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  • 201.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Smedby, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjukvårdskonsumtion och sociala faktorer hos patienter som sökt distriktsläkare för icke-ulcus dyspepsi (stencil)1983Report (Other academic)
  • 202.
    Hammar, Lena Marmstal
    et al.
    Malardalens Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden.;Dalarna Univ, Sch Educ Hlth & Soc, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden..
    Holmström, Inger K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalens Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Skoglund, Karin
    Malardalens Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Meranius, Martina Summer
    Malardalens Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden..
    Sundler, Annelle J.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, SE-50190 Boras, Sweden..
    The care of and communication with older people from the perspective of student nurses. A mixed method study2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 52, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background: Undergraduate nurse education needs to prepare student nurses to meet the demands and to have the necessary communication skills for caring for an increasing older population. The challenges involve how best to support and empower student nurses to learn the communication skills needed to care for older people. Objective: The aim of this study was to investigate student nurses' views on the care of and communication with older people. Design: A descriptive study with a mixed-method approach was conducted. Methods: Quantitative and qualitative data were collected from a questionnaire completed by third-year Swedish student nurses in 2015. Results: The student nurses reported positive attitudes to the care of and communication with older people. The findings focus on the central aspects related to relationship building, techniques for communication and external prerequisites. Conclusions: Despite positive attitudes, student nurses had a limited view of communication with older people. Educators need to increase student nurses' capacity to communicate effectively with older people. Educational interventions to improve and evaluate the communication competency of nurses and student nurses are needed.

  • 203.
    Hanning, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Maximum Waiting-time Guarantee - a remedy to long waiting lists?: Assessment of the Swedish Waiting-time Guarantee Policy 1992-19962005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Lengthy waiting times have been a problem in Swedish health services for many years. In 1992, Sweden implemented a national maximum waiting-time guarantee (MWG) through an agreement between the Swedish Government and the Federation of Swedish County Councils. The “guarantee” assured patients that the waiting time between the decision-to-treat and the treatment itself would not exceed three months. The national MWG covered twelve different treatments/interventions and remained in force for five years. This dissertation describes the genesis of the MWG, its implementation, and its effects.

    Four papers serve as a foundation for the dissertation. Paper I describes how the guarantee was implemented during the first two years. Paper II studies the impact that the MWG had on cataract surgery. Paper III uses the results of two questionnaire surveys of department heads to explain why the MWG, although successfully launched, became increasingly difficult to maintain. Paper IV analyses data from the national cataract register to determine how production and waiting times in cataract surgery were affected by termination of the MWG.

    This dissertation confirms that waiting time for health care is a complex phenomenon resulting from multiple causes. “Guarantees” are of particular interest because they define what constitutes too long in reference to waiting times. Beyond that, they are only a framework for developing a plan of action. The positive effects of the MWG were transient and based on rationalisation, introduction of new technology, and stricter prioritisation. The MWG contributed towards empowering patients and slowing the expansion of treatment indications, but it was unsuccessful in levelling out the wide regional variations in surgical rates.

    List of papers
    1. Maximum Waiting-time Guarantee - an attempt to reduce waiting lists in Sweden
    Open this publication in new window or tab >>Maximum Waiting-time Guarantee - an attempt to reduce waiting lists in Sweden
    1996 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 36, no 1, p. 17-35Article in journal (Refereed) Published
    Abstract [en]

    In Sweden, as in most countries with publicly financed health services, long waiting lists for some surgical procedures have been a serious quality problem on the health policy agenda. To reduce waiting lists, the Swedish Government and the Federation of County Councils, agreed on an initiative to offer a maximum waiting-time guarantee for 12 procedures during 1992. Patients awaiting procedures are guaranteed a waiting time no longer than 3 months from the physician's decision to treat/operate. The initial agreement was to be in force for 1 year, and a grant of 500 million SEK (USD 70 million) was appropriated for the initiative. The guarantee has been prolonged by annual decisions to be in force 1993 through 1995. However, no extra resources were set aside for these years. This article describes the background and the introduction of the guarantee, and discusses some of the major results during the first 2 years. Generally, waiting lists decreased substantially during 1991 and 1992. By the end of 1992 only a few departments were unable to serve patients within 3 months. During 1993 the reduction in the waiting lists ceased, and waiting lists for some procedures showed a tendency to increase by the end of the year. The overall successful result, in terms of waiting lists and waiting times, seems to have been achieved mainly by increased production, improved administration of the waiting lists, and a change in attitudes toward waiting lists. The expectation that the guarantee would lead to a more even use of resources across the country has not been realised since it appears that hospital departments chose to expand their own activities rather than use the new opportunity offered by the guarantee to refer patients to other hospitals.

    Keywords
    Waiting lists, Healthcare reform, Follow-up, Evaluation, Quality, Sweden
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-93077 (URN)10.1016/0168-8510(95)00791-1 (DOI)10172629 (PubMedID)
    Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2017-12-14Bibliographically approved
    2. Assessment of the Maximum Waiting time Guarantee for Cataract Surgery: The Case of a Swedish Policy
    Open this publication in new window or tab >>Assessment of the Maximum Waiting time Guarantee for Cataract Surgery: The Case of a Swedish Policy
    1998 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 14, no 1, p. 180-193Article in journal (Refereed) Published
    Abstract [en]

    Cataract is the most common reason for visual problems in old age. The introduction of intraocular lens (IOL) implantation revolutionized cataract surgery. Since the IOL technique was established in Sweden in the early 1980s, the demand for surgery has been increasing, leading to lengthy waiting lists. To shorten some of the most troublesome waiting lists, national and local governments (county councils) in Sweden introduced a maximum waiting time guarantee in 1992. The assessment of the guarantee made in this article shows that ophthalmic surgery units vary in their adoption of the guarantee, leading to different levels of goal achievement in waiting times for their patients. The less successful units could be divided into two groups: one where the units have a low operation rate, and one where the units chose not to follow the recommendations in priority setting made in the guarantee.

    Place, publisher, year, edition, pages
    Cambridge U.P., 1998
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-93078 (URN)9509805 (PubMedID)
    Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2017-12-14Bibliographically approved
    3. Maximum waiting time - a threat to clinical freedom?: Implementation of a policy to reduce waiting times
    Open this publication in new window or tab >>Maximum waiting time - a threat to clinical freedom?: Implementation of a policy to reduce waiting times
    2000 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 52, no 1, p. 15-32Article in journal (Refereed) Published
    Abstract [en]

    This article focuses on physicians as implementers of health policy reforms. In 1992, a maximum waiting-time guarantee was introduced in Sweden. Initially the policy was a successful way to come to terms with long waiting times. However, after 2 years the waiting lists started to increase. To understand this development it is important to look at the reactions to the policy among the implementers, i.e. the physicians. Three questions are addressed: Did the implementers understand the intentions and the goals of the reform? Were they able to fulfil the guarantee? And, did they approve of the initiative? The study subjects were chief physicians at the hospital departments involved with the guarantee. Their attitudes towards the policy were ascertained by two surveys. Other material, such as statistics on waiting times, was also used. The study shows that the physicians approved of the guarantee initially. The measures taken in the first years were effective and did not conflict with earlier practice. However, increased demand in combination with economic restraints necessitated new priorities among patient groups. These changes of clinical practice did not coincide with the physicians’ professional values and hence they became more critical to the initiative and finally chose to abandon the intentions in the guarantee.

    Keywords
    Waiting lists, Health care reform, Implementation of health policy, Evaluation, Sweden
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-93079 (URN)10.1016/S0168-8510(00)00060-9 (DOI)10899642 (PubMedID)
    Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2017-12-14Bibliographically approved
    4. Waiting fo Cataract Surgery - Effects of Maximum Waiting-time Guarantee policy
    Open this publication in new window or tab >>Waiting fo Cataract Surgery - Effects of Maximum Waiting-time Guarantee policy
    2007 (English)In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 12, no 1, p. 5-10Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate the effects of the Maximum Waiting-time Guarantee (MWG) policy for cataract surgery on volume, indications, waiting times and priority setting in Sweden. Methods: Comparison between 1993 and 1994, when the guarantee had been in force for one year, and 1998 and 1999, when the policy had been terminated for one year. Data from the National Cataract Registry covering 156,657 cataract operations for the years studied. Results: The number of operations increased by 43% between the two study periods. Of this increase, 61% were patients with a visual acuity above 0.5 in the better eye, i.e. low-priority patients. Waiting times were longer for all patient categories in the later period and differences in waiting times between patients with differing priority diminished. Variations among the units in priority setting and waiting times were substantial, and increased after the Guarantee was terminated.

    Conclusions: The Guarantee with its explicit indications was an effective policy instrument to limit waiting times and improve access for patients with the greatest need. It is unlikely that the Guarantee caused any 'crowding out' of other patient groups. When the Guarantee was not in force, indications for surgery widened. This, however, resulted in longer waiting times for all patient groups. After the Guarantee was terminated, the already substantial differences in access and indications among ophthalmic units became even greater.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-93080 (URN)10.1258/135581907779497503 (DOI)
    Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2017-12-14Bibliographically approved
  • 204.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Lundström, Mats
    Waiting fo Cataract Surgery - Effects of Maximum Waiting-time Guarantee policy2007In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 12, no 1, p. 5-10Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of the Maximum Waiting-time Guarantee (MWG) policy for cataract surgery on volume, indications, waiting times and priority setting in Sweden. Methods: Comparison between 1993 and 1994, when the guarantee had been in force for one year, and 1998 and 1999, when the policy had been terminated for one year. Data from the National Cataract Registry covering 156,657 cataract operations for the years studied. Results: The number of operations increased by 43% between the two study periods. Of this increase, 61% were patients with a visual acuity above 0.5 in the better eye, i.e. low-priority patients. Waiting times were longer for all patient categories in the later period and differences in waiting times between patients with differing priority diminished. Variations among the units in priority setting and waiting times were substantial, and increased after the Guarantee was terminated.

    Conclusions: The Guarantee with its explicit indications was an effective policy instrument to limit waiting times and improve access for patients with the greatest need. It is unlikely that the Guarantee caused any 'crowding out' of other patient groups. When the Guarantee was not in force, indications for surgery widened. This, however, resulted in longer waiting times for all patient groups. After the Guarantee was terminated, the already substantial differences in access and indications among ophthalmic units became even greater.

  • 205.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Köer och väntetider i sjukvården : det politiska perspektivet : intervjustudie med sjukvårdspolitiker i den södra sjukvårdsregionen våren 1997.1997Book (Other academic)
    Abstract [sv]

    Denna studie ingår i ett projekt där Landstingsförbundet, Samverkansnämndens kansli och sjukvårdshuvudmännen i den södra sjukvårdsregionen samarbetar för att ta fram ett förslag till uppföljningsmodell vad gäller köer och väntetider i sjukvården. Syftet med denna studie var att studera den landstingspolitiska nivåns uppfattning och upplevelse av köer och väntetider. I studien intervjuades sammanlagt 12 ledamöter i Södra samverkansnämnden. Intervjustudien visar att tillgänglighetsfrågor är mycket centrala i den lokala politiska debatten om sjukvården. Det var en allmän uppfattning att det inte enbart rör sig om resursbrist utan att det är fråga om komplicerade samband mellan många olika faktorer.

  • 206.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Maximum waiting time - a threat to clinical freedom?: Implementation of a policy to reduce waiting times2000In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 52, no 1, p. 15-32Article in journal (Refereed)
    Abstract [en]

    This article focuses on physicians as implementers of health policy reforms. In 1992, a maximum waiting-time guarantee was introduced in Sweden. Initially the policy was a successful way to come to terms with long waiting times. However, after 2 years the waiting lists started to increase. To understand this development it is important to look at the reactions to the policy among the implementers, i.e. the physicians. Three questions are addressed: Did the implementers understand the intentions and the goals of the reform? Were they able to fulfil the guarantee? And, did they approve of the initiative? The study subjects were chief physicians at the hospital departments involved with the guarantee. Their attitudes towards the policy were ascertained by two surveys. Other material, such as statistics on waiting times, was also used. The study shows that the physicians approved of the guarantee initially. The measures taken in the first years were effective and did not conflict with earlier practice. However, increased demand in combination with economic restraints necessitated new priorities among patient groups. These changes of clinical practice did not coincide with the physicians’ professional values and hence they became more critical to the initiative and finally chose to abandon the intentions in the guarantee.

  • 207.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Tillgänglighet och valfrihet1995In: Sjukvården i Sverige: 1995, En rapport om förhållanden inom hälso- och sjukvården, Stockholm: Socialstyrelsen , 1995, Vol. 25Chapter in book (Other academic)
  • 208.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vårdgarantins betydelse och effekter: en enkät till kliniker och sjukhus1994Report (Other (popular science, discussion, etc.))
  • 209.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winbland, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Enkäter till klinik- och sjukhusledningar angående vårdgarantins betydelse och effekter - våren 1995.1995Report (Other academic)
  • 210.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Åhs, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad Spångberg, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Lundström, Mats
    Eyenet, Sweden.
    Gränslös vård: en studie av patientrörlighet inom gråstarrskirurgi2010In: Svenska läkaresällskapets handlingar 2010, 2010Conference paper (Other academic)
  • 211.
    Hanning, Marianne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Åhs, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Lundström, Mats
    Impact of increased patient choice of providers in Sweden: cataract surgery2012In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 17, no 2, p. 101-105Article in journal (Refereed)
    Abstract [en]

    Objectives Choice of provider was introduced in Sweden in 2001. Our aim was to describe the scope and character of patient flows and to analyze any differences between patients who chose to move outside of their home county (movers) and those who did not (non-movers) with regard to age, sex, waiting time and level of need.

    Methods Use of cataract operations between 2005 and 2008 based on data from the National Cataract Register. Data were analysed using descriptive statistics, odds ratios and multivariate regression analysis to compare movers and non-movers. Information on contracting between county councils and providers in other counties was obtained from a survey.

    Results Only 4% of cataract patients were treated by a provider outside their home county. Patient flows were mainly determined by contracts between county councils and providers, and only 1% were considered to be 'true' movers (i.e. patients who were not part of any special contracting agreement). Movers differed from non-movers in that they were on average younger, had less serious visual problems and had shorter waiting times.

    Conclusion Though patient flows are minor in scope, the possibility of changing provider has probably been important in tackling long waits in some counties. However, the reform may threaten the equity of health care use.

  • 212. Hansson, Annika
    et al.
    Johansson, Ing-Marie
    Kjellgren, Karin
    Mohlin, Birgitta
    Nilsson, J. Lars G.
    Norrby, Ragnar
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wendel, Ann
    Förbättrad läkemedelsanvändning genom bättre följsamhet till läkemedelsordinationen: förslag till gemensamma mål för läkare, sjuksköterskor och farmaceuter1999Book (Other academic)
  • 213.
    Hedman, Nils Olof
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Johansson, Roine
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Clustering and inertia: structural integration of home care in Swedish elderly care2007In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 7, p. e32-Article in journal (Refereed)
    Abstract [en]

    PurposeTo study the design and distribution of different organizational solutions regarding the responsibility for and provision of home care for elderly in Swedish municipalities.MethodDirectors of the social welfare services in all Swedish municipalities received a questionnaire about old-age care organization, especially home care services and related activities. Rate of response was 73% (211/289).ResultsThree different organizational models of home care were identified. The models represented different degrees of integration of home care, i.e. health and social aspects of home care were to varying degrees integrated in the same organization. The county councils (i.e. large sub-national political-administrative units) tended to contain clusters of municipalities (smaller sub-national units) with the same organizational characteristics. Thus, municipalities' home care organization followed a county council pattern. In spite of a general tendency for Swedish municipalities to reorganize their activities, only 1% of them had changed their home care services organization in relation to the county council since the reform.ConclusionThe decentralist intention of the reform—to give actors at the sub-national levels freedom to integrate home care according to varying local circumstances—has resulted in a sub-national inter-organizational network structure at the county council, rather than municipal, level, which is highly inert and difficult to change.

  • 214.
    Hellerstedt-Börjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Oncology.
    Holmström-Knutsson, Iinger
    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, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Women with breast cancer: Experiences and impact of chemotherapy-induced pain on daily life2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no S2, p. S108-S108Article in journal (Other academic)
  • 215.
    Hellerstedt-Börjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine oncology.
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Women Treated for Breast Cancer, Experiences of Chemotherapy-Induced Pain:: Memories, Any Present Pain and Future reflections2016In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 39, no 6, p. 464-472Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP).

    OBJECTIVE: The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors.

    METHODS: Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection.

    RESULTS: A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence.

    CONCLUSIONS: Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy.

    IMPLICATIONS FOR PRACTICE: Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.

  • 216.
    Hellerstedt-Börjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Women With Breast Cancer: Experience of Chemotherapy-Induced Pain: Triangulation of Methods2015In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 38, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Chemotherapy treatment for cancer diseases can cause body pain during adjuvant therapy.

    OBJECTIVE

    The aim was to describe the perceived impact of adjuvant chemotherapy-induced pain (CHIP) on the daily lives of women with newly diagnosed breast cancer, using triangulation.

    METHOD

    Fifty-seven women scheduled for chemotherapy in doses of 75 mg/m2 or greater of epirubicin and/or docetaxel participated. Twenty-two of these women registered pain with values of 4 or more on the visual analog scale on day 10 following chemotherapy. Of these 22, 16 participated in an interview and colored a printed body image. A qualitative thematic stepwise analysis of the interviews was performed.

    RESULTS

    Chemotherapy-induced pain had a profound impact on daily life. Ten women reported the worst possible pain, with visual analog scale scores of 8 to 10. Three different categories crystallized: perception (A) of manageable pain, which allowed the women to maintain their daily lives; perception (B) of pain beyond imagination, whereby the impact of pain had become more complex; and perception (C) of crippling pain, challenging the women's confidence in survival.

    CONCLUSIONS

    The findings highlight the inability to capture CHIP with 1 method only; it is thus necessary to use complimentary methods to capture pain. We found that pain had a considerable impact on daily life, with surprisingly high scores of perceived pain, findings that to date have been poorly investigated qualitatively.

    IMPLICATIONS FOR PRACTICE

    Nurses need to (1) better identify, understand and treat CHIP, using instruments and protocols; and (2) provide improved communication about pain and pain management.

  • 217.
    Henriksen, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Contradictions in elderly care: a descriptive study of politicians' and managers' understanding of elderly care2003In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 11, no 1, p. 27-35Article in journal (Refereed)
    Abstract [en]

    The care of older people in Sweden has undergone several major reorganisations during the past decade. The healthcare organisation, governed by the county councils, previously had the responsibility of providing care services for elderly people. However, the local municipalities have taken over that duty since 1992. The obligation of the health services is now restricted solely to medical issues. The present study focused on the understanding that politicians and managers have about caring for older people. A section of Stockholm with a population of 320 000 inhabitants was studied. The authors hypothesised that differences in understanding might have an impact on the services of care which older people receive. Interviews were conducted with eight leading politicians and 12 managers responsible for elderly care services. The main focus of inquiry concerned the participants' understanding of caring for older people. The results indicate that politicians and managers in elderly care sometimes have divergent views on how the care should be developed and produced to best serve older people. Five themes of understanding elderly care services and eight contradictory statements among the respondents were identified. A follow-up group session with the respondents was conducted to discuss the results of the interviews. The different ways of understanding elderly care services showed a complex and fragmented organisation lacking clear goals, structures and leadership. However, the authors found a willingness among respondents to collaborate with one another, as well as indications of positive attitudes toward improving healthcare, domiciliary and nursing care of older people.

  • 218.
    Henriksen, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Understanding and practice: a 7-year follow-up study on implementation of a cardiac rehabilitation program2002In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 12, no 5, p. 671-684Article in journal (Refereed)
    Abstract [en]

    The authors explore the perspectives of managers, health care professionals, and patients on a comprehensive cardiac rehabilitation program. Using qualitative methodology, they compare and analyze results from individual interviews and two conceptual modeling seminars held 7 years apart. Professionals and managers understood their own tasks in a professional-centered way that did not include the client’s perspective. Patients believed they were not seen in their whole context. Initially, health care organization was fragmented, lacking clear leadership, coordination, and communication between levels of care. However, lack of common understandings of structure, process, and outcome in cardiac rehabilitation services hampered the implementation of program changes.

  • 219.
    Henriksen, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Understanding cardiac follow-up services—a qualitative study of patients, healthcare professionals, and managers2003In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 2, no 2, p. 95-104Article in journal (Refereed)
    Abstract [en]

    The study explores the experience and understanding of stakeholders involved in follow-up services after a cardiovascular event. A multimethod approach was used consisting of questionnaires, telephone surveys, and in-depth, face-to-face interviews. Five themes were identified: patients wished to be seen in their total context, patients should do as told; healthcare professionals perform check-ups and control cardiac risk factors; healthcare professionals are in charge of the care processes; and the structure and processes of the healthcare organization. Results indicate that healthcare professionals have considerable difficulty in understanding the patient's situation and to collaborate between different levels of care. Furthermore, the total healthcare organization lacked comprehensive and practical structures in the follow-up process, rehabilitation, and secondary preventive services.

  • 220.
    Henriksen, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Selander, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Can we bridge the gap between goals and practice through a common vision?: a study of politicians and managers’ understanding of the provisions of elderly care services2003In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 65, no 2, p. 129-137Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were healthcare politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the healthcare of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.

  • 221.
    Henriksson, Dorcus Kiwanuka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Stockholm, Sweden.
    Ayebare, Florence
    Makerere Univ, Sch Publ Hlth, Coll Hlth Sci, Kampala, Uganda..
    Waiswa, Peter
    Karolinska Inst, Stockholm, Sweden.;Makerere Univ, Sch Publ Hlth, Coll Hlth Sci, Kampala, Uganda..
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Makerere Univ, Sch Publ Hlth, Coll Hlth Sci, Kampala, Uganda..
    Tumushabe, Elly K.
    Mukono Dist Local Govt, Mukono, Uganda..
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Enablers and barriers to evidence based planning in the district health system in Uganda; perceptions of district health managers2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, article id 103Article in journal (Refereed)
    Abstract [en]

    Background: The District Health System was endorsed as the key strategy to achieve 'Health for all' during the WHO organized inter-regional meeting in Harare in 1987. Many expectations were put upon the district health system, including planning. Although planning should be evidence based to prioritize activities, in Uganda it has been described as occurring more by chance than by choice. The role of planning is entrusted to the district health managers with support from the Ministry of Health and other stakeholders, but there is limited knowledge on the district health manager's capacity to carry out evidence-based planning. The aim of this study was to determine the barriers and enablers to evidence-based planning at the district level.

    Methods: This qualitative study collected data through key informant interviews with district managers from two purposefully selected districts in Uganda that have been implementing evidence-based planning. A deductive process of thematic analysis was used to classify responses within themes.

    Results: There were considerable differences between the districts in regard to the barriers and enablers for evidence-based planning. Variations could be attributed to specific contextual and environmental differences such as human resource levels, date of establishment of the district, funding and the sociopolitical environment. The perceived lack of local decision space coupled with the perception that the politicians had all the power while having limited knowledge on evidence-based planning was considered an important barrier.

    Conclusion: There is a need to review the mandate of the district managers to make decisions in the planning process and the range of decision space available within the district health system. Given the important role elected officials play in a decentralized system a concerted effort should be made to increase their knowledge on evidence-based planning and the district health system as a whole.

  • 222.
    Henriksson, Dorcus Kiwanuka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Waiswa, Peter
    Karolinska Institutet, Sweden; Makerere University College of Health Sciences, Uganda.
    Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Swartling Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
    Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1327256Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Poor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system.

    METHODS: A modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study.

    RESULTS: Effective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent.

    CONCLUSION: The modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified.

  • 223.
    Henriksson, Dorcus Kiwanuka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Karolinska Institutet, Stockholm, Sweden .
    Swartling Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. United Nations Children’s Fund, New York, U.S.A.; Karolinska Institutet, Stockholm, Sweden.
    Waiswa, Peter
    Makerere University College of Health Sciences, Kampala; Karolinska Institutet, Stockholm, Sweden.
    Fredriksson, Mio
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Decision making in district health planning in Uganda: Does use of local evidence matter?2019In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 17, article id 57Article in journal (Refereed)
    Abstract [en]

    Introduction

    In a decentralized health system, district health managers are tasked with planning for health service delivery which should be evidence-based. However, planning in low-income countries such as Uganda, has been described as ad hoc. A systematic approach to the planning process using district-specific evidence was introduced to district health managers in Uganda. However, little is known about how the use of district-specific evidence does inform the planning process. In this study we further investigate how the use of this evidence affects the annual planning process.

    Methodology

    The study was conducted in two districts that were introduced to the systematic approach of using district-specific evidence in the planning process. District annual health work plans for financial years 2012/13; 2013/14; 2014/15 and 2015/16 and bottleneck analysis reports for 2012, 2013, 2014 and 2015 were reviewed. Semi-structured interviews with key informants from the districts were also conducted.

    Results

    District managers reported that they were able to produce more robust district annual work plans when they used district-specific evidence. About half of the priority activities that were identified using district-specific evidence were included in the annual work plans. Procurement and logistics, training and support supervision activities were the most prioritized. Use of local evidence was viewed positively by the health managers. However, there was a lack of clarity on what activities should be incorporated in the annual work plans and district managers considered the lack of autonomy or decision space as a constraint to the use of district-specific evidence.

    Conclusion

    District-specific evidence and a structured process for its use to prioritize activities and make decisions in the planning process at the district level helped systematize the planning process. Health managers were able to articulate and advocate for priorities related to child survival. However, the reported limited decision and fiscal space, human resource gaps, inadequate funding and high dependency on donor funding did not always allow for use of district-specific evidence in the planning process. 

  • 224. Herner, B
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Ysander, L
    Sudden illness as a cause of motor-vehicle accidents1966In: British journal of industrial medicine, ISSN 0007-1072, Vol. 23, no 1, p. 37-41Article in journal (Refereed)
  • 225. Herner, B
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Ysander, L
    [Traffic accidents caused by attacks of acute illness]1965In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 62, p. 438-48Article in journal (Refereed)
  • 226.
    Hjelmblink, Finn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Bernsten, Cecilia B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Uvhagen, Håkan
    Kunkel, Stefan
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Understanding the meaning of rehabilitation to an aphasic patient through phenomenological analysis - a case study 2007In: International Journal of Qualitative Studies on Health and Well-Being, ISSN 1748-2623, Vol. 2, no 2, p. 93-100Article in journal (Refereed)
    Abstract [en]

    Stroke patients with aphasia commonly suffer from distress related to their language deficit. They are often unable to express what they experience during their rehabilitation. Hence, the aim of this study was to reveal the meaning of rehabilitation to an aphasic person. With an approach based on the philosophy of Husserl and Merleau-Ponty, two open-ended interviews were analysed through the Empirical Phenomenological Psychological (EPP) method. The essential structure of the meaning of rehabilitation to the informant was that he lived as being responsible in a dichotomised situation. The informant had to adapt his behaviour, thereby destroying his chances of normal interactions; he was supposed to train in a goal-oriented way and believe in recuperation, but at the same time, he had to prepare himself and his next of kin for a failure. The defined impairment of aphasia misled both the informant and health care professionals to focus only language therapy, hence leaving the informant unsupported in other important aspects of the rehabilitation.

  • 227.
    Hjelmblink, Finn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    To cope with uncertainty: stroke patients' use of temporal models in narratives2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, p. 367-374Article in journal (Refereed)
    Abstract [en]

    Stroke victims have to cope with a disrupted autobiography and anxiety because of an uncertain future. Professionals share this uncertainty. The patients reveal their experiences in narratives, and when they try to regain coherence and confidence in life, they use narratives in the reconstructions. Because they have a temporal problem, time might be an important issue in these narratives. The aim of this study was to elucidate the use of time models in stroke patients' narratives. Nineteen stroke patients, who had recently been discharged to their homes after the stroke, accepted to participate in the study. Their age span was between 56 and 89 years. They had lived active urban lives before the stroke, and poststroke only three had more serious physical impairment, and none was demented. They were asked to talk about their present life and their conceptions of future life. The interviews were audio-taped and transcribed verbatim and narratives that referred to temporal aspects were thematically analysed with reference to narrative time models. The stroke accident had caused an autobiographical disruption and a temporal split because of a new awareness of human temporality and an uncertainty of the future. Confronted with these problems of time, the stroke victims constructed narratives based on the time models: time cycles and dissolution of time limits, exchange of time and exclusion from time. Hence, the time models worked as tools when the stroke victims re-established coherence in their present and future life. Stroke patients handled an uncertain future by using temporal models in their narratives. Professionals can support stroke patients by reinforcing these models.

  • 228.
    Hjelmblink, Finn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Kjeldmand, Dorte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Stroke patients' delay of emergency treatment2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 307-311Article in journal (Refereed)
    Abstract [en]

    Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.

  • 229.
    Hjelmblink, Finn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sanner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    The meaning of rehabilitation for older people who have survived stroke2009In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, no 2, p. 186-195Article in journal (Refereed)
    Abstract [en]

    Aim. To explore the meaning of rehabilitation to older, Swedish stroke survivors, from the time of the acute stroke to the end of the rehabilitation.

    Background. Many people who are stroke survivors do not resume social activities even though they have regained physical functions. However, the contents of stroke rehabilitation seems to depend on whether rehabilitation is understood from the disease perspective or the illness perspective contained in the International Classification of Functioning, Disability and Health. This in turn may determine the kind of rehabilitation offered to survivors.

    Design. Inductive, qualitative interview study undertaken during 2003.

    Method. Nineteen Swedish stroke survivors were interviewed twice, and the interviews were analysed using a Grounded Theory approach.

    Findings. To the older survivors, the meaning of rehabilitation was social reintegration. To achieve this they tried to regain lost physical and cognitive functions, relations (including play activities, everyday narratives and self-esteem) and lost certainty. The survivors needed to regain their ability to be not only to perform social activities. However, their rehabilitation ended when its focus turned to impairments found in the illness experiences of the survivors. The survivors developed their own cognitive and behavioural strategies for overcoming these kinds of obstacles to their social reintegration.

    Conclusion. Older, Swedish stroke survivors strive for a socially integrated life. Unacknowledged impairments experienced from the illness perspective of the survivors and the survivors’ own rehabilitation strategies should therefore be considered in their rehabilitation.

    Relevance to clinical practice. Stroke survivors need support from professionals who can understand and acknowledge the illness perspective of rehabilitation. Professionals should be able to understand how to facilitate the cognitive and behavioural strategies found in survivors’ illness narratives. In order to socially reintegrate, survivors’ rehabilitation should be transferred to the places where they have previously performed play activities together with family and friends.

  • 230. Hjort, P F
    et al.
    Grund, J
    Kamper-Jørgensen, F
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Härö, A S
    Panel discussion: Health services research in the 1980's1984In: Scandinavian journal of social medicine. Supplementum, ISSN 0301-7311, Vol. 34, p. 85-90Article in journal (Refereed)
  • 231.
    Hjorth, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Sjöberg, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Svanberg, Anncarin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Dalarna University, Falun, Sweden.
    Kaminsky, Elenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Langenskiöld, Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Economics.
    Rorsman, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Nurse-led clinic for patients with liver cirrhosis-effects on health-related quality of life: study protocol of a pragmatic multicentre randomised controlled trial.2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e023064Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Liver cirrhosis affects health-related quality of life (HRQoL) even in its early stages. Morbidity is especially high when the disease decompensates and self-care actions become essential. Nurse involvement in secondary prevention in other chronic diseases has contributed to better symptom control, less need of inpatient care and improved HRQoL. In order to evaluate the impact of nurse involvement in the follow-up of patients with liver cirrhosis, we decided to compare structured nurse-led clinics, inspired by Dorothea Orem's nursing theory and motivational strategies, with a group of patients receiving standard care. The primary outcome is HRQoL and the secondary outcomes are quality of care, visits to outpatient clinics or hospitals, disease progress and health literacy.

    METHODS AND ANALYSIS: This is a pragmatic, multicentre randomised controlled study conducted at six Swedish hepatology departments. Eligible patients are adults with diagnosed cirrhosis of the liver (n=500). Participants are randomised into either an intervention with nurse-led follow-up group or into a standard of care group. Recruitment started in November 2016 and is expected to proceed until 2020. Primary outcomes are physical and mental HRQoL measured by RAND-36 at enrolment, after 1 and 2 years.

    ETHICS AND DISSEMINATION: The study is ethically approved by the Regional Ethical Review Board in Uppsala. The results shall be disseminated in international conferences and peer-reviewed articles.

    TRIAL REGISTRATION NUMBER: NCT02957253; Pre-results.

  • 232.
    Hoffstedt, Caroline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Fredriksson, Magnus
    Associate Professor, Department of Journalism, Media and Communication, University of Gothenburg, Gothenburg, Sweden.
    Lenhoff, Håkan
    Värmland County Council, Karlstad, Sweden.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    When do people choose to be informed?: Predictors of information-seeking in the choice of primary care provider in Sweden2018In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134XArticle in journal (Refereed)
    Abstract [en]

    Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals’ demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals’ personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.

  • 233.
    Holmstrom, Inger K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalen Univ, Sch Hlth Care & Social Welf, Box 883, SE-72123 Vasteras, Sweden.
    Kaminsky, Elenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalen Univ, Sch Hlth Care & Social Welf, Box 883, SE-72123 Vasteras, Sweden.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    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, SE-80176 Gavle, Sweden..
    Nursing students' awareness of inequity in healthcare - An intersectional perspective2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 48, p. 134-139Article in journal (Refereed)
    Abstract [en]

    Objective: The overall aim of the present study was to explore awareness of inequity in healthcare and the intersection between different structures of power among nursing students. Another aim was to delineate the knowledge and use of Swedish Healthcare Direct in this group.

    Design: The study had a descriptive design with a quantitative approach.

    Participants: The sample consisted of 157 nursing students from three universities in central Sweden.

    Methods: The students filled out a study specific questionnaire in class. The questionnaire consisted of short descriptions of twelve fictive persons who differed in gender, age, and ethnicity, with questions about their life situation. The mean was calculated for each assessed fictive person for every item. In the next step, the assessments were ranked from the lowest probability to the highest probability. A 'Good life-index' consisting of quality of life, power over own life, and experience of discrimination, was also calculated. Free text comments were analysed qualitatively.

    Results: People with Swedish names were assessed to have the highest probability of having a good life. Among those with Swedish names, the oldest woman was assessed as having the lowest probability of a good life. All students had knowledge about Swedish Healthcare Direct, but more female students had used the service compared to male students.

    Conclusions: The results indicate that the nursing students had awareness of how power and gender, ethnicity and age, are related. Based on the free text comments, the questions and the intersectional perspective seemed to evoke some irritation which points to their sensitive nature. Therefore, the questionnaire could be used as a tool to start a discussion of equity in healthcare and in interventions where the aim is to raise awareness of inequality and intersectionality.

  • 234.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Decision aid software programs in telenursing: not used as intended? Experiences of Swedish telenurses2007In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 9, no 1, p. 23-28Article in journal (Refereed)
    Abstract [en]

    Telenurses at call centers use decision aid software programs to offer triage recommendations and self-care advice to the general public. Decision aid programs are intended to support medical safety but were suggested by telenurses to be a hindrance to the dialogue. The aim of this study was to explore the use of decision aid software programs for telenursing, from the perspective of the users. A qualitative, descriptive approach was used. Twelve telenurses in Sweden were interviewed twice. The interviews were transcribed and analyzed thematically. Four themes were found: support for assessment but not for the decision; inconsistency between actual practice and the decision aid software; limited support for learning and information; and communication challenges and software programs. The software programs were a support for assessment, rather than decision-making, assuring the nurses that the relevant questions were asked. They were not fully adapted to current clinical practice, focusing mainly on acute conditions. Nurses worked to a large extent with self-care advice, often over-riding the recommendations made.

  • 235.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Diabetes Telehealth and Computerized Decision Support Systems: A Sound System with a Human Touch Is Needed2010In: Journal of Diabetes Science and Technology, ISSN 1932-2968, Vol. 4, no 4, p. 1012-1015Article in journal (Refereed)
    Abstract [en]

    Telehealth holds the promise of improved consistency and fast and equal access to care, and will have great impact on future care. To enhance its quality and safety, computerized decision support systems (CDSS) have been launched. This commentary focuses specifically on the impact of telehealth and CDSS on diabetes patient management. Ideally, clinical information should be linked to evidence based recommendations and guidelines in the CDSS to provide tailored recommendations at the moment of care. However, technical support such as CDSS is not enough. The human touch is essential. A named healthcare provider with access to telehealth and CDSS seems to promise a way of providing both patient-centered and evidence-based care.

  • 236.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola.
    Bohlin, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Fröjd, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Swedish men and smoking: Views on screening-detected abdominal aortic aneurysm2019In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 21, no 1, p. 119-125Article in journal (Refereed)
    Abstract [en]

    Abdominal aortic aneurysms (AAA), most common among elderly male smokers, often show no symptoms before rupture. To facilitate better care and counselling targeted to smoking cessation for these patients, more knowledge is required about their views. Therefore, the aim of the present study was to describe the views on AAA and smoking among male smokers with screening‐detected AAA. A qualitative approach with individual interviews with 16 men with screening‐detected AAA was applied. Three had quit smoking by the time of the interviews. Thematic analysis was performed, and four themes emerged: (i) accepting the course of life; (ii) the elusive AAA: a disturbing experiencing or merely a minor inconvenience?; (iii) being in safe hands; and (iv) smoking as an unexpected topic of discussion. Most of the participants felt they were in “safe hands”, although thoughts about death were also evoked. However, the information about smoking cessation was unexpected, and the relationship between AAA and smoking unclear. Presenting the connection between AAA and smoking in a clear manner and motivating smoking cessation in an individually‐targeted way are important.

  • 237.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Dall' Alba, Gloria
    'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 2, p. 142-148Article in journal (Refereed)
    Abstract [en]

    Millions of calls are made to the telephone advisory services in primary health care in Sweden. The patients seem happy with the advice and counselling they receive, but little has been written about nurses' experiences of performing telephone advisory services. Yet, the nurses are expected to be patient, sensitive and have a broad knowledge of medicine, nursing and pedagogy. The aim of this study was to describe how nurses experience the patient encounter when performing telephone advisory services. A strategic sample of five nurses were interviewed and asked to describe how they experienced the central aspects of the patient encounter by telephone. The transcribed interviews were analysed by the Empirical Phenomenological Psychological method. The nurses' experience of the patient encounter when performing telephone advisory services can be characterized in terms of the conflicting demands of being both carer and gatekeeper. The constituents of these conflicting demands were: reading between the lines while pressed for time; educating patients for self-care while fearful of misinterpreting the situation; encountering patients' satisfaction and dissatisfaction. The conflicting demands of being both professional carer and gatekeeper caused stress among the nurses. The organization of the telephone advisory services seems to hinder high-quality care.

  • 238.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Health, Care and Social Welfare, Mälardalen University.
    Gustafsson, Susan
    Wesström, Josefin
    Skoglund, Karin
    Telephone nurses' use of a decision support system:: An observational study2019In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018Article in journal (Refereed)
    Abstract [en]

    Telephone nurses give advice and support and make assessments based on verbal communication only. Web-based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses' use of decision support systems is needed to develop both telephone nursing and decision support systems.

  • 239.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Swedish health care professionals' diverse understandings of diabetes care2003In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 1, p. 53-58Article in journal (Refereed)
    Abstract [en]

    Knowledge of health care professionals’ different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients’ understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals’ understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient’s agreement, and the professionals focus the patient’s understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient’s understanding. Professionals need to develop their understandings of health care and the professional–patient interaction in order to support the patients’ learning.

  • 240.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Höglund, Anna T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Det ansiktslösa mötets etik: Sjuksköterskors erfarenheter av etiska dilemman vid telefonrådgivning.2008In: Telefonrådgivning i hälso- och sjukvård / [ed] Inger Holmström, Lund: Studentlitteratur , 2008, 1.uppl., p. 91-105Chapter in book (Other academic)
  • 241.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Höglund, Anna T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Response to commentary by Sarah Winch on Holmström I & Höglund AT: The faceless encounter: ethical dilemmas in telephone nursing2008Other (Other academic)
  • 242.
    Holmström, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    The faceless encounter: ethical dilemmas in telephone nursing2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 10, p. 1865-1871Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 243.
    Holmström, Inger