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  • 301.
    Kaminsky, Elenor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Röing, Marta
    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.
    "If I didn't trust Swedish Healthcare Direct, I would never call" - views of making pediatric health calls2013In: Clinical Nursing Studies, ISSN 2324-7959, Vol. 1, no 3, p. 57-69Article in journal (Refereed)
    Abstract [en]

    The focus of the presented research is parents' expectations and experiences of calling Swedish Healthcare Direct (SHD)regarding pediatric health issues. Telenursing is a rapidly expanding service and SHD handles up to 2.4 million pediatrichealth calls yearly. Mothers make the majority of the calls and reportedly receive self-care advice more than fathers.Parents' views are important for the development and safe use of telenursing health services. The study is qualitative, withan exploratory and descriptive design. Twenty-one interviews with parents were analysed using content analysis.According to the interviewees, the decision to contact SHD or not is influenced by their degree of worry or trust in the service. Calls are carefully prepared, and who will call is often predetermined and affected by gender. Parents want to be given a chance to speak first in their communication with telenurses. They want to be listened to carefully and to be accorded respect, to have their needs fully explored and to have their concerns relieved. Most parents follow telenurses'recommendations, a few exclusively. Some primarily trust their own intuition. Learning is frequent, implying the publichealth potential of calls, not least for foreign-born callers. Exploring parents' expectations provides insight into parents'worries, potential to increase parents' learning and may develop their trust in telenurses' recommendations. Telenurses'awareness of gender impact can further develop the telenursing health service in providing safe care on equal terms for avulnerable patient group, children.

  • 302.
    Kaminsky, Elenor
    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 K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Röing, Marta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Samproduktion i motvind2016In: Samproduktionens retorik och praktik inom området hälsa och välfärd / [ed] Inger K Holmström, Jonas Stier, Per Tillgren & Gunnel Östlund, Lund: Studentlitteratur AB, 2016, 1:1, p. 83-93Chapter in book (Other academic)
  • 303.
    Kaminsky, Elenor
    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.
    Swedish Healthcare Direct managers' views on gender (in)equity - Applying a conceptual model2019In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 18, article id 114Article in journal (Refereed)
    Abstract [en]

    Background: Although Swedish legislation prescribes equity in healthcare, inequitable healthcare is repeatedly reported in Sweden. Telephone nursing is suggested to promote equitable healthcare, making it just one call away for anyone, at any time, irrespective of distance. However, paediatric health calls reflect that male parents are referred to other health services twice as much as female parents are. Regarding equity in healthcare, telephone nurses have expressed a continuum from Denial and Defence to Openness and Awareness. To make a change, Action is also needed, within organizational frames. The aim here was thus to investigate Swedish Healthcare Direct managers’ views on gender (in)equity in healthcare through the application of a conceptual model, developed based on empirical Swedish Healthcare Direct telephone RN data, as a baseline measure at the service’s national implementation.

    Methods: All Swedish Healthcare Direct managers were interviewed during the period March–May 2012. They were asked how they view equitable healthcare, and how they work to achieve it. A conceptual model for attaining equity in healthcare, including Denial, Defence, Openness, Awareness and Action, was used in a deductive thematic analysis of the interview data.

    Results: The five model concepts – Denial; Defence; Openness; Awareness and Action – were found in a variety of combinations in the manager interviews. Denial and Defence were mentioned to a higher extent than Openness and Awareness. Several informants denied inequity, arguing that the decision support tool prevented this. However, those who primarily expressed Denial and Defence were also open to learning more on the subject. Action was only mentioned twice in the informants’ answers, and then only implicitly.

    Conclusion: Although a majority of the interviewed managers expressed a lack of awareness of (in)equity in healthcare, they also expressed an openness to learning more. While this may reflect a desire to show political correctness, it also points to the need for educational training in order to increase the awareness of (in)equity in healthcare among healthcare managers. Future follow up measurements will reveal if this has happened.

  • 304.
    Kaminsky, Elenor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    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.
    Telenurses' understanding of work: detective or educator?2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 2, p. 382-390Article in journal (Refereed)
    Abstract [en]

    AIM

    This paper is a report of a study to describe the different ways of understanding work among a group of Swedish telenurses.

    BACKGROUND

    Telenursing is an expanding service in many western countries and telenursing work is likely to be understood in a variety of ways. The way in which a person understands work influences how work is performed. Telenursing demands high levels of competence.

    METHOD

    A qualitative interview study was conducted during 2004-2005. Twelve of the 20 telenurses working at a call centre in Sweden were interviewed, five of them twice because of organizational changes. The 17 interviews were analysed using a phenomenographic approach.

    FINDINGS

    Five different categories were identified in the data: (1) Assess, refer and give advice to the caller (2) Support the caller (3) Strengthen the caller (4) Teach the caller and (5) Facilitate the caller's learning. The first category can be seen as a base for telenursing work and was the only category used by some telenurses. The second category has components of traditional caring and the third is a coaching function. The fourth category contains a teaching component, but the fifth is the only category where the caller's learning is in focus. Telenurses who reported the fifth way also included all other ways of understanding work. Hence, this seems to be the most comprehensive way of understanding work.

    CONCLUSION

    The categories together constitute a telenursing 'workmap'. This 'workmap' can be used for reflection to expand telenurses' current understanding of work, and hence promote competence development. Telenurses need to be aware of their role in public health education.

  • 305.
    Kaminsky, Elenor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Röing, Marta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalen University, Västerås, Sweden.
    Björkman, Annica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Högskolan i Gävle, Gävle, 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. Mälardalen University, Västerås, Sweden.
    Telephone nursing in Sweden: A narrative literature review2017In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 19, p. 278-286Article, review/survey (Refereed)
    Abstract [en]

    Telephone nursing services are expanding globally. Swedish Healthcare Direct is the largest healthcare provider in Sweden. This paper provides a comprehensive understanding of telephone nursing, as reflected by research on Swedish national telephone nursing, and discusses the findings in relation to international literature. A descriptive, mixed-studies literature review was conducted. Twenty-four articles from January 2003 to April 2015 were identified from PubMed, Scopus, and CINAHL, and included. The issues explored in this study are how telephone nursing is perceived by callers, telephone nurses, and managers, and what characterizes such calls. Callers value reassurance, support, respect and satisfaction and involvement in decisions can increase their adherence. The telephone nurses’ perspective focused on problems and ethical dilemmas, communication, the decision support tool, and working tasks. The managers’ perspective focused on nursing work goals and malpractice claims. Concerning call characteristics, authentic calls, incident reports, and threats to patient safety were considered. Telephone nursing seems safe, but gender can play a role in calls. Future research on caller access, equity, and efficiency, healthcare cost-effectiveness, distribution, and patient safety is needed.

  • 306.
    Kandelaki, Ketevan
    et al.
    Karolinska Inst, Dept Publ Hlth Sci Hlth Syst & Policy HSP, Stockholm, Sweden..
    Marrone, Gaetano
    Karolinska Inst, Dept Publ Hlth Sci Hlth Syst & Policy HSP, Stockholm, Sweden..
    Lundborg, Cecilia Stalsby
    Karolinska Inst, Dept Publ Hlth Sci Hlth Syst & Policy HSP, Stockholm, Sweden..
    Schmidt, Ingrid
    Swedish Natl Board Hlth & Welf, Stockholm, Sweden..
    Björkman, Ingeborg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Karolinska Inst, Dept Publ Hlth Sci Hlth Syst & Policy HSP, Stockholm, Sweden..
    Patient-centredness as a quality domain in Swedish healthcare: results from the first national surveys in different Swedish healthcare settings2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009056Article in journal (Refereed)
    Abstract [en]

    Objectives: Patients' perception of the quality and patient-centredness of healthcare has gained increasing interest in the last decade in Sweden, as in other countries. The purpose of the study was to evaluate to what extent patients perceived Swedish healthcare as patient-centred and to explore the satisfaction levels related to gender, education level and to having or not having Swedish as one's mother tongue. Design and settings: This study has a cross-sectional design. Analyses were based on the first national patient surveys in Sweden, conducted between 2009 and 2010. The surveys included responses from 232 518 patients who had been in contact with primary, outpatient, inpatient, or emergency care units. Survey questions related to indicators of patient-centred care and sociodemographic variables were selected for the analysis. The patients' level of satisfaction in the selected indicators was analysed and compared by sociodemographic and background factors. Multivariable logistic regression models were used for analysis. Results: The patients expressed high levels of satisfaction in questions related to the 'Respect' indicator (81-96% satisfied) but lower levels in most of the other indicators of patient-centred care. Only 25-30% of the patients reported they had been told about possible warning signs of their condition or treatment and 58-66% said they had received enough information about their condition. Group differences were detected. The most satisfied patient groups were men, individuals with low levels of education and those with Swedish as their mother tongue. Conclusions: According to these first national patient surveys, achieving patient-centred healthcare for all citizens is a challenge for Swedish healthcare authorities. Future analyses of national patient surveys should show whether national efforts to encourage acceptance of patient-centred approaches and strategies for equal care will give intended results.

  • 307. Kebbon, L
    et al.
    Swartling, P G
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Psychiatric symptoms and psychosocial problems in primary health care as seen by doctors1985In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 3, no 1, p. 23-30Article in journal (Refereed)
    Abstract [en]

    All visits at a primary health care centre in Sweden were studied during four weeks. The frequency of psychiatric symptoms or psychosocial problems noted by the doctors was recorded on a special form in addition to routine registration of diagnoses. Such problems were noted in 553 out of 3 205 visits, corresponding to 17.3%. Considerable variation in registering problems was found between individual physicians and between different categories of doctors. The most common problems were nervousness, anxiety, psychosomatic disorders, and depression. Mental problems were especially common in connection with gastritis, precordial pain, and abdominal pain. There was a difference between the sexes: 20% of the female patients had mental problems registered compared with 14% of the male patients. Psychiatric diagnoses, however, were registered in only 6% of all cases. Of the 553 patients with mental problems, 16% were considered in need of a specialist, 52% could be dealt with at the health centre, and for 32% no special treatment for the mental problems was regarded necessary. One conclusion is that the routine registration of diagnoses at the health centre covers only some of the mental problems and is therefore insufficient in terms of planning psychiatric resources and the training of doctors. Possible reasons for the differences found are discussed.

  • 308. Kebbon, L
    et al.
    Swartling, PG
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Psykisk störning och psykosociala problem hos patienter i primärvården (stencil)1981Report (Other academic)
  • 309.
    Khoddam, Homeira
    et al.
    Iran University of Medical Sciences, Iran.
    Mehrdad, Neda
    Tehran University of Medical Sciences, Iran.
    Peyrovi, Hamid
    Iran University of Medical Sciences, Iran.
    Kitson, Alison
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Schultz, Timothy
    School of Nursing, Faculty of Health Sciences, the University of Adelaide, Australia.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. School of Nursing, University of Adelaide.
    Knowledge translation in health care: a concept analysis2014In: Medical Journal of the Islamic Republic of Iran, ISSN 1016-1430, E-ISSN 2251-6840, Vol. 28, article id 98Article in journal (Refereed)
    Abstract [en]

    Background:

    Although knowledge translation is one of the most widely used concepts in health and medicalliterature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify thecharacteristics of KT. This will assist the theoretical development of it and shape its implementation into thehealth care system

    Methods:

    Walker and Avant’s framework was used to analyze the concept and the related literature publishedbetween 2000 and 2010 was reviewed. A total of 112 papers were analyzed.

    Results:

    Review of the literature showed that "KT is a process" and "implementing refined knowledge into aparticipatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occursuccessfully, KT needssome necessary antecedents like an integrated source of knowledge, a receptive context,and preparedness. The main consequence of successful process is a change in four fields of healthcare, i.e. quali-ty of patient care, professional practice, health system, and community. In addition, this study revealed someempirical referents which are helpful to evaluate the process.

    Conclusion:

    By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, conse-quences and empiricalreferents. Identifying the characteristics of this concept may resolve the existing ambigui-ties in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these find-ings can be used as a knowledge infrastructure fordeveloping the KT-related models, theories, or tools.

  • 310.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Dow, Clare
    Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
    Calabrese, Joseph D
    University College London, United Kingdom.
    Locock, Louise
    Health Experiences Research Group, Dept Primary Care Health Sciences, University of Oxford, United Kingdom; National Institute for Health Research, Biomedical Research Centre, Oxford, United Kingdom.
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Stroke survivors’ experiences of the fundamentals of care: A qualitative analysis2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 3, p. 392-403Article in journal (Refereed)
    Abstract [en]

    Background

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

    Design

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

    Method

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

    Results

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

    Conclusions

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

  • 311.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Development and preliminary testing of a framework to evaluate patients' experiences of the fundamentals of care: a secondary analysis of three stroke survivor narratives.2013In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2013, p. 572437-Article in journal (Refereed)
    Abstract [en]

    Aim. To develop and test a framework describing the interrelationship of three key dimensions (physical, psychosocial, and relational) in the provision of the fundamentals of care to patients. Background. There are few conceptual frameworks to help healthcare staff, particularly nurses, know how to provide direct care around fundamental needs such as eating, drinking, and going to the toilet. Design. Deductive development of a conceptual framework and qualitative analysis of secondary interview data. Method. Framework development followed by a secondary in-depth analysis of primary narrative interview data from three stroke survivors. Results. Using the physical, psychosocial and relational dimensions to develop a conceptual framework, it was possible to identify a number of "archetypes" or scenarios that could explain stroke survivors' positive experiences of their care. Factors contributing to suboptimal care were also identified. Conclusions. This way of thinking about how the fundamentals of care are experienced by patients may help to elucidate the complex processes involved around providing high quality fundamentals of care. This analysis illustrates the multiple dimensions at play. However, more systematic investigation is required with further refining and testing with wider healthcare user groups. The framework has potential to be used as a predictive, evaluative, and explanatory tool.

  • 312.
    Kitson, Alison
    et al.
    School of Nursing, University of Adelaide, Australia; Centre for Evidence based Practice South Australia, School of Nursing, The University of Adelaide, Australia;Green Templeton College, University of Oxford, United Kingdom .
    Muntlin Athlin, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Nursing, University of Adelaide.
    Conroy, Tiffany
    School of Nursing, University of Adelaide, Australia.
    Anything but basic: Nursing’s challenge in meeting patients' fundamental care needs2014In: Journal of Nursing Scholarship, ISSN 1527-6546, E-ISSN 1547-5069, Vol. 46, no 5, p. 331-339Article in journal (Refereed)
    Abstract [en]

    Purpose

    Nursing has not explored the fundamental aspects of patient care in a systematic, conceptually coherent, scientific way, and this has created a number of ongoing challenges.

    Organizing Construct

    Each challenge is identified and addressed in the form of a proposition, with evidence provided to support the arguments put forward and defend the proposed actions.

    Findings

    The challenges include: the need for an integrated way of thinking about the fundamentals of care from a conceptual, methodological, and practical perspective; the ongoing and unresolved tension in nursing practice between a depersonalized and mechanistic approach (termed a “task and time” driven culture) and the need for consistency around understanding and managing the dynamics of the nurse–patient relationship or encounter (termed a “thinking and linking” approach); and the need for a systematic approach to the fundamentals or basics of care that combines the physical, psychosocial, and relational dimensions of the care encounter within the wider context of the care environment. Pragmatic and practical frameworks are needed to ensure that the basic physical and psychosocial needs of patients are embedded not only in the practice but also in the thinking, reflection, and assessment processes of the nurse.

    Conclusions

    Nursing's challenge to meet patients’ basic or fundamental needs is complex. Developing a knowledge base will include identifying researchable questions, using rigorous methodologies, ensuring the relational dimensions are not lost, and ensuring the new knowledge is applied in practice. This requires collaboration on an international scale to achieve improvements in care.

    Clinical Relevance

    To work collaboratively to generate, test, and implement meaningful ways of capturing nursing practice around basic or fundamental care in order to ensure more integrated, holistic patient care nursing practices.

  • 313.
    Kjeldmand, Dorte
    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.
    Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners2008In: Annals of Family Medicine, ISSN 1544-1709, E-ISSN 1544-1717, Vol. 6, no 2, p. 138-145Article in journal (Refereed)
    Abstract [en]

    PURPOSE: General practitioners (GPs) occupy a central position in health care and often have demanding working situations. This corps shows signs of exhaustion, and many consider quitting their job or plan to retire early. It is therefore urgent to find ways of improving GP's satisfaction with their work. One approach might be Balint group participation. The aim of this study was to explore GPs' experience of participating in Balint groups and its influence on their work life. METHODS: We conducted a descriptive, qualitative study. Nine GPs who had participated in Balint groups for 3 to 15 years were interviewed. A phenomenologic analysis was carried out to describe the phenomenon of Balint group participation. RESULTS: The GPs perceived that their Balint group participation influenced their work life. Analyses revealed several interrelating themes: competence, professional identity, and a sense of security, which increased through parallel processes, creating a base of endurance and satisfaction, thus enabling the GPs to rediscover the joy of being a physician. CONCLUSIONS: The GPs in this study described their Balint group participation as beneficial and essential to their work life as physicians in several ways. It seemed to increase their competence in patient encounters and enabled them to endure in their job and find joy and challenge in their relationships with patients. Balint groups might thus help GPs handle a demanding work life and prevent burnout. These groups might not suit all GPs, however, and additional ways to reduce stress and increase job satisfaction should be offered.

  • 314.
    Kjeldmand, Dorte
    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.
    Difficulties in Balint groups: a qualitative study of leaders’ experiences2010In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 60, no 580, p. 808-814Article in journal (Refereed)
    Abstract [en]

    Background

    Balint groups (BGs) are a means of enhancing competence in the physician-patient relationship and are also regarded as beneficial for GPs' mental health. However, voluntary BGs are still few, some members terminate their participation, and problems are reported in obligatory groups in residency programmes. This raises questions about possible negative aspects of BGs.

    Aim

    To examine difficulties in BGs as experienced by BG leaders.

    Design of study

    Qualitative study using interviews.

    Setting

    Eight BG leaders from five countries were interviewed.

    Method

    The interviews focused on the informants' experiences of difficulties in their groups and were analysed with a systematic text-condensation method.

    Results

    Three categories of difficulties emerged from the analysis: 1) the individual physician having needs, vulnerabilities, and defences; 2) the group (including the leader) having problems of hidden agendas, rivalries, and frames; and 3) the surrounding environment defining the conditions of the group. BGs were found to fit into modern theories of small groups as complex systems. They are submitted to group dynamics that are sometimes malicious, and are exposed to often tough environmental conditions.

    Conclusion

    Professionally conducted BGs seem to be a gentle, efficient method to train physicians, but with limitations. Participation of a member demands psychological stability and an open mind. BGs need support from the leadership of healthcare organisations in order to exist.

  • 315.
    Kjeldmand, Dorte
    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.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Balint training makes GPs thrive better in their job2004In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 55, no 2, p. 230-5Article in journal (Refereed)
    Abstract [en]

    In this study, we examined Balint group participants' sense of control and satisfaction in their work situation and their attitudes towards caring for patients with psychosomatic problems. Forty-one GPs filled in a questionnaire with a 10-point visual analogue scale. Of these, 20 had participated in Balint groups for more than one year and 21 were a reference group. The Balint physicians reported better control of their work situation (e.g. taking coffee breaks and participating in decision making), thought less often that the patient should not have come for consultation or that psychosomatic patients were a time-consuming burden, and were less inclined to refer patients or take unneeded tests to terminate the consultation with the patient. These results might indicate higher work-related satisfaction and better doctor-patient relationship.

  • 316.
    Kjeldmand, Dorte
    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.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    How patient-centred am I?: A new method to measure physicians' patient-centredness2006In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 62, no 1, p. 31-37Article in journal (Refereed)
    Abstract [en]

    Objective

    To describe a new method to determine physicians’ self-perceived degree of patient-centredness. A pilot study combining qualitative and quantitative methods.

    Methods

    Forty-one general practitioners (GPs) answered a questionnaire consisting of three open-ended questions about their view of the consultation and by choosing among 28 roles of the physician in the physician–patient relationship. Twenty of the GPs had participated in Balint groups while 21 had had no access to Balint group. Patient-centredness is central to Balint groups and consequently Balint group participants would be expected to be patient-centred.

    Results

    The answers to the two parts were divided into three groups each, patient-centred, non-patient-centred and intermediary, and analysed statistically. Significantly more Balint participants were patient-centred than the reference group.

    Conclusion

    The instrument describes physicians’ self-perceptions of their patient-centredness and can distinguish a group of patient-centred physicians from a group of non-patient-centred physicians.

    Practice implications

    The instrument can be useful to evaluate educational programmes and detect decline in patient-centredness as early sign of burnout.

  • 317.
    Kjeldmand, Dorte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Jablonski, Henry
    Salinsky, John
    Balint groups and Peer Supervision2013In: Clinical Uncertainty in Primary Care / [ed] Lucia Siegel Sommers, John Launer, Springer Publishing Company, 2013, p. 73-94Chapter in book (Other academic)
  • 318.
    Kjeldmand, Dorte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    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.
    Difficulties and dropouts in Balint groupsManuscript (Other academic)
  • 319.
    Kjeldmand, Dorte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    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.
    Satisfaction and sense of security: GPs' experience of Balint group participation - a qualitative studyArticle in journal (Refereed)
  • 320. Klareskog, L
    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.
    Östensson, CG
    Förtidspensionerade i Tierp1977Report (Other academic)
  • 321. Klareskog, L
    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.
    Östensson, CG
    Förtidspensionerade i Tierp1980In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 3, p. 162-69Article in journal (Refereed)
  • 322.
    Knudsen, Kati
    et al.
    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, Kungsbacksvagen 47, S-80176 Gavle, Sweden.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nilsson, Ulrica
    Orebro Univ, Sch Hlth Sci, Orebro, Sweden.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    How anaesthesiologists understand difficult airway guidelines: an interview study2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 243-248Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms.

    METHODS: A qualitative phenomenographic design was chosen to explore anaesthesiologists' views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted.

    RESULTS: Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts' consensus, a set of scientifically based guidelines for handling the difficult airway.

    CONCLUSIONS: The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently.

  • 323.
    Kristensen, Dorte V.
    et al.
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Sundler, Annelie J.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, Boras, Sweden..
    Eide, Hilde
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Hafskjold, Linda
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Ruud, Iren
    Univ Coll Southeast Norway, Fac Hlth Sci, Drammen, Norway..
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola, Hälsa och välfärd.
    Characteristics of communication with older people in home care: A qualitative analysis of audio recordings of home care visits2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4613-4621Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 324.
    Kullberg, Linn
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden.
    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.
    Health insurance for the healthy?: Voluntary health insurance in Sweden2019In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 123, no 8, p. 737-746Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, voluntary health insurance is held only by a very small part of the population, but uptake has grown rapidly since 2000. So far, little is known about who purchases this insurance and what the insurance plans contain.

    Aim: To provide a comprehensive description of the coverage and content of voluntary health insurance in Sweden.

    Methods: Data from a national survey (Riks-SOM 2016) were used to estimate insurance coverage in different population groups. Additionally, a qualitative content analysis of the voluntary health insurance plans from seven of the largest insurance companies in Sweden was conducted.

    Results: Voluntary health insurance was found to be more common among high income-earners, individuals employed in the private sector, business owners, and white-collar workers. Insurance benefits varied from visiting a general practitioner to more specialised treatments like knee or hip surgery. Pre-existing medical conditions, emergency medicine, highly specialised care and ongoing chronic care was excluded from the insurance plans.

    Conclusion: Work-related factors such as employment sector, occupation and income appeared to be key determinants for VHI uptake in Sweden. Since the insurance plans included several restrictions, individuals with high care needs are excluded. Taken together, the results indicate that voluntary health insurance in Sweden provide benefits foremost for the healthy and wealthy.

  • 325.
    Kullberg, Linn
    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.
    Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved?2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 123Article in journal (Refereed)
    Abstract [en]

    Background: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas. Methods: A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the "accreditation documents" regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013. Results: The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination. Conclusion: Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system.

  • 326.
    Kunkel, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Implementation strategies influence the structure, process, and outcome of quality systems: An empirical study of hospital departments in Sweden2009In: Quality and Safety in Healthcare, ISSN 1475-3898, E-ISSN 1470-7934, Vol. 18, no 1, p. 49-54Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse whether the organisation of quality systems (structure, process, and outcome) is related to how these systems were implemented (implementation prerequisites, cooperation between managers and staff, and source of initiative).

    Methods: A questionnaire was developed, piloted and distributed to 600 hospital departments. Questions were included to reflect implementation prerequisites (adequate resources, competence, problem-solving capacity and high expectations), cooperative implementation, source of initiative (manager, staff and purchaser), structure (resources and administration), process (culture and cooperation) and outcome (goal evaluation and competence development). The adjusted response rate was 75%. Construct validity and reliability was assessed by confirmatory factor analysis, and Cronbach alpha scores were calculated. The relationships among the variables were analysed with structural equation modelling with LISREL.

    Results: Implementation prerequisites were highly related to structure (0.51) and process (0.33). Cooperative implementation was associated with process (0.26) and outcome (0.34). High manager initiative was related to structure (0.19) and process (0.17). The numbers in parentheses can be interpreted as correlations. Construct validity was good, and reliability was excellent for all factors (Cronbach alpha>0.78). The model was a good representation of reality (model fit p value = 0.082).

    Conclusions: The implementation of organisationally demanding quality systems may require managers to direct and lead the process while assuring that their staff get opportunities to contribute to the planning and designing of the new system. This would correspond to a cooperative implementation strategy rather than to top-down or bottom-up strategies. The results of this study could be used to adjust implementation processes.

  • 327.
    Kunkel, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Quality improvement designs are related to the degree of organisation of quality systems: an empirical study of hospital departments2007In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 84, no 2-3, p. 191-9Article in journal (Refereed)
    Abstract [en]

    Quality systems can help departments do the right things and do things right, but organisation and design need to be considered. The aim was to analyse whether quality systems that include certain quality improvement designs differ with regard to organisational factors and degrees of organisation. A questionnaire was developed and sent to a random sample of 600 hospital departments in Sweden (response rate=75%). A k-means cluster analysis was used to group departments into three degrees of organisation. Analyses of variance were done to study differences in organisational factors and quality improvement designs among the clusters. LISREL analyses were done to study the relationships between organisational factors and quality improvement designs. The results showed that quality systems that included certain quality improvement designs differed with regard to the organisational factors available resources, administration, culture, cooperation, and goal achievement. The results also showed that departments with quality systems of different organisational degrees used different quality improvement designs. Some quality improvement designs may require a quality system with a high degree of organisation to support a successful implementation. The appended questionnaire could be used to plan implementations and evaluate their results.

  • 328.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Univ Uppsala Hosp, Clin Anaesthesia & Intens Care, Uppsala, Sweden..
    Monitoring the anaesthetist in the operating theatre - professional competence and patient safety2017In: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 72, p. 76-83Article, review/survey (Refereed)
    Abstract [en]

    This article about competence and patient safety in anaesthesia was inspired by a statement in the 2015 AAGBI guidelines on monitoring during anaesthesia: the presence of an appropriately trained and experienced anaesthetist is important for patient safety during anaesthesia'. The review starts with a structured description of competence, presenting five dimensions of it; the first two dimensions are identical with the two classical attributes of competence, practical skills and theoretical knowledge. Concerning skills, the value of aiming for a high level of proficiency early in a traning programme is pointed out, and deliberate practice is given as an example of a pedagogical model where aiming for excellence is a core idea. For theoretical knowledge, the value of a deep approach to learning physiology and basic sciences is stressed. The third dimension (anaesthetists' non-technical skills), represents skills necessary for good team-work in the operating theatre. The two last dimensions of competence are the understanding of work and intuitive expert knowing. Understanding work means being aware of what the work is about, appreciating the different aspects of the anaesthetist's job. Intuitive expert knowing, lastly, concerns the tacit dimension of knowledge and skills, which enables professional experts to quickly find a working solution for most clinical problems. The final part of the review is about the when' and how' of competence assessment. The main message is the importance of assessing the competence of clinically active anaesthetists regularly during their whole career.

  • 329.
    Larsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Studying tacit knowledge in anesthesiology:: a role for qualitative research2009In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 110, no 3, p. 443-4Article in journal (Refereed)
  • 330.
    Larsson, Jan
    et al.
    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 Surgical Sciences, Anaesthesiology and Intensive Care.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Testing whether the epidural works: too time consuming?2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 6, p. 761-763Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: When using epidural anaesthesia (EDA) for pain relief after major surgery, a failure rate of 10% is common. A crucial step in improving the care of patients with EDA is to define the position of the epidural catheter. The aim of this study was to investigate how much time it takes to determine whether the block is sufficient by assessing the extent of loss of cold sensation before induction of anaesthesia. METHODS: One hundred patients listed for abdominal surgery were included in the study. After an epidural catheter had been inserted and an intrathecal or an intravenous position had been made unlikely by the use of a test dose, the patient was given a bolus dose of local anaesthetic plus an opioid in the epidural catheter. The epidural block was tested every 2 min, starting at 5 min and ending at 15 min. When at least four segments were blocked bilaterally, the testing was stopped, the time was noted and the patient was anaesthetised. RESULTS: An epidural block was demonstrated after 5-6 min in 37 patients, after 7-8 min in 43 additional patients and after 9-10 min in 15 patients. In one patient, it took 12 min and in three patients, it took 15 min. In two patients, no epidural block could be demonstrated. CONCLUSION: Testing an epidural anaesthetic before the induction of anaesthesia takes only 5-10 extra minutes. Knowing whether the catheter is correctly placed means better quality of care, giving the anaesthetist better prerequisites for taking care of the patient post-operatively.

  • 331.
    Larsson, Jan
    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.
    Defining and promoting excellence in anaesthesia: In Refresher course lectures, Euroanaesthesia 20062006Conference paper (Other academic)
  • 332.
    Larsson, Jan
    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.
    Phenomenographic or phenomenological analysis: does it matter? examples from a study on anaesthesiologists' work2007In: International Journal on Qualitative Studies on health and Well-being, ISSN 1748-2623, Vol. 2, no 1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    Phenomenography is a research approach developed from an educational framework. However, practised in other areas this research approach can be misunderstood as seems to be the case in some reports on allegedly phenomenographic studies. In this article, the authors show how the phenomenographic approach differs from a phenomenological one, using as an example an interview study on anaesthesiologists' understanding of work. Having performed both a phenomenographic and a phenomenological analysis of the same transcripts, the researchers compared the results from the two approaches. The result of the phenomenographic study was four ways of understanding work: (a) monitoring and controlling the patient's vital functions; (b) guiding the patient safely through the operation; (c) serving patients, other doctors and nurses; (d) leading the operating theatre and team. The phenomenological analysis showed the essence of being an anaesthesiologist: Carrying the responsibility for the patient's vital functions; always being alert, watching carefully over the patient's body, ready to act whenever the patient's life is in danger, however difficult the circumstances. The authors discuss the differences between the two research approaches, stressing the value of phenomenographic studies in educational settings as well as its limited value in research on patients' experiences of illness.

  • 333.
    Larsson, Jan
    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.
    Pionjärers arbete i motvind födde två nya medicinska specialiteter2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 36, p. 2525-8Article in journal (Refereed)
    Abstract [en]

    [Pioneers' work against odds resulted in two new medical specialties]

    Torsten Gordh Sr and Ragnar Berfenstam are two influential Swedish doctors, who have worked in medical specialities of quite different character, namely social medicine and anaesthesiology. Still they have much in common: both introduced a new medical speciality in Sweden and both continued with research for many years after retirement. Two physicians with this background should have much to offer young doctors of today. We therefore performed an interview study to describe Torsten Gordh's and Ragnar Berfenstam's experiences as researchers and physicians. The study was based on in-depth interviews. The thematic analysis of the interview texts showed that the two pioneer physicians had to fight an uphill battle to introduce their new medical specialities. Both started new fields of scientific research; at the same time both were dedicated to their professional work. Torsten Gordhs and Ragnar Berfenstams were not only successful researchers but also proficient and considerate doctors for their patients.

  • 334.
    Larsson, Jan
    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 K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Understanding anesthesia training and trainees2012In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 25, no 6, p. 681-685Article in journal (Refereed)
    Abstract [en]

    Purpose of review:

    Patient safety is topical today. Competent professionals are necessary to keep anesthesia care safe, andteaching trainees is an important element in safety work. The purpose of this review is to present the latestresearch on anesthesia training and trainees.

    Recent findings:

    Most trainees of today aim for excellence, for which personal qualities are as important as knowledge andskills. The definition of excellence is the first subject covered here. Trainees of today can train manyprocedural skills in a simulators setting, a step forward for patient safety. Several studies about simulatortraining are reported. A dimension of competence that has received much attention during the last years isanesthesiologists’ nontechnical skills. Studies on anesthesiologists’ nontechnical skills as a valuable tool forassessing trainees’ progress in nontechnical skills are presented.

    Summary:

    Much research about anesthesia training concerns simulator training and assessment of trainees’competence. More research is needed to understand the process of learning anesthesia.

  • 335.
    Larsson, Jan
    et al.
    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 Surgical Sciences, Anaesthesiology and Intensive Care.
    Holmström, Inger Knutsson
    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 Surgical Sciences, Anaesthesiology and Intensive Care.
    How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, no 1, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Background Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, non-technical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses.

    Methods The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes.

    Results Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style.

    Conclusions Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.

  • 336.
    Larsson, Jan
    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.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Anaesthetists understand their work in different ways - Reply2004In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 93, no 2, p. 303-304Article in journal (Refereed)
  • 337.
    Larsson, Jan
    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.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Trainee anaesthetists understand their work in different ways: implications for specialist education2004In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 92, no 3, p. 381-7Article in journal (Refereed)
    Abstract [en]

    Background. Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to define the different ways in which trainee anaesthetists understand their work.

    Methods. Nineteen Swedish trainee anaesthetists were interviewed. The interviews sought the answers to three open-ended questions. (i) When do you feel you have been successful in your work? (ii) What is difficult or what hinders you in your work? (iii) What is the core of your anaesthesia work? Transcripts of the interviews were analysed by a phenomenographic approach, a research method aiming to determine the various ways a group of people understand a phenomenon.

    Results. Six ways of understanding their work were defined: giving anaesthesia according to a standard plan; taking responsibility for the patient’s vital functions; minimizing the patient’s suffering and making them feel safe; giving service to specialist doctors to facilitate their care of patients; organizing and leading the operating theatre and team; and developing one’s own competence, using the experience gained from every new patient for learning.

    Conclusions. Trainee anaesthetists understand their work in different ways. The trainee’s understanding affects both his/her way of performing work tasks and how he/she develops new competences. A major task for teachers of anaesthesia is to create learning situations whereby trainees can focus on new aspects of their professional work and thus develop new ways of understanding it.

  • 338.
    Larsson, Jan
    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.
    Rosenquist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Professional artist, good Samaritan, servant and co-ordinator: four ways of understanding the anaesthetist's work2007In: Anasthesiologie und Intensivmedizin, ISSN 0170-5334, E-ISSN 1439-0256, no 12, p. 683-689Article in journal (Refereed)
    Abstract [en]

    Background: Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work. Methods: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed. Results: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly. Conclusions: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.

  • 339.
    Larsson, Jan
    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.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Burdened by training not by anaesthesia2008In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 100, no 4, p. 560-561Article in journal (Refereed)
  • 340.
    Larsson, Jan
    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.
    Rosenqvist, Urban
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Professional artist, good Samaritan, servant and co-ordinator:: four ways of understanding the anaesthetist's work2003In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 47, no 7, p. 787-793Article in journal (Refereed)
    Abstract [en]

    Background: Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work.

    Methods: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed.

    Results: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly.

    Conclusions: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.

  • 341.
    Larsson, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Knutsson Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Fenomenografi2012In: Vetenskaplig teori och metod: från idé till examination inom omvårdnad / [ed] Maria Henricson, Lund: Studentlitteratur, 2012, 1, p. 389-405Chapter in book (Refereed)
  • 342.
    Larsson, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    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.
    Being a young and inexperienced trainee anaesthetist: a phenomenological study on tough working conditions2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 6, p. 653-8Article in journal (Refereed)
    Abstract [en]

     

    Background: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.

    Methods: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.

    Results: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.

    Conclusions: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

    Background: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.

    Methods: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.

    Results: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.

    Conclusions: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

  • 343.
    Larsson, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    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.
    Enjoying work or burdened by it? How anaesthetists experience and handle difficulties at work: a qualitative study2007In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 99, no 4, p. 493-499Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore difficulties at work from anaesthetists’ own perspective and to examine how anaesthetists handle and cope with situations that are perceived as difficult and potentially stressful.

    Methods: Two sets of interviews were conducted with 19 specialist anaesthetists in Sweden. The first set of interviews aimed at finding how the anaesthetists experienced difficulties at work. It consisted of in-depth interviews based on one open-ended question. We analysed the interviews with a phenomenological method, looking for themes in anaesthetists’ descriptions of difficulties at work. In the second set, the interviews were semi-structured with open-ended questions, based on themes found in the first interview set. These interviews aimed at exploring how the interviewees described their ways of handling difficulties and how they coped with potentially stressful situations.

    Results: Analysis of the first set of interviews resulted in five themes, describing how the anaesthetists experienced difficulties at work. All interviewees talked about difficulties related to more than one of the themes. The second set of interviews revealed two main categories of ways of handling difficulties. First, problem solving consisted of descriptions of methods for handling difficult situations which aimed at solving problems, and second, coping strategies described ways of appraising potentially stressful situations that minimized stress, despite the problem not being solved.

    Conclusions: The anaesthetists interviewed in this study maintained that they enjoyed work and could see no external obstacles to doing a good job. They had arrived at a reconciliation of their work with its inherent difficulties and problems. Getting access to their coping strategies might help young anaesthetists to come to terms with their work.

  • 344.
    Larsson, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rosenqvist, Urban
    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.
    Stressful threats or stimulating challenges: how experienced anaesthetists cope with difficult situations at work2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no Suppl. 118, p. 17-17Article in journal (Refereed)
  • 345.
    Larsson, Jan
    et al.
    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 Surgical Sciences, Anaesthesiology and Intensive Care.
    Sanner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Doing a good job and getting something good out of it: on stress and well-being in anaesthesia2010In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 105, no 1, p. 34-37Article, review/survey (Refereed)
    Abstract [en]

    Abstract: The anaesthetist's work, aimed at giving safe anaesthesia to patients, can do both harm and good to the anaesthetist. Research on stress in anaesthesia has traditionally focused on how the negative effects of stress can be avoided and much effort has been put into improving anaesthetists' work environment to reduce the level of stress. In this review, however, we give attention instead to what the individual anaesthetist can do to improve his or her well-being at work. Stress is, and will remain, an inevitable aspect of the anaesthetist's occupation but, as for any professional working in a stressful environment, adaptive coping can make a big difference in outcome. The choice between construing a difficult clinical situation as threat or challenge is important here because of the difference in the resulting stress response. The anaesthetist can reduce the stress effect of a potentially stressful situation by thinking of it in a new way, by redefining it through reappraisal. We describe here some lines of thought that experienced anaesthetists use to buffer the effects of work stress on physical health and mental well-being. By reframing a situation, they can reduce its stress content even if the problem at hand cannot be successfully solved. Trainee anaesthetists, who experience much stress at work and are at risk of burnout, would benefit from learning about these coping strategies.

  • 346.
    Lehto, Juhani
    et al.
    University of Tampere.
    Vrangbaeck, Karsten
    Copenhagen University.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    The reactions to macro-economic crisis in Nordic health system policies: Denmark, Finland and Sweden, 1980-20132015In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 10, no 1, p. 61-81Article in journal (Refereed)
    Abstract [en]

    Denmark, Finland and Sweden have experienced two major recessions during the last 25 years. The adjustments to the earlier crisis in the late 1980s (Denmark) and early 1990s (Finland and Sweden) resembled the policies in many other European countries during the present crisis. The analysis of relationship of deep economic crises and growth period between them to the health system policies and institutions in the three countries from the 1980s to 2013 is based on a categorisation of reactions to external shocks as path conforming or path breaking. The results of the empirical long-term trends show that the reactions to deep recessions have been mainly temporary adjustments and acceleration of changes already prepared before economic crisis. The economic crisis in the three countries has not been ‘good enough’ to enable paradigmatic changes in the Nordic public, decentralised and equity-oriented health systems. Changes such as the slow privatisation in care funding and production and the adoption of new management practices indicate an ongoing paradigmatic change related to longer-term societal, ideological and political developments rather than directly to economic crises or growth.

  • 347.
    Lilja, M.
    et al.
    Umea Univ, Ostersund Unit, Publ Hlth & Clin Med, S-90187 Umea, Sweden..
    Julin, B.
    Ivbar, Stockholm, Sweden..
    Andersson, G.
    Swedish Soc Diabet Nursing, Stockholm, Sweden..
    Andersson, I. -L
    Axelsen, M.
    Swedish Assoc Clin Dietitians, Nacka, Sweden..
    Ek, M.
    Stockholm Cty Council, Stockholm, Sweden..
    Kristiansson, R.
    Uppsala Cty Counsil, Uppsala, Sweden..
    Lekell, J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lindberg, A.
    Reg Skane, Malmo, Sweden..
    Lindgren, P.
    Ivbar, Stockholm, Sweden..
    Londahl, F.
    Swedish Diabet Assoc, Stockholm, Sweden..
    Muth, K. Loostrom
    Reg Vastra Gotaland, Gothenburg, Sweden..
    Svensson, A. -M
    Dahlström, Tobias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Determinants of HbA(1c) in patients with type 1 diabetes in s