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  • 1.
    Ahlström, Gerd
    et al.
    Department of Health Sciences, Lund University.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Enjoying work or Burdened by it?: How personal Assistants Experience and Handle Stress at Work2012In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 11, no 2, p. 112-127Article in journal (Refereed)
    Abstract [en]

    A personal assistant has to promote equality in living conditions for persons with severe disabilities. The aim of this study was to explore how personal assistants experience their work and what strategies they employ to alleviate work-related stress. Thirty personal assistants were interviewed and latent content analysis was performed. The findings regarding the experiences of work-related stress could be brought together under the theme of “difficulties of being in a subordinate position,” and those regarding management strategies could be brought together under the theme of “coming to terms with the work situation.” There is a need to empower personal assistants through training programs including tailored education, working communities, and coaching.

  • 2. Ahlström, Gerd
    et al.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Family members' experiences of personal assistance given to a relative with disabilities2011In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 19, no 6, p. 645-652Article in journal (Refereed)
    Abstract [en]

    Personal assistance is a type of home care common to many countries even though entitlement and legislative framework may vary from country to country. At present, there exists no knowledge about the family members' experiences of such assistance; therefore, the aim of this study was to investigate family members' experiences of personal assistance given to a relative of working age with a functional disability. Twenty-five family members who had a relative with a severe neurological disease in Sweden were interviewed about the significance of personal assistance, and the qualitative interviews were subjected to qualitative latent content analysis. The overall findings verify the close connection between the family members' experiences and their perception of the quality of the caring relationship between the personal assistant and the person with disability. The main finding was an appreciation of the personal assistance on the part of the family members. However, in situations where the encounter between the assistant and the relative with disability was perceived negatively, the family members experienced great anxiety. The shortcomings were the inability to maintain a private life with assistance and the limitation of choice because of the shortage of personal assistants. Beyond these general findings, this study found that personal assistance was experienced by the family members in terms of dignity and empowering care. This theme was generated from seven subthemes: Insight into private life, Security through the close relation, Social life through freedom of movement, Influence over the organisation of assistance, Self-determination and understanding, Friendship and mutual respect and Adaption to the dependency on assistance. The findings indicate that responsible officials, work leaders and assistants need constantly to improve the implementation of the law. In such efforts, the experiences of family members described in this study are a source of knowledge.

  • 3.
    Arving, Cecilia
    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.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Registered Nurses' Thoughts on Blended Learning in a Postgraduate Course in Cancer care: Content Analyses of Web Surveys and a Focus Group Interview2014In: Journal of Cancer Education, ISSN 0885-8195, E-ISSN 1543-0154, Vol. 29, no 2, p. 278-283Article in journal (Refereed)
    Abstract [en]

    Purpose of the research was to describe registered nurses' (RNs) (n = 53) thoughts on the blended learning format in a 'specialist nursing programme in cancer care'. The study was conducted in autumn 2007 and 2008. A content analysis of answers to open-ended questions in a web-based questionnaire and a focus group interview were carried out. The analysis revealed that the RNs appreciated blended learning. The web lectures facilitated learning and gave RNs access to the education at any time. However, according to the RNs, knowledge is gained through interaction between RNs and teachers, and this aspect needed to be improved. The RNs also thought that the content of the seminars on campus should focus on evidence-based nursing knowledge and practical skills, not just taught as stable facts and procedures. The result from the present study could help to improve the design and content of advanced nursing courses using a blended learning format.

  • 4.
    Bjurling-Sjöberg, Petronella
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Jansson, Inger
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Engström, Gabriella
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Prevalence and quality of clinical pathways in Swedish intensive care units: a national survey2014In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 1, p. 48-57Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVES

    To identify the prevalence of clinical pathways (CPs) in Swedish intensive care units (ICUs) and to explore the quality, content and evidence base of the documents.

    METHODS

    A descriptive and explorative survey of all Swedish ICUs (N84) and a review of submitted examples of CPs (n12) were conducted.

    RESULTS

    CPs were in use at 20% of the Swedish ICUs. There was a significant geographic variation but no relationship between the use of CPs and category of hospital, type of ICU, size of ICU or type of health record applied. In total, 56 CPs were reported within a range of scopes and extensions. The content of the ICUs' CPs, as well as the degree to which they were interprofessional, evidence based, and renewed varied.

    CONCLUSIONS

    Progress has been made in relation to CPs in recent years, but there is potential for further improvements. None of the ICUs had CPs that contained all key characteristics of a high-quality, interprofessional and evidence-based CP identified in the literature. Greater knowledge sharing and cooperation within the field would be beneficial, and further research is needed.

  • 5.
    Bjurling-Sjöberg, Petronella
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Jansson, Inger
    Univ Gothenburg, Inst Hlth & Caring Sci, Gothenburg, Sweden..
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice2017In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 31, no 2, p. 233-244Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe and explain teamwork and factors that influence team processes in everyday practice in an intensive care unit (ICU) from a staff perspective. The setting was a Swedish ICU. Data were collected from 38 ICU staff in focus groups with registered nurses, assistant nurses, and anaesthetists, and in one individual interview with a physiotherapist. Constant comparative analysis according to grounded theory was conducted, and to identify the relations between the emerged categories, the paradigm model was applied. The core category to emerge from the data was balancing intertwined responsibilities. In addition, eleven categories that related to the core category emerged. These categories described and explained the phenomenon's contextual conditions, causal conditions, and intervening conditions, as well as the staff actions/interactions and the consequences that arose. The findings indicated that the type of teamwork fluctuated due to circumstantial factors. Based on the findings and on current literature, strategies that can optimise interprofessional teamwork are presented. The analysis generated a conceptual model, which aims to contribute to existing frameworks by adding new dimensions about perceptions of team processes within an ICU related to staff actions/interactions. This model may be utilised to enhance the understanding of existing contexts and processes when designing and implementing interventions to facilitate teamwork in the pursuit of improving healthcare quality and patient safety.

  • 6.
    Bjurling-Sjöberg, Petronella
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Jansson, Inger
    Göteborgs universitet.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). 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 Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Struggling for a feasible tool - the process of implementing a clinical pathway in intensive care: A grounded theory study2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 831Article in journal (Refereed)
    Abstract [en]

    Background: Clinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.

    Methods: The setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.

    Results: A conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as 'Struggling for a feasible tool,' was the core category that linked all categories. The phenomenon evolved from the 'Triggers' ('Perceiving suboptimal practice' and 'Receiving external inspiration and support'), pervaded the 'Implementation process' ('Contextual circumstances,' 'Processual circumstances' and 'Negotiating to achieve progress'), and led to the process 'Output' ('Varying utilization' and 'Improvements in understanding and practice'). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.

    Conclusions: The findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.

  • 7.
    Bjurling-Sjöberg, Petronella
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Mälardalens högskola.
    Jansson, Inger
    Factors affecting the implementation process of clinical pathways: A mixed method study within the context of Swedish intensive care2015In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 2, p. 255-261Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVES: Clinical pathways (CPs) can improve quality of care on intensive care units (ICUs), but are infrequently utilized and of varying quality. Knowledge regarding factors that facilitate versus hinder successful implementation of CPs is insufficient and a better understanding of the activities and individuals involved is needed. The aim of this study was to explore the implementation process of CPs within the context of ICUs.

    METHODS: An exploratory design with a sequential mixed method was used. A CP survey, including all Swedish ICUs, was used to collect quantitative data from ICUs using CPs (n = 15) and interviews with key informants (n = 10) were used to collect qualitative data from the same ICUs. Descriptive statistics and qualitative content analysis were used, and the quantitative and qualitative findings were integrated.

    RESULTS: The CP implementation was conceptualized according to two interplaying themes: a process to realize the usefulness of CPs and create new habits; and a necessity of enthusiasm, support and time. Multiple factors affected the process and those factors were organized in six main categories and 14 subcategories.

    CONCLUSIONS: Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation.

  • 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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Josephson, Malin
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rissén, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Prominent attractive qualities of nurses work in operating room departments: A questionnaire study2015In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 4, p. 877-889Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive.

    OBJECTIVE: To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context.

    METHODS: The AWQ was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data.

    RESULTS: Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original AWQ, Cronbach's alpha varied between 0.57-0.90.

    CONCLUSIONS: Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the AWQ and the results suggest that the questionnaire can be useful in a health care context.

  • 9.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Anna-Malin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 41, p. 54-60Article in journal (Refereed)
    Abstract [en]

    Objective: to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly.

    Design: cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis.

    Setting: two large and active Swedish virtual communities.

    Sample: 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination).

    Measurements and findings: before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child.

    Key conclusions: spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences.

    Implications for practice: information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies. 

  • 10.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Institutionen för Kvinnors och Barns Hälsa, Karolinska Institutet.
    Melander Marttala, Ulla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Information following a Diagnosis of Congenital Heart Defect: Experiences among Parents to Prenatally Diagnosed Children2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 2, article id e0117995Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prenatal screening of pregnant women in Sweden has improved the detection of major congenital heart defects (CHD). The aim was to explore parental experiences and need for information following a prenatal diagnosis of CHD.

    METHODS: Semi-structured interviews conducted with six fathers and five mothers to seven prenatally diagnosed children. Data were analyzed through content analysis.

    RESULTS: Three themes and 9 categories emerged. Theme 1, Grasping the facts today while reflecting on the future, containing five categories: Difficulties sorting out information when in emotional chaos; Respectful information regarding termination of pregnancy; Early information is crucial; Understanding the facts regarding the anomaly; Preparing for the future. Theme 2, Personal contact with medical specialists who give honest and trustworthy information is valued, containing two categories: Trust in information received from medical specialists and Truth and honesty is valued. Theme 3, An overwhelming amount of information on the Internet, containing two categories: Difficulties in finding relevant information and Easy to focus on cases with a poor outcome when searching the Internet.

    CONCLUSION: Early and honest information in line with individual preferences is crucial to support the decisional process regarding whether to continue or terminate the pregnancy. The use of illustrations is recommended, as a complement to oral information, as it increases comprehension and satisfaction with obtained information. Furthermore, the overwhelming amount of information on the Internet calls for compilation of easily accessible and reliable information sources via the Internet.

  • 11.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Experiences of Informational Needs and Received Information Following a Prenatal Diagnosis of Congenital Heart Defect2016In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 36, no 6, p. 515-522Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore the need for information and what information was actually received following a prenatal diagnosis of a congenital heart defect, in a country where termination of pregnancy beyond 22 weeks of gestation is not clinically performed.

    METHODS: Twenty-six Swedish-speaking pregnant women (n = 14) and partners (n = 12) were consecutively recruited for semi-structured telephone interviews following the prenatal diagnosis of congenital heart defect. Data was analyzed using content analysis.

    RESULTS: Although high satisfaction with the specialist information was described, the information was considered overwhelming and complex. Objective, honest and detailed information about multiple subjects were needed, delivered repeatedly and supplemented by written information/illustrations. Eighteen respondents had used the Internet to search for information and found issues involving searching difficulties, low quality, and that it was too complex, insufficient or unspecific. Those who terminated the pregnancy criticized that there was a lack of information about termination of pregnancy, both from health professionals and online sources, resulting in unanswered questions and unpreparedness.

    CONCLUSION: Individuals faced with a prenatal diagnosis of a congenital heart defect need individualized and repeated information. These needs are not all adequately met, as individuals are satisfied with the specialist consultation but left with unanswered questions regarding pregnancy termination.

  • 12.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Melander, Marttala Ulla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Institutionen för Kvinnors och Barns Hälsa, Karolinska Institutet.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetric research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Institutionen för Vårdvetenskap, Ersta Sköndal Bräcke Högskola.
    Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis2017In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 6, no 2, article id e15Article in journal (Refereed)
    Abstract [en]

    Background: When a heart defect is prenatally diagnosed in the fetus, expectant parents experience a great need for information about various topics. After the diagnosis, the Web is used for supplemental information, and the scarcity of research calls attention to the need to explore patient information websites from the perspectives of the intended consumers.

    Objective: The overarching aim of this study was to explore the quality of Swedish patient information websites about congenital heart defects, from the perspectives of individuals with experience of a prenatal diagnosis of congenital heart defect in the fetus.

    Methods: This was a mixed-methods study of websites identified through systematic searches in the two most used Web-based search engines. Of the total 80 screened hits, 10 hits led to patient information websites about congenital heart defects. A quality assessment tool inspired by a previous study was used to evaluate each website’s appearance, details, relevance, suitability, information about treatment choices, and overall quality. Answers were given on a 5-point Likert scale, ranging from 1, representing the lowest score, to 5, representing the highest score. Each website was assessed individually by persons with experience of continued (n=4) and terminated (n=5) pregnancy following a prenatal diagnosis. Assessments were analyzed with Kendall’s coefficient of concordance W, Mann-Whitney U test, Friedman’s test, and a Wilcoxon-Nemenyi-McDonald-Thompson test. In addition, each assessor submitted written responses to open-ended questions in the quality assessment tool, and two joint focus group discussions were conducted with each group of assessors. The qualitative data were analyzed with inductive manifest content analysis.

    Results: Assessments represented a low score (median=2.0) for treatment choices and moderate scores (median=3.0) for appearance, details, relevance, suitability, and overall quality. No website had a median of the highest achievable score for any of the questions in the quality assessment tool. Medians of the lowest achievable score were found in questions about treatment choices (n=4 websites), details (n=2 websites), suitability (n=1 website), and overall quality (n=1 website). Websites had significantly different scores for appearance (P=.01), details (P<.001), relevance (P<.001), suitability (P<.001), treatment choices (P=.04), and overall quality (P<.001). The content analysis of the qualitative data generated six categories: (1) advertisements, (2) comprehensiveness, (3) design, (4) illustrations and pictures, (5) language, and (6) trustworthiness. Various issues with the included websites were highlighted, including the use of inappropriate advertisements, biased information, poor illustrations, complex language, and poor trustworthiness.

    Conclusions: From the perspectives of the intended consumers, patient information websites about congenital heart defects are, to a large extent, inadequate tools for supplemental information following a prenatal diagnosis. Health professionals should initiate discussions with patients about their intentions to use the Web, inform them about the varied quality in the Web-based landscape, and offer recommendations for appropriate Web-based sources.

  • 13.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Melander Marttala, Ulla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Department of Women’s and Children’s Health, Karolinska Institutet.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Involvement of persons with lived experience of a prenatal diagnosis of congenital heart defect: An explorative study to gain insights into perspectives on future research2016In: Research Involvement and Engagement, Vol. 2, no 35Article in journal (Refereed)
    Abstract [en]

    Background

    A prenatal diagnosis of a congenital heart defect in the fetus is a traumatic life event for pregnant women and their partners. Previous research indicates a need for research that takes steps to support these individuals following the diagnosis. Patient and public involvement is a proposed method of identifying relevant research topics, leading to patient-focused research protocols and relevant support interventions.The overarching aim of this study was to gain insights into relevant future research topics among persons faced with a prenatal diagnosis of congenital heart defect in the fetus.

    Methods

    One group of parents to prenatally diagnosed children with a congenital heart defect (n = 5) and one group of individuals with experience of termination of a pregnancy following a prenatal diagnosis of a congenital heart defect (n = 5) were purposefully recruited. Each group of representatives was involved in a face-to-face focus group discussion, analyzed through qualitative content analysis.

    Results

    The representatives suggested a need for future research that addresses informational support in the forms as supplemental written information or follow-up consultations. Moreover, interventions that offer emotional support were suggested, in the forms of peer support or additional professional psychosocial support.

    Conclusion

    Several interventions were suggested by patient representatives, indicating a need for multiple intervention studies to be conducted in the context of a prenatal diagnosis of a congenital heart defect in the fetus. We recommend that future studies test supplemental written information, follow-up consultations, peer support, and additional professionals psychosocial support following the diagnosis.

  • 14.
    Engström, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Häggström, Elisabeth
    Caregivers' job satisfaction and empowerment before and after an intervention focused on caregiver empowerment.2010In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 1, p. 14-23Article in journal (Refereed)
    Abstract [en]

    Aims

    To evaluate a training programme aimed at strengthening caregivers' self-esteem and empowering them, and also to study correlations between psychological empowerment and job satisfaction.

    Background

    Structural and psychological empowerment have received increased attention in nursing management, yet few intervention studies on this topic, based on theoretical assumptions, have been conducted in elderly care.

    Method

    Data on self-assessed psychological empowerment and job satisfaction were collected in an intervention (n = 14) and a comparison group (n = 32), before and after the intervention.

    Results

    When compared over time in the respective groups, there were significant improvements in the intervention group regarding the factor criticism (job satisfaction scale). There were no statistically significant differences in the comparison group. Total empowerment and all factors of empowerment correlated positively with total job satisfaction. Six out of eight factors of job satisfaction correlated positively with total empowerment.

    Conclusions

    Caregivers' perception of criticism can improve through an intervention aimed at strengthening their self-esteem and empowering them.

    Implications for nursing management

    Intervention focused on psychological empowerment and especially caregivers' communication skills seems to be beneficial for caregivers. Recommendations are to increase the programme's length and scope and to include all staff at the unit. However, these recommendations need to be studied further.

  • 15.
    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.

  • 16.
    Fröjd, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Swenne, Christine Leo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Gunningberg, Lena
    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.
    Patient information and participation still in need of improvement: evaluation of patients' perceptions of quality of care2011In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 19, no 2, p. 226-236Article in journal (Refereed)
    Abstract [en]

    Aims:

    To identify areas in need of quality improvement by investigating inpatients' perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission.

    Background:

    Nursing managers play an important role in the development of high-quality care.

    Methods:

    Quality of care was assessed using the Quality from the Patients' Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP.

    Results:

    Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors' care than did patients with planned admissions.

    Conclusion:

    Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role.

    Implications for nursing management:

    Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.

  • 17.
    Hagerman, Heidi
    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.
    Häggström, Elisabeth
    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.
    Skytt, Bernice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Male first-line managers' experiences of the work situation in elderly care: an empowerment perspective2015In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 23, no 6, p. 695-704Article in journal (Refereed)
    Abstract [en]

    AIM: To describe male first-line managers' experiences of their work situation in elderly care.

    BACKGROUND: First-line managers' work is challenging. However, less attention has been paid to male managers' work situation in health care. Knowledge is needed to empower male managers.

    METHOD: Fourteen male first-line managers were interviewed. The interview text was subjected to qualitative content analysis.

    RESULT: Work situations were described as complex and challenging; challenges were the driving force. They talked about 'Being on one's own but not feeling left alone', 'Having freedom within set boundaries', 'Feeling a sense of satisfaction and stimulation', 'Feeling a sense of frustration' and 'Having a feeling of dejection and resignation'.

    CONCLUSION: Although the male managers report deficiencies in the support structure, they largely experience their work as a positive challenge.

    IMPLICATIONS FOR NURSING MANAGEMENT: To meet increasing challenges, male first-line managers need better access to supportive structural conditions. Better access to resources is needed in particular, allowing managers to be more visible for staff and to work with development and quality issues instead of administrative tasks. Regarding organisational changes and the scrutiny of management and the media, they lack and thus need support and information from superiors.

  • 18.
    Hagerman, Heidi
    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.
    Wadensten, Barbro
    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.
    How do female first-line managers in elderly care experience their work situation? – an interview studyIn: Article in journal (Refereed)
  • 19.
    Hagerman, Heidi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden.
    Högberg, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden.
    Skytt, Bernice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden.
    Wadensten, Barbro
    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. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden.; Lishui Univ, Nursing Dept, Med & Hlth Coll, Lishui, Peoples R China.
    Empowerment and performance of managers and subordinates in elderly care: A longitudinal and multilevel study2017In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 25, no 8, p. 647-656Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

    BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

    METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

    RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

    CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

    IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

  • 20.
    Hagerman, Heidi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Skytt, Bernice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Högberg, Hans
    Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Gavle, Sweden..
    A longitudinal study of working life among first-line managers in the care of older adults2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 7-13Article in journal (Refereed)
    Abstract [en]

    Aim: To study whether the number of subordinates plays a role in first-line managers' and subordinates' ratings of empowerment, stress symptoms, and leadership-management performance. The aim was also to study relationships between managers' empowerment and stress symptoms and leadership-management performance. Methods: A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached. Results: With fewer (<= 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with >= 31 subordinates. Furthermore, structural empowerment was related to the managers' stress symptoms and leadership management performance, mediated through psychological empowerment Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms. Conclusion: The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership-management performance they rated over time.

  • 21. Hägglund, Doris
    et al.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Fear of humiliation inhibits women's care-seeking behaviour for long-term urinary incontinence.2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, p. 305-312Article in journal (Refereed)
    Abstract [en]

    Most women with urinary incontinence (UI) do not seek professional help. Women's experiences of their behaviour when seeking care for incontinence are important to improve understanding by nurses and encourage as well as enable women to seek help. The aim of this study was to illuminate the meaning of women's lived experiences of their behaviour when seeking care for long-term UI. Thirteen women were interviewed (range 37-52 years) who had not sought professional help for incontinence. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Three themes evolved from data: being in an affected situation, having personal beliefs about seeking care and having desired expectations about care. Being in an affected situation, means that the women were negatively affected by their long-term incontinence. Living with shame, altered sexual relationships and a need for distancing have negatively influenced their care-seeking behaviour (CSB). Having personal beliefs about seeking care means that the women had their own beliefs regarding morally acceptable behaviour for seeking care because of incontinence. This led to a toning down of their problem and a minimization of the problem associated with incontinence as it was considered to be a normal consequence of pregnancy and childbirth. Having desired expectations about care means that the women had opinions relevant to the care and felt being asked about incontinence and an understanding atmosphere should be included. The conclusion is that fear of humiliation inhibited women from seeking care for long-term UI. The findings suggest that nurses should be precise when asking about women's experiences of UI because otherwise they do not bring it up. Additionally, CSB can help nurses to explain the experience and enable women to seek help for this manageable condition.

  • 22. Hägglund, Doris
    et al.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Andersson, Catarina
    Aflarenko, Margareta
    Effekten av tranbärsjuice och personalutbildning i vårdhygien för att förebygga urinvägsinfektioner inom särskilt boende2009In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, no 2, p. 28-32Article in journal (Refereed)
    Abstract [en]

    Cranberry juice is often given to elderly persons in nursing homes to prevent urinary tract infections; still there is little evidence to support itsuse. Basic hygiene routines are important for preventing urinary tract infections. The aim of this study was to investigate whether cranberry juiceand staff education in hygiene care can prevent symptomatic urinary tract infections among elderly persons living in nursing homes. A quasiexperimentalstudy with three intervention groups and one control group was conducted involving 257 elderly women and men. A total of 48symptomatic urinary tract infections were documented over the six months of the study: 21 (43.7%) in the cranberry group, 11 (22.9%) in thecontrol group, 9 (18.7%) in the cranberry/hygiene care group and 7 (14.5%) in the hygiene care group. These between-group differences werenot statistic significant. Hence, our study showed no preventive effect from cranberry juice, alone or in combination with staff education in hygienecare, on the incidence of symptomatic urinary tract infections. However, more and better research with larger randomised trials or cranberrycapsules is needed to study its potential use to prevent urinary tract infections in elderly persons.

  • 23.
    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.

  • 24.
    Häggström, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hofsten, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nurses' options about a web-based distance course in a specialist education programme for the care of older people: a questionnaire study2009In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 3, p. 177-184Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate students' opinions about a web-based distance learning course that was part of a specialist education programme.

    Background

    Most registered nurses (RNs) who work with older people in Sweden do not have a specialist education in caring for older people. Design.?Survey.

    Method

    The study was a descriptive survey with both qualitative and quantitative questions.

    Results

    The students found the web-based course very useful for their theoretical and professional development. New perspectives on ageing, increased knowledge about analysing and describing theories as well as practising interviews and qualitative analysis as methods were appreciated by the students.

    Conclusions

    One way for RNs in Sweden to get a university specialist education in the care of older people is to have a distance web-based course, as it allows flexibility and improves the students' theoretical and professional knowledge and communication skills. Relevance for clinical practice.?Managers working in care for older people settings and educators will be interested in this study's finding that distance learning is a useful strategy for providing education for RNs who work with older people.

  • 25.
    Johansson, Birgitta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Fogelberg-Dahm, Marie
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Evidence-based practice: the importance of education and leadership2010In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 18, no 1, p. 70-77Article in journal (Refereed)
    Abstract [en]

    Aim:

    To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors.

    Background:

    Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance.

    Method:

    All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire.

    Results:

    The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities.

    Conclusions:

    The present study highlights the value of education in research methods and the importance of supportive leadership. Implications for nursing management Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.

  • 26.
    Karlstedt, Michaela
    et al.
    Ersta Sköndal Högskola.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ingegerd, Fagerberg
    Ersta Sköndal Högskola.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Is the competence of Swedish Registered Nurses working in municipal care of older people merely a question of age and postgraduate education?2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 307-316Article in journal (Refereed)
    Abstract [en]

    Objectives

    Previous studies suggest that not only education but also personal aspects such as experience of working as a registered nurse (RN) and age can influence competence. The objective was to explore the educational and self-rated competence of RNs and their duties within the care of older people.

    Methods

    A cross-sectional descriptive design was used. All RNs in two counties in Sweden were asked to complete a written questionnaire: a study specific questionnaire with educational and work related questions using the Nurse Competence Scale. The response rate was 61% (n 344).

    Results

    Higher self-rated satisfaction with own professional competence was related to older age, more years after nursing education and possessing at least one postgraduate education in specialist nursing. Educational needs were related to younger age and fewer years since nursing graduation. Education within elder care, including education about drugs was rated the most urgently needed area of education. The most frequently reported tasks were found in the domain helping role, whereas ensuring quality was less present in their daily work.

    Conclusions

    Educational level, age and years of experience had an impact on RNs’ self-perceived competence, which is in accordance with previous descriptions of the concept competence. It seems imperative that RNs working in care of the old and with the demands placed on them are given the opportunity to take a postgraduate specialist education in order to gain a competence level in their desired area of work. It is also important that RNs working in care of the old get tailored education in line with the requirements the organisation places on them.

  • 27.
    Kirsebom, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Pöder, Ulrika
    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.
    General practitioners' experiences as nursing home medical consultants2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To describe general practitioners' experiences of being the principal physician responsible for a nursing home.

    METHOD:

    Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation.

    RESULT:

    Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety.

    CONCLUSION:

    The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems.

  • 28.
    Kirsebom, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Pöder, Ulrika
    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.
    Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. low transfer rates2017In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 1, p. 41-48Article in journal (Refereed)
    Abstract [en]

    Aim: To explore possible factors in the organization of nursing homes that could be related to differences in the rate of transfer of residents from nursing homes to emergency department.

    Design: Explorative.

    Method: In a single municipality, qualitative and quantitative data were collected from documents and through semi-structured interviews with 11 RNs from five nursing homes identified as having the highest vs. six identified as having the lowest transfer rates to emergency department. Data were analysed by non-parametric tests and basic content analysis.

    Results: All nursing homes in the highest transfer rate group and one in the lowest transfer rate group were run by private for-profit providers. Compared with the low group, the high group had fewer updated advance care plans and the RNs interviewed had less work experience in care of older people and less training in care of persons with dementia. There was no difference in nursing home size or staff/resident ratio. The RNs described similar possibilities to provide palliative care, medical equipment and perceived medical support from GPs.

  • 29.
    Kirsebom, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hedström, Mariann
    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.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The frequency of and reasons for acute hospital transfers of older nursing home residents2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, no 1, p. 115-120Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

     

  • 30.
    Kirsebom, 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.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 4, p. 886-895Article in journal (Refereed)
    Abstract [en]

    Aim:

    To investigate registered hospital and nursing home nurses' experiencesof coordination and communication within and between care settings when olderpersons are transferred from nursing homes to hospital and vice versa.

    Background:

    It has previously been reported that transfers to hospital from nursing homes and discharge of patients from hospital are surrounded by communication difficulties. However, studies focusing on both hospital and nursing home registered nurses' experiences of communication and coordination within and between nursing homes and hospitals are uncommon.

    Design:

    A descriptive study design with a qualitative approach was used.

    Methods:

    In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). Data were analysed using content analysis.

    Results:

    Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospitalregistered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursinghome registered nurses suggested increased collaboration to understand each other's work situation better.

    Conclusion:

    Communication and coordination among hospital andnursing home registered nurses need to be furthered improved. Registered nurses'coordination and planning in the nursing home are extremely important to future elder care. We recommend that the medical care plan be regularly updated and meticulously followed, the aim being to reduce the risk of inappropriate medical treatment and nursingcare and unnecessary transfer and admission to hospital.

  • 31.
    Kjörnsberg, Amelie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Karlsson, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Babra, Annika
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Registered nurses' opinions about patient focused care2010In: Australian Journal of Advanced Nursing, ISSN 0813-0531, E-ISSN 1447-4328, Vol. 28, no 1, p. 35-44Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of the present study was to investigate registered nurses' (RN) opinions about the organisational change to patient focused care (PFC).

    Design

    A qualitative explorative design and an interview guide with open-ended questions were used.

    Setting

    One ward at a university hospital Subjects Six female registered nurses Main outcome measure(s) The interview questions included items about 'experiences of PFC', 'experiences of one's own professional role' and 'opinions about the quality of care in the model'.

    Result

    All of the interviewed nurses at the ward had overall positive attitudes towards PFC and felt the care model could facilitate nursing practice. The interviewees emphasised, however, that if one is to make a fair evaluation, more experience of working with PFC as well as total implementation of the model is needed. The interviewees did report positive effects of PFC, which they believed gave all employees at the ward greater motivation to work towards continuous development.

    Conclusions

    The RNs in the present study had overall positive attitudes towards PFC and felt the care model could facilitate nursing practice. The present study illustrates nurses' experiences of working at a ward that uses PFC as its organisational form, and this knowledge is valuable to nursing managers who are considering organisational changes. The interviewed nurses found that PFC had many advantages and that the organisational form could therefore be suitable in several clinical settings.

  • 32.
    Lejman, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Sophiahemmet University College.
    Westerbotn, Margareta
    Sophiahemmet University College; Karolinska Inst, S-10401 Stockholm, Sweden.
    Pöder, Ulrika
    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.
    The ethics of coercive treatment of people with dementia2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 3, p. 248-262Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents’ integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses’ descriptions of complications and alternative measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment.

  • 33.
    Pöder, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Dahm, Marie Fogelberg
    Univ Uppsala Hosp, Unit Care Dev, Uppsala, Sweden..
    Karlsson, Nina
    Univ Uppsala Hosp, Unit Care Dev, Uppsala, Sweden..
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Standardised care plans for in hospital stroke care improve documentation of health care assessments2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 19-20, p. 2788-2796Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To compare stroke unit staff members' documentation of care in line with evidence-based guidelines pre- and postimplementation of a multi-professional, evidence-based standardised care plan for stroke care in the electronic health record. Background. Rapid and effective measures for patients with stroke or suspected stroke can limit the extent of damage; it is imperative that patients be observed, assessed and treated in accordance with evidence-based practice in hospital. Design. Quantitative, comparative. Methods. Structured retrospective health record reviews were made prior to (n 60) and one and a half years after implementation (n 60) of a multi-professional evidence-based standardised care plan with a quality standard for stroke care in the electronic health record. Results. Significant improvements were found in documentation of assessed vital signs, except for body temperature, Day 1 post compared with preimplementation. Documentation frequency regarding body temperature Day 1 and blood pressure and pulse Day 2 decreased post compared with preimplementation. Improvements were also detected in documented observations of patients' micturition capacity, swallowing capacity and mouth status and the proportion of physiotherapist-documented aid assessments. Observations of blood glucose, mobilisation ability and speech and communication ability were unchanged. Conclusions. An evidence-based standardised care plan in an electronic health record assists staff in improving documentation of health status assessments during the first days after a stroke diagnosis. Relevance to clinical practice. Use of a standardised care plan seems to have the potential to help staff adhere to evidence-based patient care and, thereby, to increase patient safety.

  • 34.
    Pöder, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Fogelberg-Dahm, Marie
    Akademiska sjukhuset, Uppsala University Hospital.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Implementation of a multi-professional standardized care plan in electronic health records for the care of stroke patients2011In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 19, no 6, p. 810-819Article in journal (Refereed)
    Abstract [en]

    Aims

    To compare staff opinions about standardized care plans and self-reported habits with regard to documentation, and their perceived knowledge about the evidence-based guidelines in stroke care before and after implementation of an evidence-based-standardized care plan (EB-SCP) and quality standard for stroke care. The aim was also to describe staff opinions about, and their use of, the implemented EB-SCP.

    Background

    To facilitate evidence-based practice (EBP), a multi-professional EB-SCP and quality standard for stroke care was implemented in the electronic health record (EHR).

    Method

    Quantitative, descriptive and comparative, based on questionnaires completed before and after implementation.

    Results

    Perceived knowledge about evidence-based guidelines in stroke care increased after implementation of the EB-SCP. The majority agreed that the EB-SCP is useful and facilitates their work. There was no change between before and after implementation with regard to opinions about standardized care plans, self-reported documentation habits or time spent on documentation.

    Conclusions

    An evidence-based SCP seems to be useful in patient care and improves perceived knowledge about evidence-based guidelines in stroke care. Implications for nursing management  For nursing managers, introduction of evidence-based SCP in the EHR may improve the prerequisites for promoting high-quality EBP in multi-professional care.

  • 35.
    Silen, Marit
    et al.
    Hälsohögskolan, Jönköping.
    Ping Fen, Tang
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ahlström, Gerd
    Hälsohögskolan, Jönköping.
    Workplace distress and ethical dilemmas in neuroscience nursing:  2008In: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 40, no 4, p. 222-231Article in journal (Refereed)
    Abstract [en]

    This study concerns Swedish nurses' experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting. Qualitative interviews were conducted with 21 nurses. The interview results were subjected to qualitative latent content analysis and sorted into 4 content areas: workplace distress, ethical dilemmas, managing distress and ethical dilemmas, and quality of nursing. Common workplace stressors were high workload and lack of influence. These were perceived to have negative consequences for the quality of nursing. Ethical dilemmas mainly concerned decision making on initiation or withdrawal of treatment, which was experienced as a troublesome situation where conflicts could arise. The nurses managed the distress and ethical dilemmas by accepting and adjusting to the situation and seeking support from colleagues. They also endeavored to gain new strength in their private lives.

  • 36.
    Staun, Margaretha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bergström, Berit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Evaluation of a PBL strategy in clinical supervision of nursing students: Patient-centred training in student-dedicated treatment rooms2010In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 30, no 7, p. 631-637Article in journal (Refereed)
    Abstract [en]

    Aim: The present study aimed at investigating staff members' and nursing students' perception of and satisfaction with an intervention involving patient-centred training in student-dedicated treatment rooms during clinical supervision.

    Background: It is well known that clinical education is important and that the clinical learning environment influences the development of nursing students' ability to solve clinical problems. In the present study, an intervention using a problem-based learning (PBL) strategy was introduced and evaluated in clinical education. The PBL strategy is called 'Patient-centred training in student-dedicated treatment rooms'.

    Design and methods: Descriptive; both quantitative and qualitative methods were used. A questionnaire and focus group interviews were used.

    Result: Most participants found the PBL strategy to be highly satisfactory, both for staff and for students. The students seemed to feel that their time in clinical education had been used efficiently.

    Conclusion: Integration of theory and practice during clinical training has been emphasized as a necessary component, and the new strategy, which involves a method of promoting students' reflection, represents one way of facilitating such integration, in that it may bridge the gap between theory and practice. More extensive and more specific research is need in the future.

  • 37.
    Umb Carlsson, Õie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Källberg, Niklas
    Stockholm School of Economics, Sweden.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Blended Learning Among Elderly Care Managers Inspires Projects That Take Older People´s Perspectives Into Account2015In: Home Health Care Management & Practice, ISSN 1084-8223, E-ISSN 1552-6739, Vol. 27, no 3, p. 142-149Article in journal (Refereed)
    Abstract [en]

    When the national core value system was introduced in Sweden, care professionals were challenged to be part of a paradigm shift by changing their perspective, from regarding older people like passive recipients of societal efforts to treating them as active subjects and taking their preferences and wishes into consideration as well. To realize this shift in attitudes and behaviour, an interprofessional blended education course was offered. The present study explored the utility of the blended educational approach in the local implementation of the national policy in elderly care. We argue that the course has contributed to enhanced competence in terms of how professionals relate theories and targeted discussions to specific and concrete improvement in their professions and workplaces.

  • 38.
    Umb-Carlsson, Õie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Professional practice‐related training and organizational readiness for change facilitate implementation of projects on the national core value system in care of older people2018In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 4, p. 593-600Article in journal (Refereed)
    Abstract [en]

    Aim: To explore whether professional training contributed to implementation of the national core value system in practice in care of older people and to identify course participants' perceptions about factors that facilitated or obstructed them in implementing their projects. To identify participants' perceptions concerning factors that facilitate or obstruct implementation.

    Design: Descriptive and cross‐sectional.

    Methods: Data were retrieved from 451 participants who had completed the course “Understanding and providing leadership based on the national core value system for older people” at Uppsala University during spring semester and autumn semester of 2018. Quantitative and qualitative data were obtained using a web‐based questionnaire.

    Results: The results showed that the majority (73%) of project plans were initiated, although not always completed and sometimes interrupted. Organizational readiness in terms of management supporting and prioritizing these plans were two principle facilitators chosen by half of the respondents and consequently the absence of these factors was an obstacle. In addition, successful implementation required dedicated co‐workers and certain resources, such as time and funds. Surprisingly, factors related to the project leader were reported to be of limited importance.

  • 39.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Introducing older people to the theory of gerotranscendence2005In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 52, no 4, p. 381-388Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a study whose aims were to introduce the theory of gerotranscendence to a group of older people; to give participants in the group an opportunity to discuss their ageing process; to study how participants described their ageing in relation to the theory; and to gather participants' opinions about discussing their ageing in a group. BACKGROUND: The theory of gerotranscendence states that human development is a process extending into old age. Guidelines had previously been derived for its practical use in the care of older people, aiming to promote their development towards gerotranscendence. METHODS: A qualitative descriptive approach was taken, and older people were invited to participate in group sessions at a day centre. At the sessions, participants discussed their ageing, and a video presentation about the theory of gerotranscendence was shown at one of the sessions. They were encouraged to discuss the description of the ageing process presented in the video and to link this to their own experiences of growing old. The discussion in each session was tape-recorded and transcribed verbatim. Data were analysed and categorized using qualitative methods. The data were collected in 2002. FINDINGS: All women had an experience of ageing that was in some way in line with the theory's description, and they more or less agreed that this description of ageing was in accordance with their own ageing. They considered that it was interesting and fruitful to discuss ageing in a group. They felt that introduction of the view of ageing offered by the theory of gerotranscendence was beneficial because it gave them a more positive view of ageing which also allowed them to be as they were. CONCLUSION: It is possible to arrange this type of group activity for older people, resulting in possibilities to use aspects of the theory of gerotranscendence as an intervention in gerontological nursing.

  • 40.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Life situation and daily life in a nursing home as described by nursing home residents in Sweden2007In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 2, no 3, p. 180-188Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. The overall aim of this study was to investigate nursing home residents' opinion of their life situation in a nursing home and of their earlier life.

    Background. Few studies have focused on residents' perception of their daily life and life situation in nursing homes.

    Design. A qualitative explorative design was used.

    Methods. Residents in a nursing home were interviewed and qualitative content analysis was performed.

    Results. The views of life residents described and how they apprehended their situation were quite different. The findings give an understanding of what it is like to live in a nursing home and show that residents apprehend their situation in very different ways. All individuals who were content with their situation in the nursing home were also content with their earlier life.

    Relevance to clinical practice. For the nurse in gerontological care, it is a challenge to get to know each resident and to provide the best nursing care and the best individual treatment for each resident. Another challenge is to help each resident find a life in the nursing home that is acceptable for him/her, and one aspect of this involves helping residents in their ageing process. The present study highlights what an important role staff have in relation with nursing home residents.

  • 41. Wadensten, Barbro
    Nurses´ workplace distress and ethical dilemmas in Tanzanian health care.2008In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 4, p. 478-491Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe Tanzanian nurses’ meaning of and experiences with ethical dilemmas and workplace distress in different care settings. An open question guide was used and the study focused on the answers that 29 registered nurses supplied. The theme, ‘Tanzanian registered nurses’ invisible and visible expressions about existential conditions in care’, emerged from several subthemes as: suffering from (1) workplace distress; (2) ethical dilemmas; (3) trying to maintaining good quality nursing care; (4) lack of respect, appreciation and influence; and (5) a heavy workload that did not prevent registered nurses from struggling for better care for their patients. The analysis shows that, on a daily basis, nurses find themselves working on the edge of life and death, while they have few opportunities for doing anything about this situation. Nurses need professional guidance to gain insight and be able to reflect on their situations, so that they do not become overloaded with ethical dilemmas and workplace distress.

  • 42.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ahlström, Gerd
    Ethical values in personal assistance: narratives of people with disabilities2009In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 6, p. 759-774Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the experiences of persons with severe functional disabilities who receive personal assistance in their homes, the focus being on their daily life in relation to the ethical principles represented in the Swedish Disability Act: autonomy, integrity, influence and participation. Qualitative interviews were performed with 26 persons and thereafter subjected to qualitative latent content analysis. The experiences of personal assistance were very much in accordance with the said principles, the most important factor being that one is met with understanding. The participants described situations in which their integrity was violated in that they were not treated as competent adults. This indicates the importance of future efforts in nursing to support personal assistants with ethical knowledge and supervision so that they can empower people with disabilities and thereby enable them to maintain their self-esteem and dignity.

  • 43.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ahlström, Gerd
    The struggle for dignity by people with severe functional disabilities2009In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, no 4, p. 453-465Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives.

  • 44.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    A qualitative study of nursing staff members´ interpretations of signs of gerotranscendence2001In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 36, no 5, p. 635-642Article in journal (Refereed)
    Abstract [en]

    Aims

    This study was conducted in Sweden and investigated whether nursing staff working with old people could recognize signs of gerotranscendence and, if so, how they interpreted such signs. Another aim was to describe how the staff addressed and cared for older people, 65 and older, showing signs of gerotranscendence.

    Background

    The theory of gerotranscendence is a theory that, present a new understanding of the ageing process. Gerotranscendence is regarded as a natural developmental process, and the term transcendence implies a shift in an older person's meta-perspective and a new outlook on reality.

    Methods

    Proceeding from Tornstam's description of signs of gerotranscendence, an interview guide was designed, qualitative interviews performed and the theory of gerotranscendence was used as the basis for the qualitative analysis.

    Findings

    Findings showed that staff working with old people noticed signs of gerotranscendence. However, their interpretations were highly variable; in some cases such signs were interpreted as what might be interpreted as 'pathological'. This is probably because the staff had no theoretical tools with which to make other interpretations. Some signs were interpreted as common and in some cases as 'normal'. These could be theoretically understood from either an activity or developmental perspective.

    Conclusions

    Staffs' need an interpretative framework allowing them to understand the signs they sometimes observe in older people. Having an interpretative framework in which these signs are seen as normal aspects of ageing would enable staff to develop a different attitude towards older people and another approach to caring for them.

  • 45.
    Wadensten, Barbro
    et al.
    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.
    Adoption of an innovation based on the theory of gerotranscendence by staff in a Nursing home – Part III: 2007In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 2, no 4, p. 302-314Article in journal (Refereed)
    Abstract [en]

    This article presents an intervention involving introduction of the theory of gerotranscendence and practical guidelines derived from the theory. A qualitative method was used with triangulation of methods in data collection and analysis. Both the theory of gerotranscendence and the theory of innovation were used as frameworks in the analysis. Introducing this new perspective constituted an abstract intervention. It involved nursing staff changing their interpretations and values with respect to ageing and their treatment of older people in ways not compatible with extant values. The 'early adopters' were staff members who felt acquainted with the essential ideas of the theory because they perceived in themselves a personal developmental process in line with the theory. The innovation attributes, described in the innovation theory, explained some of the problems associated with adopting the guidelines.

  • 46.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Nursing theory views on how to support the process of ageing2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 42, no 2, p. 118-124Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    An important purpose of theories is to challenge practice, create new approaches to practice and remodel the structures of rules and principles. Therefore, it is of interest to study whether it is possible to make use of nursing theories in care of older people, when the aim is to support them in the process of ageing.

    AIM:

    To review 17 well-known nursing theories/models in order to delineate the views on ageing presented and discover whether there are descriptions of how nursing care of older people could be organized.

    METHODS:

    Seventeen nursing theories/models originating over a 30-year period from the early 1960s to the early 1990s were chosen. A search of CINAHL was done and lists of reference from books were used to find original sources. For the review, a list of research questions were formulated and addressed to each theory.

    RESULTS:

    Results showed that most nursing theorists see human ageing from a developmental perspective, but do not discuss what ageing implies. In only a few theories are some important aspects of nursing care of older people discussed, but no concrete instructions are given on how to apply these to nursing care.

    CONCLUSION:

    There is a need to develop a nursing care model that - more than other contemporary theories - takes into consideration human ageing.

  • 47.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    The theory of gerotranscendence in practice: guidelines for nursing – Part II2007In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 2, no 4, p. 295-301Article in journal (Refereed)
    Abstract [en]

     

    Aim. The aims of this article were to describe both how guidelines were derived from the theory of gerotranscendence and the actual guidelines. It also discusses the relevance of guidelines to practice.

    Background. This article describes how guidelines were derived from the theory of gerotranscendence as well as the content of the guidelines and how they could be used. The view of ageing introduced by the theory may have several consequences for nursing staff members’ attitudes and treatment of older people, as it offers a new understanding of living in old age.

    Resultant guidelines. Concrete guidelines at three levels – focusing on the individual, activity and organization – were derived using focus groups. The guidelines describe different ways to support older people in their process towards gerotranscendence.

    Conclusion. The theory of gerotranscendence and the guidelines could help support nursing staff in their attitude towards older people and could be used as a supplement to enrich the present care.

  • 48.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Theory-driven guidelines for practical care of older people, based on the theory of gerotranscendence2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 41, no 5, p. 462-470Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    The theory of gerotranscendence states that human development is a process extending into old age. When optimized, this process ends in a new perspective. The developmental process towards gerotranscendence can be obstructed or accelerated by life crises and grief, but elements in the culture can also facilitate or impede the process. Similarly, the caring climate can obstruct or accelerate the process toward gerotranscendence. The view introduced by the theory may have several consequences for staff treatment of and actions towards older people, as it offers a new understanding of living into old age.

    AIM:

    The aim of the present study was to derive guidelines for practical use in the care of older people. The guidelines should be used to promote a development toward gerotranscendence and should also be of value for people who already have attained a state of gerotranscendence.

    METHODS:

    The method of deriving guidelines from the theory was focus group interviews. The theory of gerotranscendence was used as a foundation for stimulating the discussions in the focus groups as well as for organizing the proposals that emerged.

    FINDINGS:

    Concrete guidelines at three levels, focusing on the individual, activity and organization, were derived. The guidelines describe different ways to support older people in their process towards gerotranscendence.

    CONCLUSION:

    These guidelines could support staff in their practical care of older people and could be used as a supplement to enrich the present care.

  • 49.
    Wadensten, Barbro
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Engholm, Rosa
    Fahlström, Gunilla
    Hägglund, Doris
    Nursing staff`s description of a good encounter in nursing homes2009In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 3, p. 203-210Article in journal (Refereed)
    Abstract [en]

    Background. It has been stated that there is too little research on what constitutes good communication and good encounters in nursing homes.

    Aim and objectives. The aim of the present study was to examine nursing staff members' views on what is important in caring encounters with older people living in nursing homes.

    Design. A qualitative descriptive study using focus group interviews with staff in a nursing home in Sweden.

    Method. Focus group interviews, analysed using qualitative content analysis.

    Results. Three main themes emerged describing nursing staff members' opinions about the content of good encounters: `Caring encounters from the perspective of equality', `Caring encounters from the perspective of integrity' and `Caring encounters from the perspective of promoting security'.

    Conclusions. The nursing staff had theoretical knowledge of what constitutes a good caring encounter, but they seemed to need more supervision and training to develop their ways of encountering older people as well as to become stronger in their professional role. When performing such training with staff, the methodology of appreciative inquiry could be a powerful tool. Relevance to clinical practice. It is important to help staff become empowered and to help them develop and improve their encounters with older care recipients.

  • 50.
    Wadensten, Barbro
    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.
    Häggström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Public nursing home staff's experience of participating in an intervention aimed at enhancing their self-esteem2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 7, p. 833-842Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the present study was to gain an understanding of how nursing staff experienced participating in a training programme aimed at strengthening their self-esteem and empowering them, to determine whether participation benefited them in any way, and to describe their opinions about possible benefits or disadvantages.

    BACKGROUND: Staff working in institutions such as nursing homes have a low status in society. A training programme was introduced to staff in a public nursing home. It focused on helping them understand factors in the work situation that influence them and on empowering them.

    METHOD: The study was explorative and qualitative in design.

    FINDINGS: The participants in the programme were generally satisfied with it. Their opinions about the benefits they received from the programme can be described using three themes: 'improved communication skills', 'enhanced self-esteem' and 'sees work in a different light'.

    CONCLUSIONS: The most important finding of the present study is that it was possible to strengthen and empower staff. Staff members were generally pleased and satisfied with the content/organization of the training programme. They felt the programme had been of value to them by improving their communication skills and increasing their self-esteem.

    IMPLICATIONS FOR NURSING MANAGEMENT: The present result could be of value to managers and educators working in the area of nursing home care when planning education and development activities for staff. Learning to communicate better and understand the social structure at the workplace could improve staff members' self-esteem, thereby enhancing the work situation and atmosphere as well as empowering the individuals.

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