skaraborg Hosp, Dept Anaesthesia, Skovde, Sweden.
    Rudolfsson, Gudrun
    Univ West, Dept Hlth Sci, Trollhattan, Sweden.;Univ Nordland, Fac Profess Studies, Bodo, Norway.
    von Vogelsang, Ann-Christin
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neurosurg, R2 02, SE-17176 Stockholm, Sweden.
    The meaning of person-centred care in the perioperative nursing context from the patient's perspective: an integrative review2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 17-18, p. 2527-2544Article, review/survey (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing.

    BACKGROUND: Person-centred care is used, but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts.

    DESIGN: Integrative Review.

    METHODS: A two-part search strategy was employed: first, a computerised database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004-2014, was performed, and second, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected, and an integrative review was conducted.

    RESULTS: Four themes were discovered: 'being recognised as a unique entity and being allowed to be the person you are', 'being considered important by having one's personal wishes taken into account', 'the presence of a perioperative nurse is calming, prevents feelings of loneliness and promotes well-being, which may speed up recovery' and 'being close to and being touched by the perioperative nurse during surgery'.

    CONCLUSIONS: Person-centred care means respecting the patient as a unique individual, considering the patient's particularities and wishes and involving the patient in their own care. Person-centred care also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone.

    RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of person-centred care, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient, resulting in personalisation of care rather than simply defining the concept.

  • 4. Arenhall, Eva
    et al.
    Kristofferzon, Marja-Leena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Fridlund, Bengt
    Nilsson, Ulrica
    The female partners' experiences of intimate relationship after a first myocardial infarction2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 11-12, p. 1677-1684Article in journal (Refereed)
    Abstract [en]

    Aim. This study aimed to explore and describe women's experience of intimate relationships in connection to and after their partner's first myocardial infarction. Background. Support from partners is important for recovery, but little is known about partners' experience of intimate relationships after myocardial infarction. Design. The study used an explorative, qualitative design. Methods. The first author interviewed 20 women having a partner who had suffered a first myocardial infarction during the preceding year. Qualitative content analysis was used to analyse the data. Findings. Three themes emerged: 'limited life space', 'sense of life lost' and 'another dimension of life'. The women described how their self-assumed responsibility led to a more stifling and limited life. Their sense of life lost was described in terms of deficits and feeling the loss. The women also described experiencing another dimension of life characterised by three subthemes: 'uncertainty of life', 'certain of relationship' and 'share life more'. Conclusions. The partners' myocardial infarction had an impact on the interviewees' intimate relationships; they suffered a major loss and missed their 'former' partner, both emotionally and sexually. They struggled with the new asymmetry in their intimate relationship and felt compelled to adapt to their partners' lack of sexual desire or function. Also, their partner controlled them, which lead towards a stifling, more limited life space. Relevance to clinical practice. Caregivers in hospital and primary care settings could apply the findings in their efforts to help couples recover or maintain intimate relationships following myocardial infarction.

  • 5. Arenhall, Eva
    et al.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avd. för hälso- och vårdvetenskap.
    Fridlund, Bengt
    Nilsson, Ulrika
    The female partners´experiences of intimate relationship after a first myocardial infarction2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, p. 1677-1684Article in journal (Refereed)
  • 6.
    Arnetz, Judith E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Zhdanova, Ludmila
    Patient involvement climate: views and behaviours among registered nurses in myocardial infarction care2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 3-4, p. 475-485Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To introduce and define the patient involvement climate and measure its quality and strength via views and behaviours among nurses in coronary care units. Background. Patient involvement is receiving increased attention among health-care providers. To better understand and optimise the interpersonal dynamics of patient involvement, it is important to study the organisational context in which the patient-provider interaction occurs. Design. Cross-sectional, self-report questionnaire study. Methods. Registered nurses across 12 coronary care units (n = 303) completed a questionnaire reporting their views and behaviours regarding patient involvement. Analyses assessed climate quality (the positive or negative nature of nurses' perceptions) and climate strength (the degree of consensus within coronary care units). Results. Climate quality and strength were greatest for the dimensions measuring nurses' views of patient involvement, the nurse-patient information exchange process and nurses' responsiveness to patient needs. Climate quality and strength were weaker for the dimensions measuring nurses' views of the hindrances associated with patient involvement, discussion of daily activities and efforts to motivate patients to take responsibility for their health. In units with consensus that patient involvement poses hindrances, nurses were less likely to address patient needs. Conclusions. When nurses perceived patient involvement as less of a hindrance in their work, they were more responsive to patient needs. A patient involvement climate characterised by motivational behaviour among nurses was marked by better information exchange and discussion of suitable activities postdischarge. Relevance to clinical practice. Managers can capitalise on positive climate aspects by encouraging ward activities that facilitate active patient involvement among nurses. One suggestion is educational interventions at the workplace focused on reducing perceptions of patient involvement as a hindrance and encouraging the attitudes that it can enrich nursing work and patient outcomes.

  • 7.
    Arving, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Creating a new profession in cancer nursing?: Experiences of working as a psychosocial nurse in cancer care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 19-20, p. 2939-2947Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the nature of being a psychosocial nurse in cancer care.

    Background. Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored.

    Design. A qualitative inductive interview approach was used.

    Methods. A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed.

    Results. The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were.

    Conclusions. This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care.

    Relevance to clinical practices. The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.

  • 8.
    Björn, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Lindberg, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. University of Gävle.
    Rissén, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Significant factors for work attractiveness and how these differ from the current work situation among operating department nurses2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 1-2, p. 109-116Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim was to examine significant factors for work attractiveness and how these differ from the current work situation among operating department nurses. A second objective was to examine the associations between age, gender, length of employment, work engagement, work ability, self-rated health indicators and attractiveness of the current work situation.

    BACKGROUND: The attractiveness of work is rarely taken into account in research on nurse retention. To expand this knowledge, it is relevant to examine factors that make work attractive and their associations with related concepts.

    DESIGN: Correlational, cross-sectional survey using a convenience sample.

    METHODS: Questionnaires were answered by 147 nurses in four operating departments in Sweden. Correlation and regression analyses were conducted.

    RESULTS: The nurses rated the significance of all factors of work attractiveness higher than they rated those factors in their current work situation; salary, organisation and physical work environment had the largest differences. The most significant attractive factors were relationships, leadership and status. A statistically significant positive correlation between work engagement and attractive work was found. In the multiple regression model, the independent variables work engagement and older age significantly predicted work attractiveness.

    CONCLUSIONS: Several factors should be considered in the effort to increase work attractiveness in operating departments and thereby to encourage nurse retention. Positive aspects of work seem to unite work engagement and attractive work, while work ability and self-rated health indicators are other important dimensions in nurse retention.

    RELEVANCE TO CLINICAL PRACTICE: The great discrepancies between the significance of attractive factors and the current work situation in salary, organisation and physical work environment suggest ways in which work attractiveness may be increased. To discover exactly what needs to be improved may require a deeper look into the construct of the examined factors.

  • 9.
    Blomqvist, Ylva Thernström
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Swedish mothers' experience of continuous Kangaroo Mother Care2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 9-10, p. 1472-1480Article in journal (Refereed)
    Abstract [en]

    Aims. To characterise the first infants receiving continuous Kangaroo Mother Care from birth to discharge in a Swedish neonatal intensive care unit and to investigate their mothers' experiences of this model of care. Background.  Admission of a newborn infant to a neonatal intensive care unit commonly implies separation of the new mother from her infant. Kangaroo Mother Care is a model of neonatal care which supports the parental role as primary care-giver and contributes to minimising the separation between the infant and parents. Design. A retrospective survey design. Method. A purposive sample consisting of 23 mother-infant pairs. Relevant infant data were obtained from their medical records. A questionnaire with questions about the infant's care and regarding Kangaroo Mother Care was designed for this study. Results.  The infants were born at a gestational age of 31-41 weeks, birth weight ranging from 1715-3700 g. The mothers of these moderately preterm and ill newborn infants showed good acceptance of the idea of providing their infants with continuous Kangaroo Mother Care during their stay at the neonatal intensive care unit. The mothers' evaluations of this method were predominantly positive. Negative comments concerned lack of information about practical application of the method, and some mothers perceived their infants' care during the night as exhausting. No mother would have preferred not to perform continuous Kangaroo Mother Care or to terminate Kangaroo Mother Care earlier than they did. Conclusions. These mothers accepted this model of care very well, provided that they received the help and support they required. Relevance to clinical practice.  Mothers whose infants are admitted to an neonatal intensive care units in settings similar to the study setting should be offered opportunities to be present and provide Kangaroo Mother Care for their infants, to the extent that they are able and willing to do so and as permitted by the infant's medical condition and care.

  • 10. Bos, Elisabeth
    et al.
    Alinaghizadeh, Hassan
    Saarikoski, Mikko
    Kaila, Päivi
    Validating the 'clinical learning environment, supervision and nurse teacher' CLES+T instrument in primary healthcare settings using confirmatory factor analysis.2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 11-12Article in journal (Refereed)
  • 11.
    Eriksson, Hanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Leo Swenne, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Arakelian, Erebouni
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Patients' experiences of postoperative health related to cytoreductive surgery and hyperthermic intraoperative chemotherapy2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 1-2, p. 201-210Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.To study patients’ descriptions of their health after cytoreductive surgery (CRS) before discharge.

    Background. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) affects the patient’s recovery. The hospital stay is long, and it is important to study how patients experience their health postoperatively.

    Design. Qualitative descriptive design.

    Methods. Between January–May 2012, individual interviews were conducted with 20 patients in a university hospital in cen- tral Sweden using a semi-structured interview guide. Data were analysed using qualitative content analysis.

    Results. Three themes (a process, body and mind, and support) and nine categories emerged. The surgery was described as a turning point, followed by a period of hope and thankfulness. Nevertheless, patients had difficulty taking in their positive feelings because they were overwhelmed by their bodily ailments. Despite the patients’ descriptions of being on an emotional roller coaster, thinking about death and an uncertain future, or being in a state somewhere between sleep and wakefulness, they described them- selves as being in good mental health. Continuous individualised information and support from the surgeon and staff members were described as being important for the recovery process, and none of the patients asked for counselling before discharge.

    Conclusion. Surgery was described as a turning point followed by an uncertain future. Despite the overwhelming nature of their bodily ailments and being on an emotional roller coaster postoperatively, patients described themselves as being in good psychological health and not needing any professional counselling. Continuous individualised information from the surgeon and staff members played an important role in the recovery process.

    Relevance to clinical practice. Both staff and future patients may benefit from the patients’ experiences after CRS and HIPEC described in this study. The knowledge gained from this study could be used in designing a care plan for future patients undergoing CRS and HIPEC.

  • 12.
    Feo, Rebecca
    et al.
    University of Adelaide/Adelaide Nursing School.
    Conroy, Tiffany
    School of Nursing, University of Adelaide, Australia.
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide.
    Brovall, Maria
    Högskolan i Skövde/Institutionen för hälsa och lärande.
    Parr, Jenny
    Department of Health Care Practice, Auckland University of Technology, New Zealand.
    Blomberg, Karin
    Örebro universitet/Institutionen för hälsovetenskaper .
    Kitson, Alison
    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 .
    Towards a standardised definition for fundamental care: A modified Delphi study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2285-2299Article in journal (Refereed)
    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.

  • 13. Flodén, Anne
    et al.
    Persson, Lars-Olof
    Rizell, Magnus
    Sanner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Forsberg, Anna
    Attitudes to organ donation among Swedish ICU nurses2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 21-22, p. 3183-3195Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To present data on Swedish ICU nurses' attitudes to brain death and organ donation and to test a questionnaire designed to explore these issues in terms of validity and reliability.

    Background

    Previous studies have identified various barriers to organ donation. The single most important factor was the attitude of ICU staff. Design.  A 34-item instrument was developed to explore attitudes and experiences of organ donation.

    Method

    The questionnaire was sent to 50% of ICU nurses in Sweden (n = 1013) and the response rate was 69% (n = 702). The expected scale dimensionality was examined both by explorative principal component analysis and confirmatory multi-trait analysis. Scale reliability was further estimated using Cronbach's alpha. Chi-squared test was used to compare proportions between ICU specialities and Pearson correlations were calculated to investigate relationships between each of the factors verified and the single items.

    Results

    The main findings were that less than half of the ICU nurses trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. Twenty-five percent of the respondents indicated that mechanical ventilation was withdrawn to reduce the possible suffering of a person assumed to be clinically dead, without the issue of organ donation being raised. A total of 39% had experienced occasions when the question about organ donation was never raised with the relatives. Four factors were verified and labelled: personal attitudes to organ donation as a situation; Organisational attitudes to organ donation as a phenomenon; Environmental resources; and Personal wish to donate, which accounted for 70% of the variance.

    Conclusions

    Swedish ICU nurses reported several barriers to organ donation. An action plan including education in brain death diagnostics, interpersonal relationships and interaction with relatives as well as regular follow-up regarding donation issues in various ICU settings would be useful.

    Relevance to clinical practice

    All nurses working in ICUs are obliged to participate in organ donation and are therefore included in these results. 

  • 14.
    Fogelberg Dahm, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nurses' experiences of and opinions about using standardised care plans in electronic health records: a questionnaire study2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 16, p. 2137-2145Article in journal (Refereed)
    Abstract [en]

    Aim.

    The aim of the present study was to investigate nurses' opinions about using standardised care plans in electronic health record and quality standards for clinical practice.

    Background.

    Following introduction of an electronic health record, use of standardised care plans and quality standards has increased among nurses at two hospitals in Sweden. Understanding nurses' opinions is important to continued development in this area. There are few previous studies on nurses' opinions about standardised care plans.

    Design.

    Survey.

    Method.

    The study was quantitative, descriptive and based on a questionnaire. The questionnaire included items on nurses' knowledge of and opinions about standardised care plans and quality standards.

    Results.

    The majority of the nurses were of the opinion that standardised care plans increase their ability to provide the same high-quality basic care for all patients. They also thought that a common standardised care plan across several professions would improve conditions for provision of high-quality care. The majority of the nurses also felt that the quality standards are a prerequisite of maintaining standardised care plans of high quality. There was no consensus on whether standardised care plans increase the risk of failing to notice patients' individual problems. Most agreed that standardised care plans decrease documentation time as well as redundant documentation. The study showed that training is needed to teach nurses how to use standardised care plans in care provision.

    Conclusions.

    The nurses in the study had positive attitudes towards use of standardised care plans and felt that they could facilitate nursing practice.

    Relevance to clinical practice.

    Use of standardised care plans can improve nursing documentation and facilitate work for nurses. Moreover, it can support nurses in their use of evidence-based nursing methods. The present study shows that nurses have positive attitudes, which could facilitate continued use of standardised care plans.

  • 15. Fonad, Edit
    et al.
    Wahlin, Tarja-Brita Robins
    Winblad, Bengt
    Emami, Azita
    Sandmark, Helene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Falls and fall risk among nursing home residents2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 1, p. 126-134Article in journal (Refereed)
    Abstract [en]

    Aim and objectives. The aim of this study was to identify risk factors for falls in older people living in nursing homes. Background. Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved. Method. The study was carried out over four years (2000-2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom-restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient-bound. The study covered 2343 reported incidents. Results. There was a significant correlation between falls and fractures (r = 0.365, p = 0.004), fall risk and use of wheelchairs (r = 0.406, p = 0.001, safety belts (r = 0.403, p = 0.001 and bed rails (r = 0.446, p = 0.000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0.352, p = 0.005). Associations were also found between fall risk and the use of anti-depressants (r = 0.412, p = 0.001). Conclusions. In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti-depressants and sleeping pills, especially benzodiazepines.

  • 16. Franzén Dahlin, Å.
    et al.
    Laska, A-C
    Larson, J.
    Wredling, R.
    Billing, Ewa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Murray, V.
    Predictors of life situation among significant others of depressed or aphasic stroke patients2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 12, p. 1574-1580Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to examine predictors of the life situation of the significant other of depressed or aphasic stroke patients. Background. Depression and aphasia are common consequences of stroke, and both may put pressure on the significant other who have to deal not only with a possible physical handicap but also with communication and/or serious psychiatric difficulties. Design. Descriptive, cross-sectional study. Methods. The participants were significant others of 71 depressed and 77 aphasic stroke patients. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder, and degree of aphasia was diagnosed with the Amsterdam Nijmegen Everyday Language Test. Assessments of the life situation, state of depression and aggression, personality change and need of assistance were made through questionnaires issued to the significant others. Results. Perceived need of assistance was the only common predictor of life situation of the significant other in both groups (p < 0.001). With respect to the aphasic patients, perceived personality change (p < 0.001) and living with the patient (p = 0.004) were factors that had a negative effect on the life situation of the significant other. Conclusions. This study highlights that the perception of the patient's need of assistance is an important factor in predicting the life situation among spouses of depressed as well as aphasic stroke patients. A comparison of the two groups to explain the life situation of the significant others revealed greater explanatory power for the aphasic group. Relevance to clinical practice. Assessments of the spouses' perception as well as of the patients' factual situation may identify those significant others at risk. With this new approach, necessary steps may be taken to alleviate pressure on the significant other.

  • 17. Franzén-Dahlin, Åsa
    et al.
    Larsson, Jenny
    Murray, Veronica
    Wredling, Regina
    Billing, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Predictors of psychological health in spouses of persons affected by stroke2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 5, p. 885-891Article in journal (Refereed)
    Abstract [en]

    Aim.To identify predictors of psychological health and examine if these predictors change over time in spouses of stroke patients during the first year after stroke. A second aim was to identify gender differences in psychological health among the spouses. Background. The impact of burden in long-term caregivers may result in psychological consequences for the spouse. The rehabilitation process for the patient can be negatively affected by a stressed caregiver and result in long-term hospitalization. To identify spouses at risk for physical and psychological distress is, therefore, essential to support those in need. Design. Longitudinal, comparative study. Methods. One hundred spouses of stroke patients were assessed at baseline, as well as after six and 12 months, regarding psychological health, well-being, own illness, need of assistance from general practitioner and/or district nurse, social network and knowledge about stroke. Stepwise multiple regression analyses were conducted for baseline, six- and 12-month assessments, respectively, with psychological health as the dependent variable. Results. General well-being and presence of illness in spouse were the most prominent predictors of psychological health, throughout the first year. Conclusions. Enhancing psychological health and preventing medical problems in the caregiver are essential considerations to enable patients with stroke-related disabilities to continue to live at home. Relevance to clinical practice. Evaluating the situation for spouses of stroke patients is an important component when planning for the future care of the patient.

  • 18.
    Frauenfelder, Fritz
    et al.
    Psychiat Univ Hosp Zurich, Directorate Nursing Therapies & Social Work, Zurich, Switzerland..
    van Achterberg, Theo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Leuven, Belgium.;Radboud Univ Nijmegen, Sci Inst Qual Hlth Care, Med Ctr, Nijmegen, Netherlands..
    Staub, Maria Muller
    Pflege PBS Projects Consulting Res, Wil, Switzerland.;Hanze Univ, Groningen, Netherlands..
    Nursing diagnoses related to psychiatric adult inpatient care2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 3-4, p. e463-e475Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To detect the prevalence of NANDA-I diagnoses and possible relationships between those and patient characteristics such as gender, age, medical diagnoses and psychiatric specialty/setting.

    Background: There is a lack on studies about psychiatric inpatient characteristics and possible relationships among these characteristics with nursing diagnoses.

    Design: A quantitative-descriptive, cross-sectional, completed data sampling study was performed.

    Methods: The data were collected from the electronic patient record system. Frequencies for the social-demographic data, the prevalence of the NANDA-I diagnoses and the explanatory variables were calculated.

    Results: In total, 410 nursing phenomena were found representing 85 different NANDA-I diagnoses in 312 patients. The NANDA-I diagnosis Ineffective Coping was the most frequently stated diagnosis followed by Ineffective Health Maintenance, Hopelessness and Risk for Other-Directed Violence. Men were more frequently affected by the diagnoses Ineffective Coping, Hopelessness, Risk for Self-Directed Violence, Defensive Coping and Risk for Suicide, whereas the diagnoses Insomnia, Chronic Confusion, Chronic Low Self-Esteem and Anxiety were more common in women. Patients under the age of 45years were more frequently affected by Chronic Low Self-Esteem and Anxiety than older patients. Ineffective Coping was the most prevalent diagnosis by patients with mental disorders due to psychoactive substance use. Patients with schizophrenia were primarily affected by the diagnoses Ineffective Coping, Impaired Social Interaction and Chronic Low Self-Esteem.

    Conclusions: This study demonstrates the complexity and diversity of nursing care in inpatient psychiatric settings. Patients' gender, age and psychiatric diagnoses and settings are a key factor for specific nursing diagnosis.

    Relevance to clinical practice: There are tendencies for relationships between certain nursing diagnosis and patient characteristics in psychiatric adult inpatients. This enhances the specific, extended knowledge for nursing care and its demands in this setting and therefore supports the daily nursing psychiatric care and its needs.

  • 19.
    Gunnarsson, Anna-Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Lönn, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 9, p. 1325-1333Article in journal (Refereed)
    Abstract [en]

     The aims were to investigate whether there were any differences between patients receiving nutritional intervention preoperatively and over five days postoperatively and patients who did not, in terms of postoperative complications, rehabilitation, length of stay and food and liquid intake. BACKGROUND: Patients with hip fractures are often malnourished at admission to hospital and they typically do not receive the energy and calories needed postoperatively. DESIGN: The design was a quasi-experimental, pre- and post-test comparison group design without random group assignment. METHODS: One hundred patients with hip fractures were consecutively included. The control group (n = 50) received regular nutritional support. The intervention group (n = 50) received nutrition according to nutritional guidelines. The outcome measures used were risk of pressure ulcer, pressure ulcers, weight, nosocomial infections, cognitive ability, walking assistance and functional ability, collected preoperatively and five days postoperatively. Each patient's nutrient and liquid intake were assessed daily for five days postoperatively. RESULTS: Significantly fewer (p = 0.043) patients in the intervention group (18%) had pressure ulcers five days postoperatively compared with the control group (36%). Nutrient and liquid intake was significantly higher (p < 0.001) in the intervention group. Median length of stay decreased from nine to seven days (p = 0.137), as did nosocomial infections, from 18-8.7% (p = 0.137). CONCLUSION: Patients with hip fractures receiving nutrition according to nutritional guidelines developed fewer pressure ulcers. This is invaluable to patients' quality of life and a major economic saving for society. RELEVANCE TO CLINICAL PRACTICE: Great benefits can be gained for the patients through modest efforts by nurses and physicians such as nutritional intervention.

  • 20.
    Gunningberg, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Fogelberg-Dahm, Marie
    Uppsala University.
    Ehrenberg, Anna
    Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 11, p. 1557-1564Article in journal (Refereed)
    Abstract [en]

    AIMS: One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. BACKGROUND: With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). DESIGN: A cross-sectional retrospective review of health records. METHODS: Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper-based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0.001), size (p = 0.004), risk assessment (p = 0.002), nursing history (p = 0.040), nursing diagnoses (p < 0.001), nursing goals (p < 0.001) and nursing outcomes (p = 0.016) in 2006 than in 2002. One third of the recordings used preformulated templates. CONCLUSIONS: Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow-up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. RELEVANCE TO CLINICAL PRACTICE: Education related to the use of the electronic health record and evidence-based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user-friendly.

  • 21.
    Gunningberg, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Lindholm, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Sjödén, Per-Olow
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Implementation of risk assessment and classification of pressure ulcers as quality indicators for patients with hip fractures1999In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 8, no 4, p. 396-406Article in journal (Refereed)
    Abstract [en]

    The aims of the study were (i) to investigate the prevalence of pressure ulcers in patients with hip fracture, on arrival at a Swedish hospital, at discharge, and two weeks post-surgery; (ii) to test whether clinical use of the Modified Norton Scale (MNS) could identify patients at risk for development of pressure ulcers; and (iii) to compare the reported prevalence of pressure ulcer in the experimental group, where risk assessment and classification of pressure ulcers was performed on a daily basis, with that of the control group, where it was not. The study design was prospective, with an experimental and a control group. The intervention in the experimental group consisted of risk assessment, risk alarm and skin observation performed by the nurse on duty, in the A & E Department, and daily throughout the hospital stay. To facilitate the nurse's assessment, a 'Pressure Ulcer Card' was developed, consisting of the MNS and descriptions of the four stages of pressure ulcers. On arrival at the hospital, approximately 20% of patients in both groups had pressure ulcers. At discharge, the rate had increased to 40% (experimental) and 36% (control). Clinical use of the MNS made it possible to identify the majority of patients at risk for development of pressure ulcers. Patients who were confused on arrival developed significantly more pressure ulcers than patients who were orientated to time and place. No significant difference was found in the reported prevalence of pressure ulcers between the experimental and control groups.

  • 22.
    Haglund, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Psychiatric wards with locked doors: advantages and disadvantages according to nurses and mental health nurse assistants2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 4, p. 387-394Article in journal (Refereed)
    Abstract [en]

    Aims and objective. To describe nurses’ and mental health nurse assistants’ perceptions of advantages and disadvantages about working on a psychiatric ward with a locked entrance door.

    Background. Psychiatric staff sometimes needs to protect patients from harming themselves or others. To keep the entrance door locked may help staff to achieve this goal. How locked entrance doors at psychiatric wards are experienced by staff, working on these wards, has been investigated to a very limited extent.

    Design. The study was explorative and descriptive.

    Method. Audio taped, semi-structured interviews with open-ended questions about advantages and disadvantages about working on a psychiatric ward with a locked entrance door, were conducted with 20 nurses and 20 mental health nurse assistants. Data were analyzed with content analysis.

    Results. A content analysis revealed eight categories of advantages and 18 categories of disadvantages. Most advantages mentioned by nurses and mental health nurse assistants were categorized as providing staff with control over patients, providing patients with a secure and efficient care and protecting patients and staff against ‘the outside’. Most disadvantages mentioned by nurses were categorized as causing extra work for staff, making patients feel confined, making patients feel dependent and creating a non-caring environment. Most disadvantages mentioned by mental health nurse assistants were categorized as causing extra work for staff, making patients feel confined, causing emotional problems for patients, making staff's power obvious and forcing patients to adapt to other patients’ needs. Nurses and mental health nurse assistants mentioned more disadvantages than advantages and nurses mentioned more disadvantages than mental health nurse assistants.

    Conclusion. Nurses and mental health nurse assistants perceive a number of advantages and disadvantages for themselves, patients and significant others with a locked door at a psychiatric ward. Most of these concern patients’ experiences.

    Relevance to clinical practice. It is important for staff working within psychiatric care to reflect upon the fact that a locked entrance door is connected with a range of negative as well as positive perceptions and to minimize patient and own concerns connected to the locked door.

  • 23.
    Hamblin, Lydia E.
    et al.
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA.;Wayne State Univ, Dept Psychol, Detroit, MI 48201 USA..
    Essenmacher, Lynnette
    Wayne State Univ, Sch Med, Detroit Med Ctr Occupat Hlth Serv, Detroit, MI 48201 USA..
    Upfal, Mark J.
    Wayne State Univ, Sch Med, Detroit Med Ctr Occupat Hlth Serv, Detroit, MI 48201 USA.;Wayne State Univ, Sch Med, Dept Emergency Med, Occupat Med, Detroit, MI 48201 USA..
    Russell, Jim
    Detroit Med Ctr Occupat Hlth Serv, Occupat Hlth Serv, Detroit, MI USA..
    Luborsky, Mark
    Wayne State Univ, Inst Gerontol, Detroit, MI 48201 USA.;Karolinska Inst, Dept Neurobiol Caring Sci & Soc, Stockholm, Sweden..
    Ager, Joel
    Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA..
    Arnetz, Judith E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Wayne State Univ, Sch Med, Dept Family Med & Publ Hlth Sci, Detroit, MI 48201 USA..
    Catalysts of worker-to-worker violence and incivility in hospitals2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 17-18, p. 2458-2467Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesTo identify common catalysts of worker-to-worker violence and incivility in hospital settings. BackgroundWorker-to-worker violence and incivility are prevalent forms of mistreatment in healthcare workplaces. These are forms of counterproductive work behaviour that can lead to negative outcomes for employees, patients and the organisation overall. Identifying the factors that lead to co-worker mistreatment is a critical first step in the development of interventions targeting these behaviours. DesignRetrospective descriptive study. MethodsQualitative content analysis was conducted on the total sample (n=141) of employee incident reports of worker-to-worker violence and incivility that were documented in 2011 at a large American hospital system. ResultsMore than 50% of the incidents involved nurses, and the majority of incidents did not involve physical violence. Two primary themes emerged from the analysis: Work Behaviour and Work Organisation. Incidents in the Work Behaviour category were often sparked by unprofessional behaviour, disagreement over responsibilities for work tasks or methods of patient care, and dissatisfaction with a co-worker's performance. Incidents in the Work Organisation category involved conflicts or aggression arising from failure to following protocol, patient assignments, limited resources and high workload. ConclusionIncidents of worker-to-worker violence and incivility stemmed from dissatisfaction with employee behaviour or from organisational practices or work constraints. These incident descriptions reflect worker dissatisfaction and frustration, resulting from poor communication and collaboration between employees, all of which threaten work productivity. Relevance to clinical practiceViolence and incivility between hospital employees can contribute to turnover of top performers, hinder effective teamwork and jeopardise the quality of patient care. Identification of common catalysts for worker-to-worker violence and incivility informs the development of mistreatment prevention programmes that can be used to educate hospital staff.

  • 24.
    Hasson, Henna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Arnetz, Judith
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 4, p. 468-481Article in journal (Refereed)
    Abstract [en]

    Aims. The aims of this study were to: (1) compare older people care nursing staff's perceptions of their competence, work strain and work satisfaction in nursing homes and home-based care; and (2) to examine determinants of work satisfaction in both care settings. Background. The shift in older people care from hospitals to community-based facilities and home care has had implications for nursing practice. Lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff in both care settings have been associated with high turnover. Few studies have compared staff perceptions of their competence and work in nursing homes as opposed to home-based care. Design. A cross-sectional questionnaire survey. Methods. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire in 2003 in two older people care organizations in Sweden. Comparisons of all outcome variables were made between care settings both within and between the two organizations. Multiple regression analysis was used to determine predictors of work satisfaction in home care and nursing homes respectively. Results. In general, staff in home-based care reported significantly less sufficient knowledge compared with staff in nursing homes. However, home care staff experienced significantly less physical and emotional strain compared with staff in nursing homes. Ratings of work-related exhaustion, mental energy and overall work satisfaction did not differ significantly between care settings. In both care settings, work-related exhaustion was the strongest (inverse) predictor of work satisfaction. Conclusions. Future interventions should focus on counteracting work-related exhaustion and improving competence development to improve work satisfaction among older people care nursing staff in both care settings. Relevance to clinical practice. Work-related exhaustion and lack of competence development may have significant negative implications for work satisfaction among older people care nursing staff in both home care and nursing homes.

  • 25. Hasson, Henna
    et al.
    Arnetz, Judith E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Care recipients' and family members' perceptions of quality of older people care: a comparison of home-based care and nursing homes2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 9-10, p. 1423-1435Article in journal (Refereed)
    Abstract [en]

    Aims. To compare care recipients' and their relatives' perceptions of quality of care in nursing homes and home-based care. Background. Older people care is increasingly being provided in community care facilities and private homes instead of hospitals. A few studies have compared care recipients' and relatives' perceptions of care quality in nursing homes as opposed to home-based care. Design. Cross-sectional surveys. Methods. Care recipients' and relatives' perceptions of quality of care were measured by questionnaire in 2003 in two older people care organisations. Quality measures were compared between care settings. Multiple regression was used to determine the predictors of overall quality ratings for each group, and possible interactions between quality measures and care settings were tested. Results. Care recipients rated their opportunities for activities significantly lower in home care than in nursing homes. Relatives of care recipients in home-based care rated several aspects of care quality significantly lower than relatives of nursing home residents. No significant interaction effects regarding predictors of overall quality ratings between the care settings were found. Staff behaviour was the strongest predictor of care recipients' overall quality rating, and staff professional skills were the strongest predictor of relatives' overall quality rating. Conclusions. Compared with nursing homes, home-based older people care seems to be in greater need of development regarding staff competence, staff interaction with relatives and activities offered to older people. In both settings, nursing staff behaviour influences these stakeholders' satisfaction with care. Relevance to clinical practice. These results point to a need to improve services in both care settings, but especially in home-based care. It is suggested that care recipients' preferences for social and physical activities be investigated on a regular basis in both care settings. Efforts should also be made to improve communication and interaction between family members and older people care staff, especially in home-based care.

  • 26.
    Hedlund, Mathilde
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ronne-Engström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    From monitoring physiological functions to using psychological strategies: Nurses' view of caring for the aneurysmal subarachnoid haemorrhage patient2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 3, p. 403-411Article in journal (Refereed)
    Abstract [en]

    AIMS: The aims of this study were: (1) to describe nurses' views of the physical and supportive needs of patients who have suffered a subarachnoid haemorrhage (SAH), (2) to describe nurses' views of changes in social circumstances and (3) changes in the mental condition of patients after SAH. BACKGROUND: As patients with SAH are generally younger and predominantly female compared with other stroke groups they may have different needs of nursing support to facilitate adaptation. Caring for persons surviving stroke involves advanced nursing skills such as monitoring neurological functions in neurointensive care and providing physical care during rehabilitation. DESIGN: Explorative descriptive design. METHOD: Semi-structured interviews were performed with 18 nurses in neurointensive and rehabilitation care. A qualitative latent content analysis was conducted. RESULTS: Nurses viewed patients' need for support as a process ranging from highly advanced technological care to 'softer' more emotional care. However, shortages in the communication between neurointesive and rehabilitation nurses regarding this support were acknowledged. Changes in social circumstances and mental conditions were viewed both as obstacles and advantages regarding return to everyday life. Nurses also viewed that the characteristics of the group with SAH was not particularly different from the group with other types of stroke. CONCLUSIONS: Support to patients with SAH is viewed as a process carried out by nurses at neurointensive care units and rehabilitation units. Shortages in communication, regarding this support, were acknowledged. Obstacles and advantages with respect to returning to everyday life could apply to any stroke group, which could make it more difficult for nurses to detect the specific needs of patients with SAH. RELEVANCE TO CLINICAL PRACTICE: The communication between neurointensive nurses and rehabilitation nurses regarding support to patients with SAH is not satisfactory. Occasionally the specific needs of patients with SAH are not recognized.

  • 27.
    Hedlund, Mathilde
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Zetterling, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Ronne-Engström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Perceived recovery after aneurysmal subarachnoid haemorrhage in individuals with or without depression2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11-12, p. 1578-1587Article in journal (Refereed)
    Abstract [en]

    AIMS: The aims of the study were to describe what patients with no or only minor neurological deficits after aneurysmal subarachnoid haemorrhage (SAH) perceived to be important for recovery, and perceived consequences of the illness. BACKGROUND: Quantitative studies indicates unfavourable outcomes after aneurysmal SAH, concerning for example mental health and return to everyday life, among patients expected to recover completely. Thus, it is important to investigate the perceptions of patients and to give them the opportunity to communicate what they consider important for recovery. DESIGN: Qualitative descriptive design. METHOD: Semi-structured interviews with 20 aneurysmal subarachnoid haemorrhagic patients were conducted approximately 12 months after the onset. Analyses were carried out in two steps, beginning with a qualitative content analysis. Due to the findings in the initial content analysis, a structured clinical interview for psychiatric disorders was used as a second step to verify the presence or absence of depression in the participants. RESULTS: Two patterns were identified. One pattern revealed that informants without depression experienced a 'confident perception of recovery', which included perceptions of meaningfulness. Another pattern revealed that depressed informants experienced a 'pessimistic perception of recovery', which included perceptions of hopelessness. Expectations regarding care after departure from the neurointensive care unit were not met. CONCLUSIONS: Individuals suffering from depression after aneurysmal SAH have a pessimistic view of their recovery in contrast to those without depression. These findings highlight the importance of better recognition and treatment of depression in the aftermath of SAH. RELEVANCE TO CLINICAL PRACTICE: These findings highlight the importance of better recognition and treatment of depression after aneurysmal SAH, where nurses play an active role. Nurses should seek to take actions to better meet patient's needs after departure from neurointensive care units.

  • 28.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    The faceless encounter: ethical dilemmas in telephone nursing2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1865-1871Article in journal (Refereed)
    Abstract [en]

    Aim. This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work.

    Background. Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue.

    Method. A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically.

    Results. Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers' information needs with professional responsibility; and differences in judging the caller's credibility.

    Conclusion. The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing.

    Relevance to clinical practice. The work organization should provide opportunities for ethical competence-building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.

  • 29.
    Holmström, Inger K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Nokkoudenmaki, Mai-Britt
    Tunafors Primary Healthcare Ctr, Eskilstuna, Sweden..
    Zukancic, Selma
    Sundler, Annelie J.
    Malardalen Univ, Vasteras, Sweden.;Univ Boras, Fac Caring Sci Work Life & Social Welf, S-50190 Boras, Sweden..
    It is important that they care: older persons' experiences of telephone advice nursing2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 11-12, p. 1644-1653Article in journal (Refereed)
    Abstract [en]

    Aims and objectivesThe aim of the study was to explore older persons' experiences of telephone advice nursing at primary healthcare centres. BackgroundTelephone advice nursing is expanding worldwide, and the older population is increasing. Little is known about older persons' experiences of telephone advice nursing provided by primary healthcare. DesignThis study has a descriptive design with a qualitative inductive approach. MethodsData were collected via interviews with a purposive sample of 10 older persons in 2014. The data were analysed using qualitative content analysis. ResultsThe older persons' experiences were described in two themes: the patient-friendly aspects of telephone advice nursing and the patient-unfriendly aspects of telephone advice nursing. The themes can be understood as two sides of the same coin; the differences point to both the advantages and disadvantages of the service and are further illuminated through seven subthemes. ConclusionsThis study contributes to increased awareness of the advantages and disadvantages of the telephone advice nursing system as experienced by older persons. To be the focus of attention during calls was highlighted as important; and clear communication was deemed crucial. When the communication between the nurse and the older persons was perceived as good and the perspective of the caller was the focus, an experience of safety and satisfaction was described. Older persons had great confidence in the telephone nurses' competence and perceived their ability to access the service as mostly good, even if it was sometimes difficult to use the service. Relevance to clinical practiceThe communicative competence of telephone nurses is essential when providing telephone advice nursing to older persons. In addition, a person-centred approach is important to provide optimal care in telephone advice nursing.

  • 30.
    Hommel, Ami
    et al.
    Skane Univ Hosp, Lund, Sweden.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Idvall, Ewa
    Malmo Univ, Fac Hlth & Soc, Malmo, Sweden.; Skane Univ Hosp, Malmo, Sweden..
    Bååth, Carina
    Karlstad Univ, Dept Hlth Sci, Karlstad, Sweden.; Country Council Va armland, Karlstad, Sweden..
    Sucessful factors to prevent pressure ulcers - An interview study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 1-2, p. 182-189Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: The aim of present study was to explore successful factors to prevent pressure ulcers (PU) in hospital settings.

    BACKGROUND: PU prevalence has been recognized as a quality indicator for both patient safety and quality of care in hospital and community settings. Most PU can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions (SALAR) initiated nationwide PU prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of PU in the spring of 2014 was 14% in hospital settings with a range from 2.7% to 36.4%.

    DESIGN: Qualitative semi-structured interviews were conducted.

    METHODS: A qualitative content analysis, in addition to PARIHS frameworks was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014.

    RESULTS: Three main categories were identified as successful factors to prevent PU in hospitals: creating a good organization, maintaining persistent awareness, and realising the benefits for patients.

    CONCLUSION: The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of PU is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organization in prevention work.

    RELEVANCE TO CLINICAL PRACTICE: The nurse managers' attitude and crucial to enable the personnel to work actively with PU prevention. Strategies are proposed to advance clinical leadership, knowledge, skills, and abilities for the crucial implementation of PU prevention.

  • 31. Hrisanfow, Elisabet
    et al.
    Hägglund, Doris
    School of Health and Medical Sciences, Family Medicine Research Centre, Örebro University, Örebro, Sweden.
    Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 97-105Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care.

    Background

    Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant.

    Design

    A questionnaire survey.

    Method

    The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease.

    Results

    Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality of life scores, women with incontinence had lower physical state scores (37.6+10.4 vs. 41.4+9.9; p<0.001) and mental state scores (44.3+10.2 vs. 47.1+10.5; p<0.007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality of life scores, men with incontinence had lower mental state scores than did men without incontinence (46.0+9.7 vs. 49.8+9.7; p<0.001).

    Conclusion

    The present results indicate that cough and urinary incontinence leads to poor quality of life in women and men with chronic obstructive pulmonary disease.

    Relevance to clinical practice

    In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.

  • 32.
    Hägglund, Doris
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ahlström, Gerd
    The meaning of women's experience of living with long term urinary incontinence is powerlessness2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1946-1954Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). BACKGROUND: Living with long-term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. METHOD: Fourteen women with UI (range: 34-52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. FINDINGS: The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub-themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub-themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. RELEVANCE TO CLINICAL PRACTICE: Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self-care abilities.

  • 33.
    Häggström, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Barbro, Barbro Wadensten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    A nine-month intervention programme focusing on empowerment: caregivers' descriptions of changed behaviour and increased room for acting2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 6, p. 866-873Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe public nursing home Enrolled Nurses' and Nurses Aides' view of their work and their perceptions of themselves in their professional role while they were receiving a serious of role awareness sessions focusing on empowerment for nine months.

    BACKGROUND: According to several studies, it is typical that women may experience problems and injustices at work. The main focus of the intervention was to help enrolled nurses' and nurses aides' in developing their self-image and professional role.

    DESIGN: This study was descriptive and qualitative in design.

    METHODS: The present study comprises semi-structured interviews conducted with enrolled nurses and nurses aides (n = 14) from public nursing homes at start of the intervention and again nine months following the intervention. The text from the interviews was analysed using latent content analysis.

    RESULTS: The main findings primarily show an improved professional role for the caregivers, as described in the following themes: the move from passivity to activity, the move from complaining to understanding, the move from expectations to frustration and the move from being silent to speaking loud.

    CONCLUSIONS: For caregivers working with older people within public nursing home care, it seems to be a good form of clinical supervision to implement a serious of role awareness sessions in order to improve their professional role.

    RELEVANCE TO CLINICAL PRACTICE: The findings showed that an intervention providing opportunities with focus on empowerment improved the enrolled nurses' and nurses aides' professional role in working with older people. This can be useful information for managers and educators and they may want to adapt it when working in a public nursing home.

  • 34.
    Höglund, Anna T
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    "It's easier to talk to a woman" - aspects of gender in Swedish telenursing2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 22, p. 2979-2986Article in journal (Refereed)
    Abstract [en]

    Aim. To describe and explore gender aspects in telenursing as experienced by Swedish telenurses.

    Background. Telenurses at call centres in Sweden offer triage recommendations and self-care advice to the general public over the telephone, on a wide range of health problems. The demands on telenurses are multifaceted and competence is needed in many fields such as nursing, pharmacology, psychology and communication. Previous studies have shown that telenurses encounter many ethical dilemmas and that some of these are to do with gender related issues. Most telenurses, as well as most callers, are women. It is, therefore, reasonable to believe that gender plays an important role in the work of telenurses.

    Design. Descriptive and explorative qualitative design.

    Methods. A purposive sample of 12 female telenurses in Sweden participated in in-depth interviews twice during 2004–2005. The transcribed interviews were analysed inductively with a stepwise thematic method.

    Results. Five themes emerged from the interviews, namely: female subordination in the family, disrespect in dialogue with female nurses, distrust in fathers' competence, reluctant male callers and woman-to-woman connection.

    Conclusions. Gender construction and cultural gender norms seem to be at work in the encounter between Swedish telenurses and callers. Questions of power relations, the picture of the mother/woman as the primary carer for small children and distrusting men in their parental role were particularly highlighted.

    Relevance to clinical practice. Telenurses should be aware of the risk of stereotyping their dialogues with callers in a way that seems to fit better with female callers' ways of communicating. Clinical supervision based on reflective practice and peer reviews of calls might diminish this risk. Telenurses also need more training in handling overt or covert power messages based on male superiority.

  • 35.
    Jakobsson Larsson, Birgitta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Askmark, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Nygren, Ingela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Coping strategies among patients with newly diagnosed amyotrophic lateral sclerosis2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 21-22, p. 3148-3155Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To prospectively identify different coping strategies among newly diagnosed amyotrophic lateral sclerosis patients and whether they change over time and to determine whether physical function, psychological well-being, age and gender correlated with the use of different coping strategies.

    BACKGROUND: Amyotrophic lateral sclerosis is a fatal disease with impact on both physical function and psychological well-being. Different coping strategies are used to manage symptoms and disease progression, but knowledge about coping in newly diagnosed amyotrophic lateral sclerosis patients is scarce.

    DESIGN: This was a prospective study with a longitudinal and descriptive design.

    METHODS: A total of 33 patients were included and evaluation was made at two time points, one to three months and six months after diagnosis. Patients were asked to complete the Motor Neuron Disease Coping Scale and the Hospital Anxiety and Depression Scale. Physical function was estimated using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale.

    RESULTS: The most commonly used strategies were support and independence. Avoidance/venting and information seeking were seldom used at both time points. The use of information seeking decreased between the two time points. Men did not differ from women, but patients ≤64 years used positive action more often than older patients. Amyotrophic Lateral Sclerosis Functional Rating Scale was positively correlated with positive action at time point 1, but not at time point 2. Patients' psychological well-being was correlated with the use of different coping strategies.

    CONCLUSIONS: Support and independence were the most used coping strategies, and the use of different strategies changed over time. Psychological well-being was correlated with different coping strategies in newly diagnosed amyotrophic lateral sclerosis patients.

    RELEVANCE TO CLINICAL PRACTICE: The knowledge about coping strategies in early stage of the disease may help the nurses to improve and develop the care and support for these patients.

  • 36.
    Jangland, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Mirza, Noeman
    Thompson Rivers Univ, Sch Nursing, Kamloops, BC, Canada.
    Conroy, Tiffany
    Univ Adelaide, Adelaide Nursing Sch, Adelaide, SA, Australia.
    Merriman, Clair
    Oxford Brookes Univ, Fac Hlth & Life Sci, Oxford, England.
    Suzui, Emiko
    Otemae Univ, New Dept Preparatory Off, Kobe, Hyogo, Japan.
    Nishimura, Akiko
    Hyogo Univ Hlth Sci, Sch Nursing, Dept Nursing, Kobe, Hyogo, Japan.
    Ewens, Ann
    Staffordshire Univ, Ctr Excellence Healthcare Educ, Stoke On Trent, Staffs, England.
    Nursing students' understanding of the Fundamentals of Care: A cross-sectional study in five countries2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2460-2472Article in journal (Refereed)
    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.

  • 37.
    Jangland, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Teodorsson, Therese
    Molander, Karin
    Muntlin Athlin, Åsa
    Inadequate environment, resources, and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    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. This article is protected by copyright. All rights reserved.

  • 38.
    Jeffs, Lianne
    et al.
    Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide, Australia.
    Needleman, Jack
    UCLA Fielding School of Public Health / Department of Health Policy and Management, USA.
    Jackson, Debra
    Oxford Brookes University/Department of Nursing,Faculty of Health and Life Sciences, UK.
    Kitson, Alison
    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 .
    Building the Foundation to Generate a Fundamental Care Standardized Data Set2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2481-2488Article in journal (Refereed)
    Abstract [en]

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

  • 39.
    Johnston, Bridget
    et al.
    Univ Nottingham, UK.
    Larkin, Philip
    Univ Coll Dublin, Ireland ; Our Ladys Hosp & Care Serv, Ireland..
    Connolly, Michael
    Univ Coll Dublin, Ireland ; Our Ladys Hosp & Care Serv, Ireland.
    Barry, Catriona
    Our Ladys Hosp & Care Serv, Ireland.
    Narayanasamy, Melanie
    Univ Nottingham, UK.
    Östlund, Ulrika
    Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV).
    McIlfatrick, Sonja
    Univ Ulster, UK.
    Dignity-conserving care in palliative care settings: An integrative review2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 13-14, p. 1743-1772Article, review/survey (Refereed)
    Abstract [en]

    Aims and objectivesTo report an integrative review of evidence relating to dignity-conserving care in palliative care settings. It will also suggest avenues for future research. BackgroundResearch suggests that dignity is welcomed by those receiving palliative and end of life care. However, as dignity is a subjective term, it is not always explicit how this may be employed by nurses. Given that the preferred place of care for patients with palliative care needs is the home, the issue of dignity may be particularly important for community nurses. Therefore, synthesising evidence of dignity-conserving care for community nurses caring for people with palliative care needs provides clarity in a complex area of palliative care research. DesignIntegrative literature review. MethodThe review involved key bibliographic and review databases CINAHL, MEDLINE, EMBASE, ASSIA and PsycInfo. Medical Subject Headings and free terms were undertaken for articles published from January 2009-September 2014 and retrieved papers were assessed against inclusion criteria. Final included articles were reviewed for reported dignity-conserving care actions, which were classified under nine themes of the Dignity Model. ResultsThirty-one articles were included. Nine Dignity Model themes were used to classify care actions: Level of Independence; Symptom Distress; Dignity-Conserving Perspectives; Dignity-Conserving Practices; Privacy Boundaries; Social Support; Care Tenor; Burden to Others; and Aftermath Concerns. Reported care actions included listening, conveying empathy, communication and involving patients in care. ConclusionCare actions could be classified under most of Dignity Model themes. However, there were less reported care actions related to Level of Independence and Aftermath Concerns, which meant that these had to be formulated independently. Future research should be structured around these areas to determine appropriate care actions for nurses to give dignity-conserving care that addresses these specific themes. Relevance to clinical practiceSynthesising the available evidence of dignity-conserving care identifies evidence-based care actions and provides guidance to nursesin clinical practice caring for patients with palliative care needs. Future opportunities for research are identified to guide promotion of dignity in palliative care.

  • 40.
    Kristensen, Dorte V.
    et al.
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Sundler, Annelie J.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, Boras, Sweden..
    Eide, Hilde
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Hafskjold, Linda
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Ruud, Iren
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola, Hälsa och välfärd.
    Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4613-4621Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: To describe the characteristics of communication practice in home care visits between older people (over 65years old) and nurse assistants and to discuss the findings from a person-centered perspective.

    Background: The older population is increasing worldwide, along with the need for healthcare services in the person's home. To achieve a high-quality care, person-centered communication is crucial.

    Design: A descriptive design with a qualitative inductive approach was used.

    Method:Fifteen audio recordings of naturally occurring conversations between 12 nurse assistants and 13 older people in Norway were analysed by qualitative content analysis.

    Results:Four categories were revealed through analysis: (i) supporting older people's connection to everyday life; (ii) supporting older people's involvement in their own care; (iii) attention to older people's bodily and existential needs; and (iv) the impact of continuity and predictability on older people's well-being.

    Conclusions: The communication between the older people and the nurse assistants during home care visits was mainly task-oriented, but also related to the person. The older people were involved in the tasks to be carried out and humour was part of the communication. Greater attention was paid to bodily than existential needs. The communication was connected with the older people's everyday life in several ways. Time frames and interruptions concern the older people; hearing and speech impairments were a challenge to communication. To enhance person-centred communication, further studies are needed, especially intervention studies for healthcare professionals and students.

    Relevance to clinical practice:Being responsive to older people's subjective experiences is important in meeting their needs in home care. Communication that addresses the need for trust and predictability is important for older people. Responding to existential needs require more attention. The home care setting has an impact on communication.

  • 41.
    Kristofferzon, Marja-Leena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Löfmark, Rurik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Striving for balance in daily life: Experiences of Swedish women and men shortly after a myocardial infarction2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 2, p. 391-401Article in journal (Refereed)
    Abstract [en]

    The aim is to describe experiences of daily life of women and men during the first four to six months after a myocardial infarction. The focus is on problems, managing problems and support from their network. Background.  A cardiac event is traumatic and may influence well-being during a significant period of time. Few qualitative studies have investigated experiences of both women and men after a myocardial infarction and remarkably little research has been conducted on men's experiences. Design.  The study design was descriptive, retrospective and qualitative. Methods.  Semi-structured interviews were conducted with 20 women and 19 men from January 2000 to November 2001. Data were analysed using qualitative content analysis. Results.  Three themes were generated from the analysis: `Threatening ordinary life', `Struggling for control' and `The ambiguous network'. Physical symptoms and emotional distress were the most commonly described problems during the first months after a myocardial infarction. The informants manage the problems by negotiating with themselves, relying on their own capabilities, changing attitudes and behaviours and taking their own decisions and actions. The network was generally supportive but rather often the informants also experienced communication problems when they interacted with their network. Conclusions.  Women and men strive for balance between problems and resources in daily life after a myocardial infarction. How well they succeeded depends on how secure they feel how well they communicate their needs to their network and how sensitive their network is to their spoken and unspoken needs. Relevance to clinical practice.  The findings provide an insight into what kind of problems women and men may experience after myocardial infarction and how caregivers can aid them to increase security in their daily life. Some risk characteristics that may have increased their problems in daily life are suggested, for women and men respectively.

  • 42.
    Kristofferzon, Marja-Leena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Löfmark, Rurik
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Striving for balance in daily life: experiences of Swedish women and men shortly after myocardial infarction2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, p. 391-401Article in journal (Refereed)
  • 43.
    Larsson, Kjerstin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Section for Social Work, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden..
    Lööf, Lars
    Drug and Therapeutics committee, Västerås, Sweden..
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Stress, coping and support needs of patientes with ulcerative colitis and Crohn's disease: a qualitative descriptive study2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 5-6, p. 648-657Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To examine disease‐related stress, coping strategies and the need for information and support in patients with inflammatory bowel disease (ulcerative colitis or Crohn's disease).

    Background

    Psychological stress is an important factor in ulcerative colitis and Crohn's disease, and therefore, coping strategies and support needs should be considered in routine clinical practice.

    Design

    This is a qualitative study using a descriptive interview‐based approach.

    Method

    Fifteen patients with ulcerative colitis (n = 7) or Crohn's disease (n = 8) were interviewed. The interviews were analysed with content analysis.

    Results

    The informants largely focused on disease‐related stress (e.g. access to a toilet, symptoms and worries) and relations to other people (various reactions from others and social situations). Behavioural strategies (i.e. taking actions and the need for making plans, prepare and adapt), social strategies (seeking help and information and sharing feelings about the disease with others) and emotional strategies (distraction, positive attitude and acceptance) were adopted to cope with the stress associated with the disease. The need for information and support concerned instrumental support (disease‐related information) and emotional support (to talk about disease management).

    Conclusion

    Faecal urgency and the fear of losing bowel control are important stressors for patients with inflammatory bowel disease. The patients handle this problem using various coping strategies depending on the type of stressful events. Both instrumental and emotional support were requested which primarily occurred at the time of diagnosis and disease flare‐ups.

    Relevance to clinical practice

    Patients with ulcerative colitis or Crohn's disease ask for information and psychosocial support that are tailored to their individual needs and at different stages in the disease trajectory to improve everyday life and strengthen self‐management strategies.

  • 44.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Ågren, Susanna
    Jaarsma, Tiny
    Strömberg, Anna
    Perceived caring needs in patient-partner dyads affected by heart failure: a qualitative study2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2928-38Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the perceived caring needs in patient-partner dyads affected by heart failure to develop an understanding of potential areas of support.

    BACKGROUND: Being affected by heart failure has a great impact on both the patient and the partner but until now contemporary care has remained patient focused.

    DESIGN: A qualitative study design was used.

    METHODS: Eight focus group interviews were performed, which included nineteen patients diagnosed with heart failure and their cohabiting partner. Patients were aged between 55-89 years and partners' ages ranged from 48-87 years. Data were analysed using qualitative content analyses.

    RESULTS: The dyads perceived that caring needs could be summarised in two themes 'Dyads perceive a need for continuous guidance through the different phases of the illness trajectory' and 'Dyads perceive a need to share burden and support with each other and others'. The dyads described a need to learn more about heart failure to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital, and having someone who cared about the well-being of the partners was perceived as comforting. Both the patient and the partner need to be present at the clinic visits. Receiving the same information and being able to ask questions reduce insecurity. Meeting others in the same situation and sharing the burden in group sessions were proposed as an opportunity to support each other and others.

    CONCLUSIONS: There is a need to improve education and support for patient-partner dyads affected by heart failure.

    RELEVANCE TO CLINICAL PRACTICE: The result shows the importance to provide continuous healthcare contacts throughout the illness trajectory. Furthermore, partners should be included at follow-up, and support groups should be organised so that dyads can meet and support each other.

  • 45.
    Lindberg, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Wikström, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lindberg, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 21-22, p. 2997-3005Article in journal (Refereed)
    Abstract [en]

    Aims

     To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain vary between patients in groups with different cognitive profiles.

    Background

     Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions.

    Design

     Explorative cross-sectional multi-centre survey

    Methods

     The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One way analysis of variance (ANOVA) or Pearson’s chi-square test were used for comparing subgroups.

    Results

     Three distinct subgroups were found and subsequently labelled: 1) low self-efficacy, 2) distraction and depressive symptoms and 3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output, or in receiving any fluid intake advice.

    Conclusions

     Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms.

    Relevance to clinical practice

     Based on this study we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient’s fluid control, is introduced.

  • 46.
    Lindberg, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Skytt, Bernice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The Multidrug-Resistant Bacteria Attitude Questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 424-436Article in journal (Refereed)
    Abstract [en]

    Aim. To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers and politicians responsibility for adherence to preventive measures for infection control.

    Background. Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement.

    Design. Descriptive and correlational cross-sectional survey.

    Method. Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed.

    Results. Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process.

    Conclusion. The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great.

    Relevance to clinical practice. There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

  • 47.
    Ludvigsen, Mette S
    et al.
    Department of Renal Medicine, Aarhus University Hospital,.
    Hermansen, Hanne M
    Department of Renal Medicine, Aarhus University Hospital,.
    Lindberg, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The quality of nursing care during intradialytic fluid removal in haemodialysis: time to change practice?2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 11-12, p. 1733-1736Article in journal (Refereed)
  • 48.
    Lundberg, Pranee C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Doan, Thoa Thi Kim
    Dinh, Thu Thi Xuan
    Oach, Nhung Kim
    Le, Phong Hoang
    Caregiving to persons living with HIV/AIDS: experiences of Vietnamese family members2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 5-6, p. 788-798Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To examine the experiences of caregiving among Vietnamese family members of persons living with HIV/AIDS.

    BACKGROUND:

    As the number of persons living with HIV/AIDS increases, the need of family caregivers who can take responsibility for the home care of these persons increases. Vietnam has one of the fastest growing HIV epidemics in Asia.

    DESIGN:

    A descriptive cross-sectional study with quantitative and qualitative methods was used.

    METHODS:

    A purposive sample of 104 family caregivers, both male and female, participated voluntarily by answering a questionnaire of caregiver burden, and 20 of them participated in in-depth interview.

    RESULTS:

    Female caregivers were mainly mothers and wives while male caregivers were mainly husbands, fathers and siblings. The largest group of family caregivers reported moderate to severe burden. There was no difference between genders in total caregiver burden, but there were several differences between older and younger caregivers in some items of caregiver burden. Five categories of experiences emerged: Different types of caregiving to persons living with HIV/AIDS, cultural and religious issues associated with caregiving, keeping secret to avoid stigma and discrimination, lack of knowledge about disease and provision of care, and fear, anxiety and frustration.

    CONCLUSIONS:

    Stigma and discrimination should be decreased by providing knowledge to the general public about HIV/AIDS, in particular about ways of transmission and protection. Special knowledge should be given to family caregivers to enable them to give care to persons living with HIV/AIDS at home. This could be done through culturally appropriate training/intervention programmes in which coping methods should be included. Support group interventions should also be carried through. The results obtained can be used as baseline information.

    RELEVANCE TO CLINICAL PRACTICE:

    Health care providers should consider gender, age and culture of family members of persons living with HIV/AIDS. Knowledge about HIV/AIDS, provision of care at home and in hospital, and support groups should be developed and implemented.

  • 49.
    Lundberg, Pranee C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Kerdonfag, Petcharat
    Spiritual care provided by Thai nurses in intensive care units2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 7-8, p. 1121-1128Article in journal (Refereed)
    Abstract [en]

    AIM

    The aim of this study was to explore how Thai nurses in intensive care units of a university hospital in Bangkok provided spiritual care to their patients.

    BACKGROUND

    The function of nursing is to promote health, prevent illness, restore health and alleviate suffering. An holistic approach to this promotion includes spirituality.

    DESIGN

    An explorative qualitative study was used.

    METHOD

    Thirty Thai nurses, selected through purposive sampling with the snowball technique, participated voluntarily. Semi-structured interviews with open-ended questions were carried out, taped-recorded, transcribed verbatim and subjected to content analysis.

    RESULTS

    Five themes related to the provision of spiritual care emerged: giving mental support, facilitating religious rituals and cultural beliefs, communicating with patients and patients' families, assessing the spiritual needs of patients and showing respect and facilitating family participation in care. Several ways of improving the spiritual care were suggested by the nurses.

    CONCLUSIONS

    Spirituality was an important part of the care for the nurses when meeting the needs of their patients and the patients' families. Therefore, nursing education should enhance nurses' understanding and awareness of spiritual issues and prepare them to respond to human spiritual needs.

    RELEVANCE TO CLINICAL PRACTICE

    Nurses should consider spirituality as an important component of holistic care. During their professional career, they should expand their knowledge and understanding of spirituality and develop tools for assessment of spiritual needs.

  • 50.
    Lundberg, Pranee C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Thrakul, Supunnee
    Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 13-14, p. 1907-1916Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes. Background The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes. Design A descriptive qualitative study was conducted. Methods Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis. Results Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice. Conclusions The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance. Relevance to clinical practice Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.

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