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  • 151.
    Erlandsson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Lindner Brundin, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Omvårdnadsproblem hos patienter som genomgår avancerad bukkirurgi: En intervjustudie med sjuksköterskor på kirurgisk vårdavdelning2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy may have extensive and complicated nursing needs with risk of complications. However, there is no research on the postoperative care at the surgical ward.

    Aim: The purpose was to describe, from the nurse's perspective, which nursing needs patients who had undergone CRS with HIPEC expressed and whether they received the nursing care they needed.

    Method: A descriptive qualitative interview study with semi-structured interviews with nurses (n = 12) was conducted on two surgical wards. Data was analyzed with a qualitative content analysis.

    Result: The analysis resulted in three categories: Physical nursing needs - complex to remedy and common with setbacks, To get the care adapted to individual needs and Psychosocial nursing needs are not met. The result showed that the most distinctive nursing needs in the patients were nausea, pain/anxiety and mobilization. During the care period, it was important that the nurse was responsive and that a good relationship between the healthcare staff and the patient was developed. The nurses described that patients had a need for more information and mental support.

    Conclusion: The results show that patients undergoing CRS with HIPEC have many nursing problems and the nursing care needs to be improved in several areas. A more structured and person-centered nursing could meet several nursing needs. This complex patient group should be cared for by nurses with professional experience and higher education, eg specialist nurses (surgical care). Further research should be conducted with patients who have undergone CRS with HIPEC as informants.

  • 152.
    Erlingmark, Julia
    et al.
    University Hospital, Uppsala, Sweden.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Lindberg, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap.
    Nurse staffing and renal anaemia outcomes in haemodialysis care2016In: Journal of Renal Care, ISSN 1755-6678, E-ISSN 1755-6686, Vol. 42, no 3, p. 185-189Article in journal (Refereed)
    Abstract [en]

    Background: Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes.

    Objectives: To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management.

    Design: Cross-sectional audit.

    Participants: Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data.

    Measurements: The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management.

    Results: The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres.

    Conclusions: These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation.

  • 153.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rahmqvist, M
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Communication challenges in Swedish telephone advice nursing: analysis of actual calls2011Article in journal (Refereed)
  • 154.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Gävle University.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rahmqvist, Mikael
    Linköping University.
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Telephone nurses’ communication and response to callers’ concern: a mixed methods study2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 23, p. 116-121Article in journal (Refereed)
    Abstract [en]

    Aims

    To describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concern

    Background

    Telephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.

    Method

    RIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.

    Results

    Telephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapproval were found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.

    Conclusion

    Telephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.

  • 155.
    Ernesäter, Annica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Winblad, Ulrika Spångberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Holmstrom, Inger Knutsson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case-control study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

  • 156. Ferm Widlund, Kjerstin
    et al.
    Gunnarsson, Cecilia
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hansson, Mats G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Pregnant women are satisfied with the information they receive about prenatal diagnosis, but are their decisions well informed?2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 10, p. 1128-1132Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE. To survey the information about prenatal diagnosis that midwives give to pregnant women and to find out how the women experience the information. Furthermore, to evaluate the midwives' opinion about their knowledge and personal need for education. DESIGN. Descriptive cross-sectional study. SETTING. The southeast healthcare region of Sweden. METHODS. One hundred and fifty-seven midwives and 150 pregnant women were invited to reply to a confidential questionnaire in 2008. RESULTS. The reply rate was 78% for the midwives and 53% for the women. Ninety-six percentage of the midwives used < or =10 minutes to inform women about prenatal diagnosis. Seventy-two percentage always informed about the advantages and 41% about the choice to continue or terminate the pregnancy if a serious abnormality was detected. In addition, 41% considered that they had sufficient knowledge to inform about prenatal diagnosis, while 84% wanted additional education. Seventy-six percentage of the women took the decision to have prenatal diagnosis as soon as they found out that they were pregnant. A majority considered that they had been given enough time for questions and reflections. CONCLUSIONS. There was discrepancy between the amount of information, which midwives gave to pregnant women about prenatal diagnosis compared to what would be needed for a complete understanding of the relevant medical facts and the risks involved, but even so the women were satisfied with the information.

  • 157.
    Florin, Jan
    et al.
    Dalarna Univ, Dept Hlth & Social Sci, Falun, Sweden.
    Bååth, Carina
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, Karlstad, Sweden.; Cty Council Varmland, Varmland, Sweden.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Dept Hlth & Caring Sci, Fac Hlth & Occupat Studies, Gavle, Sweden.
    Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument2016In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 5, p. 655-662Article in journal (Refereed)
    Abstract [en]

    The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.

  • 158.
    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.

  • 159.
    Forsberg, Markus
    et al.
    Cty Council Gavleborg, Dept Anaesthesia, Gavleborg, Sweden.
    Björn, Catrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Cty Council Gavleborg, Dept Anaesthesia, Gavleborg, 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, Dept Hlth & Caring Sci, Gavle, Sweden.
    Nilsson, Annika
    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, Dept Hlth & Caring Sci, Gavle, Sweden.
    Nurse Anesthetists' Reflections on Caring for Patients With Previous Substance Dependence: Balancing Between Professionalism and Preconceptions2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 1, p. 69-77Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The study aim was to describe nurse anesthetists' reflections on the provision of perioperative care to patients with previous substance dependence.

    DESIGN: A qualitative approach with a descriptive design.

    METHODS: Semistructured interviews based on clinical vignettes were conducted with 10 nurse anesthetists.

    FINDINGS: The perioperative care provided to patients with previous substance dependence was perceived as balancing between professionalism and preconceptions for this specific patient group. The nurse anesthetists felt that anesthetizing this group of patients constituted a challenge with regard to knowledge, experience, and time. However, the nurses also had feelings of distrust and uncertainty because of lack of knowledge.

    CONCLUSIONS: The nurse anesthetists strove to uphold the principle that patients who are/have been substance dependent have the same right to adequate treatment and care as all patients. If guidelines were developed for this patient group, care could be made safer and nurses' sense of uncertainty minimized.

  • 160. Forsman, Henrietta
    et al.
    Jansson, Inger
    Leksell, Janeth
    Lepp, Margret
    Sundin Andersson, Christina
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nilsson, Jan
    Clusters of competence: Relationship between self-reported professional competence and achievement on a national examination among graduating nursing students.2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    AIMS: To identify clusters based on graduating nursing students' self-reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students' perceptions of overall quality of the nursing programme and students' general self-efficacy.

    DESIGN: A cross-sectional study combining survey data and results from a national examination.

    METHODS: Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the General Self-Efficacy scale and results from the National Clinical Final Examination. A Two-Step Cluster Analysis was used to identify competence profiles, followed by comparative analyses between clusters.

    RESULTS: Three clusters were identified illustrating students' different competence profiles. Students in Cluster 1 and 2 passed the examination, but differed in their self-assessments of competence, rating themselves under and above the overall median value respectively. Students in Cluster 3 failed the examination but rated themselves at the overall median level or higher.

    CONCLUSION: The study illustrates how nursing students' self-assessed competence might differ from competency assessed by examination, which is challenging for nursing education. Self-evaluation is a key learning outcome and is, in the long run, essential to patient safety.

    IMPACT: The study has identified clusters of students where some overestimate and others underestimate their competence. Students who assessed their competence low but passed the exam assessed their general self-efficacy lower than other students. The findings illuminate the need for student-centered strategies in nursing education, including elements of self-assessment in relation to examination to make the students more aware of their clinical competence.

  • 161.
    Frauenfelder, Fritz
    et al.
    Psychiat Univ Hosp Zurich, Directorate Nursing Therapies & Social Work, Zurich, Switzerland..
    van Achterberg, Theo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Leuven, Belgium.;Radboud Univ Nijmegen, Sci Inst Qual Hlth Care, Med Ctr, Nijmegen, Netherlands..
    Staub, Maria Muller
    Pflege PBS Projects Consulting Res, Wil, Switzerland.;Hanze Univ, Groningen, Netherlands..
    Nursing diagnoses related to psychiatric adult inpatient care2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 3-4, p. e463-e475Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 162.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The trade-off between choice and equity: Swedish policymakers’ arguments when introducing patient choice2013In: Journal of European Social Policy, ISSN 0958-9287, E-ISSN 1461-7269, Vol. 23, no 2, p. 192-209Article in journal (Refereed)
    Abstract [en]

    How do policymakers deal with the tension between choice and equity in healthcare? An analysis and critical examination of Swedish policymakers' arguments when introducing legislated choice of primary care provider in 2010 shows that even when deciding on a reform with a potentially great impact on distribution of health resources, implications for equity were not systematically addressed. Effects with regards to current patterns of healthcare consumption in the population as well as existing inequalities in health outcomes were not adequately addressed. Neither was the primary are choice reform, which is based on the values of consumerism and individual choice, problematized in relation to current healthcare legislation such as the Health and Medical Services Act. Given that the values of equity and social solidarity have had such a prominent place in Swedish health policy and discourse in past decades, this is a surprising finding. In conclusion, we argue that because inequalities in health constitute one of the main challenges for public health today, the impact of healthcare reforms on equity should receive more attention in policymaking.

  • 163.
    Fröjd, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Cancer Patients’ Satisfaction with Doctors’ Care: Consequences and Contributing Conditions2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main aims were to: explore whether there is a relation between doctors’ ability to identify patients’ worry and wish for information and self-efficacy with regard to communicating with patients about difficult matters; describe which cues doctors consider when estimating patients’ worry and wish for information, and investigate whether there is a relation between patients’ satisfaction with doctors’ care and patients’ psychosocial function.

    Eleven doctors and 69 patients (of which 36 patients participated in the longitudinal study) with carcinoid tumours participated. Doctors’ self-efficacy, and ability to identify patients’ worry/wish for information were investigated at patients’ first admission. Doctors were interviewed about which cues they considered when estimating patients worry/wish for information. Patients’ satisfaction with care (CASC SF 4.0) and psychosocial function (EORTC QLQ-C30, HADS) were measured longitudinally, during the first year after diagnosis.

    Doctors reported higher self-efficacy when showing good ability to identify patients’ wish for information, than when showing less good ability, overestimated patients’ worry and underestimated patients’ wish for information. Doctors considered patients’ verbal behaviour and body language together with knowledge and experience when estimating patients worry and wish for information. Patients who met doctors showing good ability to identify their wish for information, reported a higher cognitive function than patients who met doctors showing less good ability. At all assessments patients expressed high satisfaction with doctor’ care and patients’ satisfaction did not change over time. Patients’ satisfaction with doctors’ care were related to their psychosocial function shortly after the first three admissions to specialist care. Patients with carcinoid tumours in some respects reported a worse HRQoL than the general Swedish population. Fatigue, diarrhoea, limited possibilities to work/pursue daily activities, and worry that the illness will get worse were among the most prevalent, and worst, aspects of disease- and treatment related distress.

    List of papers
    1. Is doctors' ability to identify cancer patients' worry and wish for information related to doctors' self-efficacy with regard to communicating about difficult matters?
    Open this publication in new window or tab >>Is doctors' ability to identify cancer patients' worry and wish for information related to doctors' self-efficacy with regard to communicating about difficult matters?
    2006 (English)In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 15, no 4, p. 371-378Article in journal (Refereed) Published
    Abstract [en]

    The aims were to investigate whether: (A) doctors' ability to identify patients' worry about prognosis/wish for information about disease and treatment is related to doctors' self-efficacy with regard to communicating about difficult matters and patients' satisfaction with a consultation/hope to live a good life in spite of the disease; and (B) patients and doctors agree on how much worry/wish for information a patient experiences/wishes. Sixty-nine patients with carcinoid and 11 doctors participated. Ability to identify worry/wish for information was estimated by posing questions to doctors/patients concerning how much worry/information a patient experienced/wished during a consultation. Doctors' self-efficacy was measured by nine questions, patients' satisfaction and hope by two questions. When doctors show good ability to identify wish for information, they report higher self-efficacy (t = 3.5, d.f. = 67, P < 0.001) than when they show less good ability. Patients finding the consultation very satisfying meet doctors reporting higher self-efficacy than patients finding the consultation satisfying (t = 2.26, d.f. = 65, P < 0.05). Doctors fail to identify patients who report less worry/wish more information than the average patient. The findings underscore the importance of further enhancing doctors' self-efficacy with regard to communicating about difficult matters and ability to identify patients who are less worried/wish more information than the average patient.

    Keywords
    cancer, doctors, information, patients, self-efficacy, worry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96314 (URN)10.1111/j.1365-2354.2006.00670.x (DOI)000240367300009 ()16968320 (PubMedID)
    Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2017-12-14Bibliographically approved
    2. Patient attitudes, behaviours, and other factors considered by doctors when estimating cancer patients' anxiety and desire for information
    Open this publication in new window or tab >>Patient attitudes, behaviours, and other factors considered by doctors when estimating cancer patients' anxiety and desire for information
    Show others...
    2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 523-529Article in journal (Refereed) Published
    Abstract [en]

    The aim was to describe the patient attitudes, behaviours, and other factors, considered by doctors when estimating cancer patients' worry about how the disease may develop and the desire for information about the disease and its treatment. Data was gathered through semi-structured interviews with 19 doctors regarding 29 patients within endocrine oncology and haematology care, and the data were analysed by content analysis. The doctors considered the patients' verbal expressions, verbal behaviours, questions, body language, and facial expressions together with their own professional knowledge and experience, when estimating the patients' worry and desire for information. The doctors also considered contextual factors, patients' demographical factors, and medical situation when estimating the patients' worry, and also when estimating the patients' desire for information. The findings illustrate that estimating patients' worry and desire for information is a multifaceted and complex task, and that doctors consider not only the patients' verbal and nonverbal cues, but also factors, such as their own professional knowledge and experience, contextual factors, and patients' demographical variables. The findings should be communicated to doctors who meet cancer patients in medical consultations in order to illuminate the complexity of the medical consultation. The awareness of potentially important patient cues and other factors may aid doctors in their efforts to gain insight about their patients' emotions and informational needs.

    Keywords
    cancer, worry, communication, doctor, information
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-13022 (URN)10.1111/j.1471-6712.2007.00507.x (DOI)000251206600014 ()18036016 (PubMedID)
    Available from: 2008-09-01 Created: 2009-04-02 Last updated: 2017-12-11Bibliographically approved
    3. Is satisfaction with doctors' care related to health related quality of life, anxiety, and depression among patients with carcinoid tumours?: A longitudinal report
    Open this publication in new window or tab >>Is satisfaction with doctors' care related to health related quality of life, anxiety, and depression among patients with carcinoid tumours?: A longitudinal report
    2009 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 1, p. 107-116Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate (i) whether specific aspects of the initial consultation (IC) and/or patients' satisfaction with doctors' care are related to health-related quality of life (HRQoL), anxiety and depression among patients with carcinoid tumours and (ii) whether patients' satisfaction with doctors' care changes over time. The study has a longitudinal design. The HRQoL and psychosocial function among patients who met the doctors showing good ability to identify patients' worry and wish for information were compared with those patients who met doctors showing less good ability. Patients' HRQoL, anxiety, depression and satisfaction with doctors' care were assessed longitudinally, shortly after each of the first four admissions to specialist care. Patients who met doctors showing good ability to identify their wish for information at the IC reported higher levels of cognitive function. Higher satisfaction with doctors' care was related to higher emotional and cognitive function, to higher global QoL, and to lower levels of problems with diarrhoea, financial difficulties, constipation, anxiety and depression shortly after each of the first three admissions, although not after the fourth admission to the specialist care. Although most patients with carcinoid tumours report high satisfaction with care, it is important to be aware of the fact that some patients may be less satisfied. Doctors should provide patients with information which matches the individual patients' needs and preferences as patients' satisfaction with doctors' provision of information is related to patients' HRQoL, anxiety and depression.

    Keywords
    Anxiety, Carcinoid tumours, Care, Depression, Health-related quality of life, Information, Satisfaction
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96316 (URN)10.1111/j.1471-6712.2008.00596.x (DOI)000263466900013 ()19250453 (PubMedID)
    Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2017-12-14Bibliographically approved
    4. Health related quality of life and psychosocial function among patients with carcinoid tumours. A longitudinal, prospective, and comparative study
    Open this publication in new window or tab >>Health related quality of life and psychosocial function among patients with carcinoid tumours. A longitudinal, prospective, and comparative study
    2007 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 5, p. 18-Article in journal (Refereed) Published
    Abstract [en]

    Background: The aim was to investigate HRQoL and psychosocial function among patients with carcinoid tumours, longitudinally and prospectively, and to compare HRQoL among patients with carcinoid tumours to that of the Swedish general population. The aim was also to investigate the prevalence of distress during the first year after diagnosis. Methods: At four assessments during the first year after diagnosis, HRQoL was measured by the EORTC QLQ-C30 3.0, anxiety and depression by the HADS, and prevalence, and worst aspects of distress by an interview guide. ANOVA was performed in order to study changes over time with regard to HRQoL, anxiety and depression. Comparisons regarding HRQoL between patients and the Swedish population were made by the use of one-sample t-tests and changes over time regarding the prevalence of distress was investigated by means of Cochran's Q. Results: High levelsof physical-, emotional-, cognitive-, and social function and somewhat lower levels of role function and global quality of life were reported at all assessments. Role- and emotional function increased over time. Patients reported lower role function and global quality of life and more problems with fatigue and diarrhoea than the Swedish general population, at all assessments. Fatigue, limitations to work and pursue daily activities, and worry that the illness will get worse were among the most prevalent aspects at all assessments. At all assessments the majority reported worrying about the family's situation, the ability to care for the family, and worrying before the check-up. Conclusion: It is concluded that HRQoL and psychosocial function among patients with carcinoid tumours remains stable during the first year, that the patients report a lower HRQoL than the Swedish general population, and that a majority of the patients report a number of aspects of emotional distress. In the clinical care, it should be considered that the majority of patients report not only fatigue and diarrhoea but also worries about their prognosis, their families, tests, and examinations. Efforts to reduce these worries should be made.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-100807 (URN)10.1186/1477-7525-5-18 (DOI)000245722000001 ()17428340 (PubMedID)
    Available from: 2009-04-07 Created: 2009-04-07 Last updated: 2017-12-13Bibliographically approved
  • 164.
    Fröjd, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Birgegård, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Patient attitudes, behaviours, and other factors considered by doctors when estimating cancer patients' anxiety and desire for information2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, p. 523-529Article in journal (Refereed)
    Abstract [en]

    The aim was to describe the patient attitudes, behaviours, and other factors, considered by doctors when estimating cancer patients' worry about how the disease may develop and the desire for information about the disease and its treatment. Data was gathered through semi-structured interviews with 19 doctors regarding 29 patients within endocrine oncology and haematology care, and the data were analysed by content analysis. The doctors considered the patients' verbal expressions, verbal behaviours, questions, body language, and facial expressions together with their own professional knowledge and experience, when estimating the patients' worry and desire for information. The doctors also considered contextual factors, patients' demographical factors, and medical situation when estimating the patients' worry, and also when estimating the patients' desire for information. The findings illustrate that estimating patients' worry and desire for information is a multifaceted and complex task, and that doctors consider not only the patients' verbal and nonverbal cues, but also factors, such as their own professional knowledge and experience, contextual factors, and patients' demographical variables. The findings should be communicated to doctors who meet cancer patients in medical consultations in order to illuminate the complexity of the medical consultation. The awareness of potentially important patient cues and other factors may aid doctors in their efforts to gain insight about their patients' emotions and informational needs.

  • 165.
    Fröjd, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Is satisfaction with doctors' care related to health related quality of life, anxiety, and depression among patients with carcinoid tumours?: A longitudinal report2009In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 1, p. 107-116Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate (i) whether specific aspects of the initial consultation (IC) and/or patients' satisfaction with doctors' care are related to health-related quality of life (HRQoL), anxiety and depression among patients with carcinoid tumours and (ii) whether patients' satisfaction with doctors' care changes over time. The study has a longitudinal design. The HRQoL and psychosocial function among patients who met the doctors showing good ability to identify patients' worry and wish for information were compared with those patients who met doctors showing less good ability. Patients' HRQoL, anxiety, depression and satisfaction with doctors' care were assessed longitudinally, shortly after each of the first four admissions to specialist care. Patients who met doctors showing good ability to identify their wish for information at the IC reported higher levels of cognitive function. Higher satisfaction with doctors' care was related to higher emotional and cognitive function, to higher global QoL, and to lower levels of problems with diarrhoea, financial difficulties, constipation, anxiety and depression shortly after each of the first three admissions, although not after the fourth admission to the specialist care. Although most patients with carcinoid tumours report high satisfaction with care, it is important to be aware of the fact that some patients may be less satisfied. Doctors should provide patients with information which matches the individual patients' needs and preferences as patients' satisfaction with doctors' provision of information is related to patients' HRQoL, anxiety and depression.

  • 166.
    Fröjd, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Larsson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Health related quality of life and psychosocial function among patients with carcinoid tumours. A longitudinal, prospective, and comparative study2007In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 5, p. 18-Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to investigate HRQoL and psychosocial function among patients with carcinoid tumours, longitudinally and prospectively, and to compare HRQoL among patients with carcinoid tumours to that of the Swedish general population. The aim was also to investigate the prevalence of distress during the first year after diagnosis. Methods: At four assessments during the first year after diagnosis, HRQoL was measured by the EORTC QLQ-C30 3.0, anxiety and depression by the HADS, and prevalence, and worst aspects of distress by an interview guide. ANOVA was performed in order to study changes over time with regard to HRQoL, anxiety and depression. Comparisons regarding HRQoL between patients and the Swedish population were made by the use of one-sample t-tests and changes over time regarding the prevalence of distress was investigated by means of Cochran's Q. Results: High levelsof physical-, emotional-, cognitive-, and social function and somewhat lower levels of role function and global quality of life were reported at all assessments. Role- and emotional function increased over time. Patients reported lower role function and global quality of life and more problems with fatigue and diarrhoea than the Swedish general population, at all assessments. Fatigue, limitations to work and pursue daily activities, and worry that the illness will get worse were among the most prevalent aspects at all assessments. At all assessments the majority reported worrying about the family's situation, the ability to care for the family, and worrying before the check-up. Conclusion: It is concluded that HRQoL and psychosocial function among patients with carcinoid tumours remains stable during the first year, that the patients report a lower HRQoL than the Swedish general population, and that a majority of the patients report a number of aspects of emotional distress. In the clinical care, it should be considered that the majority of patients report not only fatigue and diarrhoea but also worries about their prognosis, their families, tests, and examinations. Efforts to reduce these worries should be made.

  • 167.
    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.

  • 168.
    Fröjd, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Is doctors' ability to identify cancer patients' worry and wish for information related to doctors' self-efficacy with regard to communicating about difficult matters?2006In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 15, no 4, p. 371-378Article in journal (Refereed)
    Abstract [en]

    The aims were to investigate whether: (A) doctors' ability to identify patients' worry about prognosis/wish for information about disease and treatment is related to doctors' self-efficacy with regard to communicating about difficult matters and patients' satisfaction with a consultation/hope to live a good life in spite of the disease; and (B) patients and doctors agree on how much worry/wish for information a patient experiences/wishes. Sixty-nine patients with carcinoid and 11 doctors participated. Ability to identify worry/wish for information was estimated by posing questions to doctors/patients concerning how much worry/information a patient experienced/wished during a consultation. Doctors' self-efficacy was measured by nine questions, patients' satisfaction and hope by two questions. When doctors show good ability to identify wish for information, they report higher self-efficacy (t = 3.5, d.f. = 67, P < 0.001) than when they show less good ability. Patients finding the consultation very satisfying meet doctors reporting higher self-efficacy than patients finding the consultation satisfying (t = 2.26, d.f. = 65, P < 0.05). Doctors fail to identify patients who report less worry/wish more information than the average patient. The findings underscore the importance of further enhancing doctors' self-efficacy with regard to communicating about difficult matters and ability to identify patients who are less worried/wish more information than the average patient.

  • 169.
    Gadbois, Emily A
    et al.
    Center for Gerontology and Healthcare Research Brown University School of Public Health Providence USA.
    Tyler, Denise A
    RTI International Research Triangle Park USA.
    Shield, Renee
    Center for Gerontology and Healthcare Research Brown University School of Public Health Providence USA.
    McHugh, John
    Mailman School of Public Health Columbia University New York USA.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Teno, Joan M
    Division of General Internal Medicine & Geriatrics Oregon Health Sciences University Portland USA.
    Mor, Vincent
    Center for Gerontology and Healthcare Research Brown University School of Public Health Providence USA.
    Lost in Transition: a Qualitative Study of Patients Discharged from Hospital to Skilled Nursing Facility2019In: Journal of general internal medicine, ISSN 0884-8734, E-ISSN 1525-1497, Vol. 34, no 1, p. 102-109Article in journal (Refereed)
    Abstract [en]

    Objective

    This research aimed to understand the experiences of patients transitioning from hospitals to skilled nursing facilities (SNFs) by eliciting views from patients and hospital and skilled nursing facility staff.

    Design

    We conducted semi-structured interviews with hospital and skilled nursing facility staff and skilled nursing facility patients and their family members in an attempt to understand transitions between hospital and SNF. These interviews focused on all aspects of the discharge planning and nursing facility placement processes including who is involved, how decisions are made, patients' experiences, hospital-SNF communication, and the presence of programs to improve the transition process.

    Participants

    Participants were 138 staff in 16 hospitals and 25 SNFs in 8 markets across the country, and 98 newly admitted, previously community-dwelling SNF patients and/or their family members in five of those markets.

    Approach

    Interviews were qualitatively analyzed to identify overarching themes.

    Key Results

    Patients reported they felt rushed in making their SNF decisions, did not feel they were appropriately prepared for the hospital-SNF transition or educated about their post-acute needs, and experienced transitions that felt chaotic, with complications they associated with timing and medications. Hospital and SNF staff expressed similar opinions, stating that transitions were rushed, there were problems with the timing of the discharge, with information transfer and medication reconciliation, and that patients were not appropriately prepared for the transition. Staff at some facilities reported programs designed to address these problems, but the efficacy of these programs is unknown.

    Conclusions

    Results indicate problematic transitions stemming from insufficient care coordination and failure to appropriately prepare patients and their family members. Previous research suggests that problematic or hurried transitions from hospital to SNF are associated with medication errors and unnecessary rehospitalizations. Interventions to improve transitions from hospital to SNF that include a focus on patients and families are needed.

  • 170. Galvin, Kathleen
    et al.
    Emami, Azita
    Dahlberg, Karin
    Bach, Shirley
    Ekebergh, Margaretha
    Rosser, Elizabeth
    Powell, Jane
    Edlund, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bondas, Terese
    Uhrenfeldt, Lisbeth
    Challenges for future caring science research: a response to Hallberg (2006)2008In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 45, no 6, p. 971-974Article in journal (Refereed)
  • 171.
    Gardulf, Ann
    et al.
    Karolinska Univ Hosp, Karolinska Inst, Dept Lab Med, Div Clin Immunol,Unit Clin Nursing Res & Clin Res, SE-14186 Stockholm, Sweden.;Japanese Red Cross Inst Humanitarian Studies, Tokyo, Japan..
    Nilsson, Jan
    Japanese Red Cross Inst Humanitarian Studies, Tokyo, Japan.;Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, Karlstad, Sweden..
    Florin, Jan
    Dalama Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalama Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Lepp, Margret
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Gothenburg, Sweden.;Ostfold Univ Coll, Holden, Norway..
    Lindholm, Christina
    Sophiahemmet Univ, Stockholm, Sweden..
    Nordström, Gun
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, Karlstad, Sweden.;Hedmark Univ Coll, Hedmark, Norway..
    Theander, Kersti
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, Karlstad, Sweden.;Cty Council Varmland, Primary Care Res Unit, Karlstad, Sweden..
    Wilde-Larsson, Bodil
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, Karlstad, Sweden.;Hedmark Univ Coll, Hedmark, Norway..
    Carlsson, Marianne
    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..
    Johansson, Eva
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Dept Nursing, Stockholm, Sweden..
    The Nurse Professional Competence (NPC) Scale: Self-reported competence among nursing students on the point of graduation2016In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 36, p. 165-171Article in journal (Refereed)
    Abstract [en]

    Background: International organisations, e.g. WHO, stress the importance of competent registered nurses (RN) for the safety and quality of healthcare systems. Low competence among RNs has been shown to increase the morbidity and mortality of inpatients. Objectives: To investigate self-reported competence among nursing students on the point of graduation (NSPGs), using the Nurse Professional Competence (NPC) Scale, and to relate the findings to background factors. Methods and participants; The NPC Scale consists of 88 items within eight competence areas (CAs) and two overarching themes. Questions about socio-economic background and perceived overall quality of the degree programme were added. In total, 1086 NSPGs (mean age, 28.1[20-56] years, 87.3% women) from 11 universities/university colleges participated. Results: NSPGs reported significantly higher scores for Theme I "Patient-Related Nursing" than for Theme II "Organisation and Development of Nursing Care". Younger NSPGs (20-27 years) reported significantly higher scores for the CAs "Medical and Technical Care" and "Documentation and Information Technology". Female NSPGs scored significantly higher for "Value-Based Nursing". Those who had taken the nursing care programme at upper secondary school before the Bachelor of Science in Nursing (BSN) programme scored significantly higher on "Nursing Care", "Medical and Technical Care", "Teaching/Learning and Support", "Legislation in Nursing and Safety Planning" and on Theme I. Working extra paid hours in healthcare alongside the BSN programme contributed to significantly higher self-reported scores for four CAs and both themes. Clinical courses within the BSN programme contributed to perceived competence to a significantly higher degree than theoretical courses (932% vs 875% of NSPGs). Summary and conclusion: Mean scores reported by NSPGs were highest for the four CAs connected with patient-related nursing and lowest for CAs relating to organisation and development of nursing care. We conclude that the NPC Scale can be used to identify and measure aspects of self-reported competence among NSPGs.

  • 172.
    Gavell, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Malmsten, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hur patienter i onkologisk vård upplever studenters medverkan i vården: En enkätstudie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 173. Gemzell-Danielsson, Kristina
    et al.
    Thunell, Louise
    Lindeberg, Mia
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Marintchieva-Petrova, Maya
    Oddens, Bjoern J.
    Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods: results of the CHOICE program in Sweden2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 869-877Article in journal (Refereed)
    Abstract [en]

    Objective. To study the influence of counseling on women's contraceptive decisions. Design. A cross-sectional multicenter study. Setting. Seventy Swedish family planning clinics. Population. Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. Methods. Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. Main Outcome Measures. Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. Results. In all, 173 healthcare professionals and 1 944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% ( n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method. Conclusions. Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.

  • 174.
    Ghafouri, Bijar
    et al.
    Linkoping Univ, Div Community Med, Dept Med & Hlth Sci, Fac Hlth Sci, SE-58185 Linkoping, Sweden.;Anaesthet Operat & Specialty Surg Ctr, Pain & Rehabil Ctr, SE-58185 Linkoping, Sweden.;Linkoping Univ, Div Neuro & Inflammat Sci, Dept Clin & Expt Med, Occupat & Environm Med Ctr,Heart & Med Ctr, SE-58185 Linkoping, Sweden..
    Carlsson, Anders
    Linkoping Univ, Div Community Med, Dept Med & Hlth Sci, Fac Hlth Sci, SE-58185 Linkoping, Sweden.;Anaesthet Operat & Specialty Surg Ctr, Pain & Rehabil Ctr, SE-58185 Linkoping, Sweden..
    Holmberg, Sara
    Dept Res & Dev, Region Kronoberg, Vaxjo, Sweden..
    Thelin, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Tagesson, Christer
    Linkoping Univ, Div Neuro & Inflammat Sci, Dept Clin & Expt Med, Occupat & Environm Med Ctr,Heart & Med Ctr, SE-58185 Linkoping, Sweden..
    Biomarkers of lsystemic inflammation in farmers with musculoskeletal disorders: a plasma proteomic study2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, article id 206Article in journal (Refereed)
    Abstract [en]

    Background: Farmers have an increased risk for musculoskeletal disorders (MSD) such as osteoarthritis of the hip, low back pain, and neck and upper limb complaints. The underlying mechanisms are not fully understood. Workrelated exposures and inflammatory responses might be involved. Our objective was to identify plasma proteins that differentiated farmers with MSD from rural referents. Methods: Plasma samples from 13 farmers with MSD and rural referents were included in the investigation. Gel based proteomics was used for protein analysis and proteins that differed significantly between the groups were identified by mass spectrometry. Results: In total, 15 proteins differed significantly between the groups. The levels of leucine-rich alpha-2-glycoprotein, haptoglobin, complement factor B, serotransferrin, one isoform of kininogen, one isoform of alpha-1-antitrypsin, and two isoforms of hemopexin were higher in farmers with MSD than in referents. On the other hand, the levels of alpha-2-HS-glycoprotein, alpha-1B-glycoprotein, vitamin D-binding protein, apolipoprotein A1, antithrombin, one isoform of kininogen, and one isoform of alpha-1-antitrypsin were lower in farmers than in referents. Many of the identified proteins are known to be involved in inflammation. Conclusions: Farmers with MSD had altered plasma levels of protein biomarkers compared to the referents, indicating that farmers with MSD may be subject to a more systemic inflammation. It is possible that the identified differences of proteins may give clues to the biochemical changes occurring during the development and progression of MSD in farmers, and that one or several of these protein biomarkers might eventually be used to identify and prevent work-related MSD.

  • 175.
    Giesbers, A. P. M. (Suzanne)
    et al.
    Canisius Wilhelmina Hosp, POB 9015, NL-6500 GS Nijmegen, Netherlands.;Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands..
    Schouteten, Roel L. J.
    Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands..
    Poutsma, Erik
    Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands..
    van der Heijden, Beatrice I. J. M.
    Radboud Univ Nijmegen, Inst Management Res, POB 9108, NL-6500 HK Nijmegen, Netherlands.;Open Univ Netherlands, Sch Management, POB 2960, NL-6401 DL Heerlen, Netherlands.;Univ Kingston, Kingston Business Sch, Kingston Hill, Kingston Upon Thames KT2 7LB, Surrey, England..
    van Achterberg, Theo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Kapucijnenvoer 35, B-3000 Leuven, Belgium.;Radboud Univ Nijmegen, Med Ctr, Radboud Inst Hlth Sci, Sci Ctr Qual Healthcare, POB 9101, NL-6500 HB Nijmegen, Netherlands..
    Nurses' perceptions of feedback to nursing teams on quality measurements: An embedded case study design2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 64, p. 120-129Article in journal (Refereed)
    Abstract [en]

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

  • 176.
    Gillespie, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Mörlin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hammarlund-Udenaes, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Hedström, Mariann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Perceived value of ward-based pharmacists from the perspective of physicians and nurses2012In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 34, no 1, p. 127-135Article in journal (Refereed)
    Abstract [en]

    Background

    Clinical pharmacy in a hospital setting is relatively new in Sweden. Its recent introduction at the University Hospital in Uppsala has provided an opportunity for evaluation by other relevant professionals of the integration of clinical pharmacists into the health-care team.

    Objectives

    The objectives of this descriptive study were to evaluate the perceived value of wardbased clinical pharmacists from the perspective of hospital based physicians and nurses and to identify potential advantages and disadvantages related to the new inter professional collaboration. Another objective was to evaluate the experiences of general practitioners on receiving medication reports from wardbased clinical pharmacists.

    Setting

    Two acute internal medicine wards at the University Hospital in Uppsala, where a previously reported randomized controlled trial investigating the effects of ward based clinical pharmacists on re-visits to hospital was undertaken.

    Methods

    Data were collected by questionnaires containing closed- and openended questions. The questionnaires were distributed during the nine-month study period of the randomized controlled trial by an independent researcher to 29 hospital-based physicians and 44 nurses on the study wards and to 21 general practitioners who had received two or more medication reports. Answers were analysed descriptively for the closedended questions and by content analysis for the open-ended questions.

    Main outcome measure

    The main outcome measure was the physicians’ and nurses’ level of satisfaction with the new collaboration with clinical pharmacists, from a hospital and primary care perspective.

    Results

    Seventy-six percent of the hospital-based physicians and 81% of the nurses completed the questionnaire. Ninety-five percent of the physicians and 93% of the nurses were very satisfied with the collaboration. Out of the 17 general practitioners (81%) that completed the questionnaire 71% wanted to continue to receive medication reports in a similar way in the future. Increased patient safety and improvements in patients’ drug therapy were the main advantages stated by all three groups of respondents. Eighteen percent of the hospital-based physicians and 21% of the nurses thought that the collaboration had been time-consuming to certain or to a high extent.

    Conclusions

    The majority of the respondents, both GPs and hospital based physicians and nurses, were satisfied with the new collaboration with the ward based pharmacists and perceived that the quality of the patients’ drug therapy and drug-related patient safety had increased.

  • 177.
    Godskesen, Tove
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Ersta Sköndal University College.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hansson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Kihlbom, Ulrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Phase 1 clinical trials in end-stage cancer: patient understanding of trial premises and motives for participation2013In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 21, no 11, p. 3137-3142Article in journal (Refereed)
    Abstract [en]

    In cancer, phase 1 clinical trials on new drugs mostly involve patients with advanced disease that is unresponsive to standard therapy. The purpose of this study was to explore the difficult ethical problems related to patient information and motives for participation in such trials. A descriptive and explorative qualitative design was used. Fourteen cancer patients from three different phase 1 trials in end-stage cancer were interviewed. The interviews were analysed using qualitative content analysis. The patients expressed unrealistic expectations of therapeutic benefit and inadequate understanding of the trials' purpose, so-called therapeutic misconception. However, they reported a positive attitude towards participation. Thus, the patients valued the close and unique medical and psychological attention they received by participating. Participation also made them feel unique and notable. Patients with end-stage cancer participating in phase 1 clinical trials are unaware of the very small potential for treatment benefit and the risk of harm. Trial participation may offer hope and social-emotional support and a strategy for coping with the emotional stress associated with advanced cancer and may, consequently, improve emotional well-being.

  • 178.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. 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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Bendrik, Regina
    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, Family Medicine and Preventive Medicine.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ställberg, Björn
    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.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Prevalence of subjective swallowing dysfunction in patients with stable COPD: Results from the TIE-study2017Conference paper (Other academic)
  • 179.
    Gonzalez Lindh, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. 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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Ställberg, Björn
    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.
    Bröms, Kristina
    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, Family Medicine and Preventive Medicine.
    Swallowing dysfunction in COPD: Is it more related to burden of disease than lung function: Results from the TIE-study2017Conference paper (Other academic)
  • 180.
    Gottvall, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Introduction of School-Based HPV Vaccination in Sweden: Knowledge and Attitudes among Youth, Parents, and Staff2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis is to provide a better understanding of knowledge, attitudes, consent, and decision-making regarding Human papillomavirus (HPV) vaccination, seen from the perspectives of concerned parties – high school students, school nurses, and parents.

    Two quantitative studies were performed: one descriptive cross-sectional study and one quasi-experimental intervention study. Qualitative studies using focus group interviews and individual interviews were also performed.

    High school students’ knowledge about HPV and HPV prevention was low but their attitudes toward HPV vaccination were positive. An educational intervention significantly increased the students’ knowledge regarding HPV and HPV prevention. Their already positive attitudes toward condom use and HPV vaccination remained unchanged. The students wanted to receive more information about HPV from school nurses. The school nurses were also positive to HPV vaccination but identified many challenges concerning e.g. priorities, obtaining informed consent, culture, and gender. They saw an ethical dilemma in conflicting values such as the child’s right to self-determination, the parents’ right to make autonomous choices on behalf of their children, and the nurse’s obligation to promote health. They were also unsure of how, what, and to whom information about HPV should be given. Parents, who had consented to vaccination of their young daughters, reasoned as follows: A vaccine recommended by the authorities is likely to be safe and effective, and the parents were willing to do what they could to decrease the risk of a serious disease for their daughter. Fear of unknown adverse events was overweighed by the benefits of vaccination. Parents also saw the school nurse as an important source of HPV information.

    Conclusions: Positive attitudes toward HPV vaccination despite limited knowledge about HPV, are overarching themes in this thesis. School nurses have a crucial role to inform about HPV prevention. It is important that the concerned parties are adequately informed about HPV and its preventive methods, so that they can make an informed decision about vaccination. A short school-based intervention can increase knowledge about HPV among students. From a public health perspective, high vaccination coverage is important as it can lead to a reduced number of HPV-related disease cases. 

    List of papers
    1. High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students
    Open this publication in new window or tab >>High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students
    2009 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 14, no 6, p. 399-405Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate knowledge of human papillomavirus (HPV) and attitudes to HPV vaccination and condom use among Swedish first year upper secondary school students. METHODS: Classroom questionnaire filled in by 608 students from a strategic sample of seven upper secondary schools in Sweden. RESULTS: Only 13.5% (n = 82) of the students had heard about HPV and 6% (n = 35) were aware of HPV vaccination. As many as 84% (n = 508) would like to be vaccinated against HPV. The high cost of vaccination was the greatest obstacle (total group 37%, n = 227); among girls the second major hindrance was the fear of needles (19%, n = 65). Before considering an HPV vaccination 73% (n = 443) wanted more information and 36% (n = 220) would like to receive such information from the school nurse. The students considered it less likely that they would use a condom when having intercourse with a new partner if they were vaccinated than if they were not (p < 0.001). CONCLUSION: Despite intensive marketing directed at potential vaccine consumers, knowledge of HPV and of HPV vaccines was very low among first year upper secondary school students. Their attitude towards vaccination was positive but most of them wanted more information before considering vaccination.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-111802 (URN)10.3109/13625180903229605 (DOI)000277147900004 ()19929642 (PubMedID)
    Available from: 2009-12-22 Created: 2009-12-22 Last updated: 2017-12-12Bibliographically approved
    2. Knowledge of human papillomavirus among high school students can be increased by an educational intervention
    Open this publication in new window or tab >>Knowledge of human papillomavirus among high school students can be increased by an educational intervention
    2010 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 21, no 8, p. 558-562Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate the effect of an educational intervention concerning human papillomavirus (HPV) directed at Swedish first year high school students. The intervention consisted of a class room lesson, a website and a folder. Outcome variables were knowledge of HPV and attitudes to preventive methods such as HPV vaccination, condom use and Pap smear testing. An intervention group (n = 92) was matched with two comparison groups (n = 184). At baseline, the median score for HPV knowledge was one out of 10 in both groups. At follow-up, the median knowledge score had increased to six in the intervention group, but was still one in the comparison group (P < 0.001). Attitudes to HPV vaccination, condom use and Pap smear testing remained the same (P > 0.05). In conclusion, a short school-based intervention can greatly increase the students' knowledge about HPV, but attitudes and behaviours are less easy to influence.

    Keywords
    hpv, knowledge, adolescent, intervention, HPV vaccine, prevention, condom
    National Category
    Dermatology and Venereal Diseases
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-132897 (URN)10.1258/ijsa.2010.010063 (DOI)000284445200006 ()20975088 (PubMedID)
    Projects
    HPV projekt
    Available from: 2010-10-28 Created: 2010-10-28 Last updated: 2017-12-12Bibliographically approved
    3. Challenges and opportunities of a new HPV immunization program: Perceptions among swedish school nurses
    Open this publication in new window or tab >>Challenges and opportunities of a new HPV immunization program: Perceptions among swedish school nurses
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    2011 (English)In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 29, p. 4576-4583Article in journal (Refereed) Published
    Abstract [en]

    Aim To investigate school nurses’ perceptions of HPV immunization, and their task of administering the vaccine in a planned school-based program in Sweden. Method: Data were collected through five focus group interviews with school nurses (n = 30). The interviews were recorded, transcribed verbatim and analyzed using content analysis.

    Findings The theme Positive attitude to HPV immunization despite many identified problems and challenges summarizes the results. The school nurses saw the program as a benefit in that the free school-based HPV immunization program could balance out social inequalities. However, they questioned whether this new immunization program should be given priority given their already tight schedule. Some also expressed doubts regarding the effect of the vaccine. It was seen as challenging to obtain informed consent as well as to provide information regarding the vaccine. The nurses were unsure of whether boys and their parents should also be informed about the immunization.

    Conclusion Although some positive aspects of the new HPV immunization program were mentioned, the school nurses primarily identified problems and challenges; e.g. regarding priority setting, informed consent, culture and gender. In order to achieve a good work environment for the school nurses, and obtain a high coverage rate for the HPV immunization, these issues need to be taken seriously, be discussed and acted upon.

    Keywords
    HPV, Vaccination, School nurses, Focus groups, Dilemmas, Gender
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-153525 (URN)10.1016/j.vaccine.2011.04.054 (DOI)000292471700006 ()
    Available from: 2011-05-14 Created: 2011-05-14 Last updated: 2018-05-16Bibliographically approved
    4. Informed Consent for HPV Vaccination: A Relational Approach
    Open this publication in new window or tab >>Informed Consent for HPV Vaccination: A Relational Approach
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    2015 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 23, no 1, p. 50-62Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent's choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.

    National Category
    Medical Ethics
    Research subject
    Medical Science
    Identifiers
    urn:nbn:se:uu:diva-212366 (URN)10.1007/s10728-012-0237-9 (DOI)000348414900004 ()23275146 (PubMedID)
    Available from: 2013-12-16 Created: 2013-12-09 Last updated: 2017-12-06Bibliographically approved
    5. Trust versus concerns: how parents reason when they accept HPV vaccination for their young daughter
    Open this publication in new window or tab >>Trust versus concerns: how parents reason when they accept HPV vaccination for their young daughter
    Show others...
    2013 (English)