| 1. |
- Berg, Marie, 1955, et al.
(författare)
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Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden
- 2019
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215 .- 1745-6215. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. METHODS/DESIGN: Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman's wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7-10 on a scale of 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women's self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. DISCUSSION: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03948815. Registered 13 May 2019-retrospectively registered.
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| 2. |
- Gillberg, Nanna, et al.
(författare)
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Resilience Capability and Capacity in Unexpected Crises: Experiences and Lessons Learned in a Healthcare Organisation during the COVID-19 Pandemic
- 2023
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Ingår i: Journal of Nursing Management. - 0966-0429 .- 1365-2834.
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The current article aims to gain insight into (a) what characterises organisational resilience during an unexpected crisis such as COVID-19 and (b) how organisations respond to developments in their environments. Background. In times of societal crises, such as the COVID-19 pandemic, the resilience of the healthcare organisation is tested. Method. This research is based on a case study in a university hospital and a county hospital in Sweden using surveys with both structured and open answers. Results. The result shows ambiguity and “polarised” experiences, emphasising flexibility vs. structure, clear hierarchical information vs. spaces for peer learning through dialogue, and focus on acute care vs. determination to continue with core operations. Conclusion. The article concludes that the pandemic resulted in paradoxes, tensions, and new experiences in organisational processes and interactions. These create opportunities for learning not only during crises but also for improving nursing management in both acute and planned care. Three relations are important in building organisational resilience in crises: resilience capability, resilience capacity, and sustainable resilience practices. Implications for Nursing Management. Organisational resilience under extraordinary circumstances, such as a pandemic, as well as enhancing the previous literature on nursing management that offer a more individually oriented perspective.
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| 3. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study
- 2022
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Ingår i: Women and Birth. - : Elsevier BV. - 1878-1799 .- 1871-5192. ; 35:4, s. e337-e347
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Tidskriftsartikel (refereegranskat)abstract
- Labour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors. Aim: To explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward. Methods: Five months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a ‘Regular’ birthing room (n = 8) or a specially designed, ‘New room’ (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process. Findings: The analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women's agency was facilitated. Conclusion: Institutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women's needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women's sense of agency.
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| 4. |
- Gustafsson, Tanja, PhD student, 1980-
(författare)
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Att mötas genom och bortom orden : Implementering av personcentrerad kommunikation inom vård och omsorg i hemmet
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Communication between older persons and nursing staff is an important component in the provision of person-centered home care. However, there is a lack of research on how to implement person-centered communication in home care settings. Aim: The overall aim of the thesis was to explore the communication between older persons and nursing assistants (NAs) in home care, as well as to implement and evaluate an educational intervention on person-centered communication. Methods: The thesis consist of four studies combining qualitative and quantitative approaches. Study I explore emotional communication during home care visits. Data was collected by audio-recordings and analyzed by using VR-CoDES and thematic analysis based on descriptive phenomenology. Study II was a process evaluation of the implementation, where multiple data was gathered and analyzed by mixed methods. Study III explore the NAs’ experiences of developing communication skills. Data collection consisted of interviews and written assignments, analyzed using a phenomenological approach. Study IV explore the feasibility of evaluating the intervention by using a self-efficacy questionnaire and measuring job satisfaction, analyzed descriptively and statistically. Main results: Emotional communication during home care visits can create empathic opportunities for meaningfulness and trust, at the same time as it can be challenging, requiring courage, time, and communication skills. The intervention, aimed at supporting the NAs to develop communication skills, was implemented through a web-based educational program. The program format offered flexibility and accessibility for the NAs. The education contributed to insights on strengths and weaknesses in the NAs communication through reflection, and they obtained strategies on how to communicate in challenging situations. Organizational barriers challenged the implementation process and program completion. The NAs ratings of communication skills before and after the intervention showed tendencies towards improvement. There was no difference in their estimate of job satisfaction before and after intervention. Conclusion: Emotional communication is a complex and dynamic phenomenon, requiring NAs being equipped with a repertoire of communication skills that can guide them to manage different situations in home care. Key factors for successful implementation of educational interventions were identified: the possibility to adapt and modify the implementation to the context, and organizational prerequisites that support the implementation process and the participants’ learning. Educational interventions, together with support from the organization, can enable NAs to flourish in their communication with older persons through words and beyond.
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| 5. |
- Jenholt Nolbris, Margaretha, 1956, et al.
(författare)
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Meals are more than nutrition for children with a malignant or non-malignant disorder with a gastrostomy tube: A qualitative study
- 2024
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Ingår i: European Journal of Oncology Nursing. - 1462-3889 .- 1532-2122. ; 72
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo elucidate mealtime experiences of children hospitalized with a malignant or severe non-malignant disorder —and their parents—after a gastrostomy tube insertion. MethodsA qualitative design involving a child-centred care approach was used. Parents of children aged 1–18 years old who had received a gastrostomy tube during treatment for a malignant or non-malignant disorder were included, as were the children themselves when aged 5–18 years old. Semi-structured interviews with 21 families were carried out and a thematic analysis performed. ResultsThe findings were presented in four themes: changed meal conditions, a troublesome sensory dimension, aggravating obstacles and solving the unmanageable. Hospitalization involves challenges regarding environmental aspects, hospital food and side effects, contributing to impaired nutritional intake and aggravated mealtime situations. ConclusionsHospital environment and hospital food have a profound impact on children's nutritional intake and mealtime situations. In addition, sensory aspects and side effects aggravate the child's motivation to eat, resulting in demanding meals. The families described a gastrostomy tube as a valuable strategy for improving mealtime situations.
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| 6. |
- Nilsson, Christina, et al.
(författare)
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Effects of Birthing Room Design on Maternal and Neonate Outcomes: A Systematic Review
- 2020
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Ingår i: Herd-Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 13:3, s. 198-214
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To summarize, categorize, and describe published research on how birthing room design influences maternal and neonate physical and emotional outcomes. Background: The physical healthcare environment has significant effects on health and well-being. Research indicates that birthing environments can impact women during labor and birth. However, summaries of the effects of different environments around birth are scarce. Methods: We conducted a systematic review, searching 10 databases in 2016 and 2017 for published research from their inception dates, on how birthing room design influences maternal and neonate physical and emotional outcomes, using a protocol agreed a priori. The quality of selected studies was assessed, and data were extracted independently by pairs of authors and described in a narrative analysis. Results: In total, 3,373 records were identified and screened by title and abstract; 2,063 were excluded and the full text of 278 assessed for analysis. Another 241 were excluded, leaving 15 articles presenting qualitative and quantitative data from six different countries on four continents. The results of the analysis reveal four prominent physical themes in birthing rooms that positively influence on maternal and neonate physical and emotional outcomes: (1) means of distraction, comfort, and relaxation; (2) raising the birthing room temperature; (3) features of familiarity; and (4) diminishing a technocratic environment. Conclusions: The evidence on how birthing environments affect outcomes of labor and birth is incomplete. There is a crucial need for more research in this field.
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| 7. |
- Nolbeck, Kajsa, et al.
(författare)
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A Descriptive Study of Swedish Secure Youth Homes in Terms of Their Spatial Factors and Residents’ Individual Characteristics
- 2024
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Ingår i: Residential Treatment for Children & Youth. - : Taylor & Francis. - 0886-571X .- 1541-0358. ; 41:3, s. 367-389
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to describe secure institutional youth care homes in Sweden in terms of the conditions of their spatial environment (i.e. physical design and objects) and the individual characteristics of the youths placed there. Data were collected through a survey and from the Swedish National Board of Institutional Care. The study population consisted of 18 units and 1,859 youths in secure institutions in Sweden from 2006 to the end of 2016. The results showed that 74.1% of the youths were enrolled under acute circumstances. They often present with physical and mental health problems, such as sleep disturbance and lack of impulse control; the young people are placed in a restricted environment with little possibility to maintain a sense of security. Due to their previous traumatic experiences, this can be problematic in terms of care and treatment. The results show a tension between different aspects of control, highlighting the importance of offering care environments that both offer the staff “control functions” (i.e. functions facilitating observation and control over the environment) and offer the youths “control opportunities.” Such environments need to be as homelike as possible, while simultaneously maintaining safe care for young people and a safe working environment for staff.
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| 8. |
- Nolbeck, Kajsa, 1982, et al.
(författare)
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Be prepared and do the best you can: a focus group study with staff on the care environment at Swedish secure youth homes
- 2023
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- This study focuses on the care environment of secure youth homes run by the Swedish National Board of Institutional Care, where youths up to 21 years old are placed according to law due to extensive care needs or sentences. Purpose This study examined staff members' experiences of the institutional care environment within secure youth homes. Methods Data were collected through three focus group discussions with 17 staff members at two secure youth homes. Subsequently, a thematic analysis was conducted. Results The analysis indicated two main themes: risk management and damage control in a restricted environment and compensating and reconstructing ordinariness-trying to make the best of it; each theme had three subthemes. The care environment seems to be experienced by staff as characterized by conflicting demands, thus constituting a gap between needs and what is possible to achieve-a balancing act that constitutes a constant struggle. Conclusions The staff members' constant struggle could be interpreted as conflicting moral and instrumental demands; they know what the youths need, but the environment of the secure youth homes demands the decorous behaviour of sociomaterial control practices-rather than care practices.
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| 9. |
- Roxberg, Åsa, 1953-, et al.
(författare)
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Space and place for health and care
- 2020
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - Abingdon : Taylor and Francis Ltd.. - 1748-2623 .- 1748-2631. ; 15:sup1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This discussion paper aims to contribute to a greater understanding of the state of the art of research engaged with conceptual matters of space and place for health and care. Method: The authors, who represent a variety of academic disciplines, discuss and demonstrate the conceptual recognition of space and place in research in health and caring sciences building upon own work and experience. Results: To explore the concepts of space and place for health and care is a research pursuit of utmost importance, and should be made through transdisciplinary research collaborations, whereby spatial theories from various disciplines could be communicated to cultivate truly novel and well-informed research. Furthermore, engaging with relational and topological perceptions of space and place poses methodological challenges to overcome in future research on health and care. Conclusions: We argue that there is a need for accelerating spatially informed research on health and care that is informed by current theories and perspectives on space and place, and transdisciplinary research collaborations are a means to achieving this. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 10. |
- Wennman, Ingela, et al.
(författare)
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Fast track to stroke unit for patients not eligible for acute intervention, a case-control register study on 1066 patients.
- 2023
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Ingår i: Scientific reports. - : Springer Nature. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.
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