| 1. |
- Avallin, Therese, 1982-
(författare)
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Achieving person-centred pain management for the patient with acute abdominal pain : Guided by the Fundamentals of Care framework
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to explore how to achieve and measure person-centred pain management (PCPM) for the patient with acute abdominal pain (AAP) in acute surgical care. The Fundamentals of Care (FoC) framework guides all studies.The methods: In Study I, focused ethnography is used with 92h of participant observations (n=34) at the emergency department (n=1) and surgical wards (n=2), including 261 patient–provider interactions. In Study II, case study is used for secondary analysis of 20 observations from Study I. In Study III, a questionnaire is developed in a systematic process to measure PCPM, performed by combining; a validated questionnaire, theoretical and empirical evidence. The questionnaire is tested by question appraisal, theoretical experts (n=2), patients (n=5) and providers (n=5), and thereafter by patients (n=100) at surgical wards (n=4). In Study IV, a qualitative systematic review is performed with a synthesis by thematic analysis, to test and refine a model for PCPM from Study I. The synthesis includes 15 qualitative studies representing patients (n=495) and/or nurses (n=259) from n= 3 emergency departments and n=17 hospital wards in n=9 countries. The patients are ≥ 18 years old, with AAP (Studies I-IV), or acute pain from surgery (Study IV). The results confirms that the patient still suffer from unmanaged pain in acute surgical care, and presents actions on behalf of the patient and provider, and contextual factors including the organizational culture, to achieve and measure PCPM. The studies presents a model for PCPM from the patient perspective (Study I), patient-provider communications contributing to meeting fundamental care needs (Study II), an initially feasible and valid questionnaire to measure PCPM (Study III), and a tested and refined model for PCPM from the patient and nurse perspective (Study IV). Conclusion: This thesis presents scientific evidence providing an in-depth understanding of what is important for successful pain management from the patient’s and nurses’ perspectives, how these parts are interconnected, and how they can be achieved and measured. The results also show the feasible role of communication in meeting the patient’s fundamental care needs. This evidence is suggested to be tested and evaluated in clinical practice to perform PCPM, relieving the patient from pain.
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| 2. |
- Godfrey, Marjorie M.
(författare)
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Improvement Capability at the Front Lines of Healthcare : Helping through Leading and Coaching
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- SUMMARY This thesis addresses improvement capability at the front lines of healthcare with a focus on interprofessional health care improvement teams who provide care and improve care. The overall aim is to explore high performing clinical microsystems and evaluate interventions to cultivate health care improvement capabilities of frontline interprofessional teams.Methods Descriptive and evaluative study designs were employed in the five studies which comprise this thesis. A total of 495 interprofessional health care providers from a variety of health care contexts in the United States (Study I, II, III & IV) and Sweden (Study V) participated in the studies. The mixed methods research included qualitative observation, interviews, focus groups and surveys analyzed with qualitative manifest content analysis. The quantitative data were analyzed with statistics appropriate for non-parametric data.Findings Study I and II describe how leaders who understand health care improvement can create conditions for interprofessional teams to provide care and simultaneously improve care. Study III evaluates adapted clinical microsystem processes and tools successfully adapted in two different hospitals. Frontline staff reported that they needed help to balance providing care and improving care. Study IV and V explored and tested team coaching to help interprofessional teams to increase their improvement capabilities within improvement collaboratives. The participants perceived team coaching mostly positively and identified supportive coaching actions. In Study V an intervention with “The Team Coaching Model” was tested in Sweden and showed increased acquisition of improvement knowledge in the intervention teams compared to teams who did not receive the coaching model.Conclusions The thesis findings show leaders can help cultivate health care improvement capability by designing structures, processes and outcomes of their organizational systems to support health care improvement activities, setting clear improvement expectations of all staff, developing the knowledge of every staff member in the microsystem to know their operational processes and systems to promote action learning in their daily work, and providing help with team coaching using a Team Coaching Model.
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| 3. |
- 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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| 4. |
- Hultin, Lisa, 1977-
(författare)
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Preventing pressure ulcers : – risk assessment and patient participation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pressure ulcers are considered as an adverse event. Identifying patients at risk is the first step in pressure ulcer prevention. The patient should receive relevant information about their risk status and be encouraged to participate in their own preventive care. PURPOSE T is a new pressure ulcer risk assessment instrument, and the CBPM system shows the patient’s pressure points visually in real time. Aim: This thesis aimed to evaluate the psychometric values, usability and feasibility of PURPOSE T and to investigate the possibility of improving patient participation through the CBPM system. Method: The study setting was a university hospital and three nursing homes. Nurses (n=28) risk assessed patients (n=235) with PURPOSE T in an observational, descriptive and comparative study (I). Focus group interviews were then conducted with the nurses (II). A mixed-method study evaluated the feasibility of PURPOSE T with patient record review (n=60), individual patient interviews (n=15) and focus group interviews with nurses (n=15) and assistant nurses (n=8) (III). A descriptive study with patients (n=31) evaluated if the CBPM system increased patient participation (IV). Results: Study I demonstrated good inter-rater and test-retest reliability of PURPOSE T. Study II showed that PURPOSE T had good clinical usability. It was an efficient risk assessment instrument performed at bedside; the nurses gained a deeper understanding and awareness of risk factors. Study III showed that PURPOSE T has good clinical feasibility. More patients were identified at risk for pressure ulcers and were prescribed more preventive interventions in comparison with patients assessed with the Modified Norton Scale. These results were mirrored in the focus group interviews with the nurses´ and assistant nurses’ experiences. Risk assessment took the same amount of time despite being more comprehensive; the instrument encouraged more preventive actions, and nurses were more involved at bedside. However, almost all the patients expressed not receiving any information about pressure ulcers. Study IV showed that the CBPM system increased the patients’ knowledge, and as they became aware of increased pressure, they started to take preventative action in their own care. Thus, patient participation increased. Conclusion: The evaluation of PURPOSE T in Sweden demonstrates good results and could be considered as replacing the Modified Norton Scale at a national level. Providing information to the patient needs to be a priority, and new information and communication technologies, such as the CBPM system, need to be taken advantage of, to benefit the patients.
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| 5. |
- Jobe, Ingela
(författare)
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“A chain is only as strong as its weakest link” : collaborative care planning as a person-centred practice
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, person-centred care has become one of the major goals of health and social care policies. A method used, to facilitate collaboration and integrate the person’s perspective in the decision-making process, is the collaborative care planning process. The collaborative care planning process, taking place within primary health care with actors from different welfare services, is a relative new phenomenon. There is a need for more research to understand the process and outcomes.The overall aim of the thesis was to explore and describe the collaborative care planning process as a person-centred practice. This was achieved by conducting four studies describing the collaborative care planning conference (I), exploring how the person-centred practice framework can be applied to professionals participating in collaborative care planning (II), exploring which attributes contribute to making the collaborative care planning process work for all participants (III) and exploring documented collaborative care plans (IV). The design of the studies were a single – instrumental qualitative case study (I), explorative deductive approach (II), qualitative explorative with a grounded theory approach (III) and explorative descriptive approach (IV). Using different methodologies, data were collected through interviews with older adults, their care partners and health and social care professionals, focus group discussion with health and social care managers, observations of collaborative care planning conferences and documented collaborative care plans. Data were analysed with qualitative case study, qualitative content analysis, constructivist grounded theory and content analysis.Older adults wanted to be actively engaged in decision-making processes regarding their care and services. However, the professionals had challenges in carrying out the collaborative care planning process (I). Collaborative care planning and person-centred practice was a complex process that needed to take into account system factors both on macro- and micro level (II). A joint philosophy, an ethic, could facilitate and guide professionals in everyday practice (III). The collaborative care plans had poor quality, insufficient content and lack of personcentredness (IV). Further research is needed to understand the role of the documented collaborative plan and the best way of working to make the collaborative care planning process and collaborative care plan person-centred. To gain a deeper understanding of the studies (I – IV) results an interpreted synthesis were conducted resulting in two common threads, personhood and power asymmetry. The two common threads were discussed using philosophy and Paul Ricoeur’s (1994) “little ethics”. The collaborative care planning process has to be seen in a larger context for it to be person-centred. All levels, the older adult and their care partners, the professionals and the organizations, need to be permeated of ethics and human values, and these have to be visible in every action and practice. Health and social care are relational practices and organizations. During the collaborative care planning the professionals, the older adults, and their care partners become interwoven. By using reciprocity and balancing the different dimensions and perspectives, the plan, their relationships and the organizations can improve. In conclusion, the thesis highlight the importance of ethics, relationships and reciprocity during the collaborative care planning process. The philosophical texts by Ricoeur expand the perspectives and contribute to a greater understanding of the collaborative care planning process as a person-centred practice.
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| 6. |
- Johansson, Gunilla
(författare)
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Nature-based interventions to promote health in people with stress-related illness
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress-related illness is increasing and is a common cause of sick leave in Sweden. Spending time in nature reduces stress and promotes health and well-being. Consequently, nature-based interventions (NBI) for people with stress-related illness have been developed, implemented and studied in southern Scandinavia. However, such interventions are uncommon in the Circumpolar North with a different climate which affect conditions for outdoor activities. The overall aim of this doctoral thesis was to explore NBIs to promote health in people with stress-related illness from the perspectives of previous research, people with stress-related illness, healthcare professionals and entrepreneurs offering NBIs with a specific focus on northern natural conditions.The thesis includes four studies. An integrative literature review (I) identified and summarised scientific studies of NBIs for people with stress-related illness. Studies using both qualitative and quantitative designs were included. Study II explored key stakeholders’ perceptions of the value of NBIs in promoting health in people with stress-related illness. Semi-structured interviews were conducted with people with stress-related illness experience, healthcare professionals, and entrepreneurs offering NBI and data were analysed through qualitative content analysis. In study III people with stress-related illness experiences of participating in an NBI program in a northern natural setting were explored. A longitudinal case study design was used, and data were collected through repeated semi-structured interviews, diary entries and self-assessment questionnaires. Qualitative content analysis was used to analyse interviews and reflections from diaries and data from self-assessing questionnaires were presented descriptively. Study IV explored people with stress-related illness experiences of nature prescription. Data were collected through interviews with open-ended questions and analysed with a phenomenological-hermeneutic method.Findings show that natural environments offer unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. In NBI people with stress-related illness find a source for recovery, joy, and well-being. Spending time in nature is perceived as calming and facilitates being in the present. NBIs improve health and strengthen self-efficacy and work ability. Time in nature provides new perspectives, supports existential reflections, and empowers people with stress-related illness to find opportunities for change to achieve balance in everyday life. NBIs can be helpful for people with stress-related illness to overcome barriers to going out in nature or to find their way back to nature. In conclusion, NBIs seem to be beneficial in promoting health in people with stress-related illness. Different stakeholders have similar perceptions of the value of NBIs, indicating that it could be a valuable complement to health care. NBIs in a northern natural setting seems to have similar health promoting qualities as those seen in studies of NBIs in other natural settings.
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| 7. |
- Kleebthong, Duangkaew, 1971-
(författare)
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Depression among older people in rural Thailand : Knowledge of population, experiences and perceptions of patients, families, and psychiatric nurses
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The number of older persons (defined as age 60 and over) in Thailand has grown rapidly, and will be projected to increase to over 20 million by 2035. With an aging population, the number of older people suffering from health problems (such as non-communicable and degenerative diseases) was increasing as well. Older people faced physical and mental health challenges that need to be recognized. Depression among older people is significantly high and associated with physical illness; however it remains overlooked, improperly diagnosed, and inadequately treated.Aim: The overall aim of the study was to gain deeper knowledge of the phenomenon of depression in older people in rural Thai areas. The aim of each the study was to describe and understand the experiences and perceptions of individual psychiatric nurses, patients, and their family members, as well as to study public knowledge about depression among older people in rural Thailand.Methods: The setting of this thesis was a rural area in Thailand. It included four studies. The first three studies involved qualitative research, and latent content analysis was used to analyze data. In-depth interviews were used to collect data. Purposive sampling was used to select participants for the first three studies, which included 13 psychiatric nurses (study I), 14 older people with depression (study II), and 13 family members of older patients suffering from depression (study III). The fourth study is a quantitative cross-sectional study with 2,636 respondents aged 18 years to 75 and living in a household while data was collected. Respondents were selected using multi-stage random sampling.Results: Study I - The psychiatric nurses’ experiences and perceptions of their professional role were mirrored in the following themes: 1) managing a central role in patient care; 2) conflicting interests between the professional needs of caregiving and other requests; and 3) being compassionate beyond their official duties. Study II - the experiences and perceptions of older Thai people with depression were abstracted into two themes. The first theme was 1) leading a life of detachment, and the second theme was 2) inconvenience of obtaining mental health treatment. Study III - the experiences and perceptions of family members of older people showing major depression were abstracted into two themes. The first theme was 1) perceiving a traditional rural view on mental illness, and the second was 2) experiencing complexity in everyday life when caring for older depressed family member. Study IV - The 2,636 respondents have moderate knowledge about depression among older people, with a respondent mean score of 5.86 (SD = 1.68). Education level was significantly associated with knowledge about depression. If education level changes from lower to higher, the odds for level of knowledge about depression increase. This result may indicate the need for enhanced mental health literacy in rural areas.Conclusion: Older people with depression in a rural Thai area were the responsibility of an inadequate number of psychiatric nurses. The resultsshowed sign of lacking knowledge about depression among older people and an imbalance between the needs of patients and the mental health care provided by the psychiatric nurses in rural areas. The patients and their relatives, and psychiatric nurses felt burdened in daily life. An immediate concern for mental healthcare providers is providing mental literacy in rural areas. These primary results can be used by mental health authorities to develop plans to enhance quality of care for older people with depression, and as such, provide psychosocial support for patients and their family. This would reduce the burden on psychiatric nurses and adjust human resources in mental health services in district hospitals.
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| 8. |
- Lindahl, Jeanette
(författare)
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Optimerad fysisk vårdmiljö på akutmottagning : ur patienters, närståendes och personals perspektiv
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: This dissertation called the COPE (Caring Optimized Physical Environment) project, aimed to evaluate the perceptions of patients, family members, and staff regarding support from the physical environment, with a focus on light, color, and person-centered climate, before and after there furbishment and remodeling of an emergency department (ED).Methods: A quasi-experimental design was employed, implementing evidence-based design principles for light and color in the ED. The study evaluated the perceived support and person-centered climate among participants using a newly developed and validated questionnaire, the Light and Color Questionnaire (LCQ). It also validated a Swedish version of the Person-centered Climate Questionnaire for family members (PCQ-F). A total of 600 participants, including patients, family members, and staff, were included in the study.Results: The scores for the perceptions of light and color and person centered climate were higher after the redesign than before for patients, family members, and staff. Thus, redesign of a healthcare environment based on knowledge and experience in light and color design corresponded with a positive change in self rated perceived support of that environment to all three groups: patients, family members, and staff. The redesign involved enhancing access to natural daylight by incorporating additional windows and diverse artificial lighting options. The redesign also included the use of color coding to facilitate way finding and uniform colors for shared floor surfaces and contrasting colors for non-patient areas to enhance safety.Conclusion: The intervention, which focused on optimizing lighting and color in the ED, coincided with an increased perceived support from light and color for patients, family members, and staff. Further, the changes in light and color, along with the overall redesign, concurred with a higher score for perceived person-centered climate. These findings emphasize the importance of evidence-based design interventions and highlight the potential benefits they can bring to staff and patients in other health care settings.
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| 9. |
- Ljungholm, Linda
(författare)
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Patients’ experiences of continuity of care : What is needed and how can it be measured?
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim for this thesis was to explore continuity of care through patients’, family carers’, and health care personnel’s perceptions, and to develop and evaluate a patient-reported experience measure of continuity of care.Method: This thesis consists of four studies; I have a qualitative explorative design and II have a qualitative descriptive design, whereas III and IV are methodological studies. In studies I and II, data were collected from four geographically disparate areas in Sweden; in studies III and IV, data were collected in one of these areas. Data were collected using individual (I, II, III), focus groups, pair interviews (II), and questionnaires (III, IV). Data were analyzed using constructivist grounded theory (I), conventional content analysis (II), and according to classical test theory (III), and Rasch measurement theory (IV).Results: For patients to experience continuity of care, all aspects were interconnected, as access to tailored information was essential for gaining mutual understanding regardless of who was performing a care task. This required clarity in responsibilities and roles, interprofessional collaboration, and a trusting relationship over time and space between each link in the patient’s care trajectory (I). Further, Study II showed that to achieve continuity of care, professional and cross disciplinary cooperation at micro, meso and macro levels were needed. Continuity of care is dependent on long-term and person-centered relationships, dynamic stability in the organizational structure, and shared responsibility for cohesive care enabling uniform solutions for knowledge and information exchange (II). Studies III and IV resulted in the Patient-Experienced Continuity of care Questionnaire (PECQ). The instrument contains 20 items measuring four dimensions of continuity of care: Information (four items), Relation (six item), Management (five item), and Knowledge (five item). Overall, the PECQ showed satisfactory measurement properties according to classical test theory and Rasch measurement theory (III, IV) regarding factor structure, unidimensional, local independence, response category function, differential item functioning for age and sex, and internal consistency reliability.Conclusion: Continuity of care is perceived as multidimensional, containing several important aspects working in synergy and varying over time. To achieve continuity of care, information and knowledge sharing need to cross disciplinary and organizational boundaries. Collaborative responsibility is needed, vertically through all levels of the system, instead of focusing on personal responsibility horizontally. The PECQ can provide information on different dimensions of continuity, useful for driving quality improvements in the primary care context.
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| 10. |
- Peterson, Anette
(författare)
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Learning and understanding for quality improvement under different conditions : An analysis of quality registry-based collaboratives in acute and chronic care
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The demands that are placed on healthcare systems continue to increase, but several studies show that patient care and healthcare system outcomes are not as good as they could be. To come to terms with these problems, many stakeholders turn to systematic quality improvement methods. However, research and practice also shows that change in organisations is difficult. Consequently many quality improvement projects fail. Quality Improvement Collaboratives (QICs), introduced through the use of the Breakthrough series model, represent a commonly used approach. Despite their widespread application, uncertainty remains regarding the effectiveness of QICs. In Sweden, a number of national quality registries document healthcare actions and outcomes for different patient-groups and problem-areas. While these registries have long been used for follow-up purposes and for clinical research, they have not been used extensively for systematic clinical improvement purposes. The overall aim of this thesis was to examine if, and how, QICs which are supported by national quality registries can contribute to quality improvement in the provision of healthcare. The aim was also to examine what learning and new understanding occurred in the application of QICs in different settings.The empirical material in this thesis comes from three QICs which included participating teams from different hospitals and health centres in Sweden. Each QIC included a national quality registry: the National Quality Registry for Acute Myocardial Infarction Care (RIKS-HIA); the National Diabetes Registry (NDR); and the Swedish Paediatric Diabetes Quality Registry (SWEDIABKIDS).The thesis draws on an interactive research approach. The data collection and analysis employed both qualitative and quantitative methods. Data fromthe National Quality Registries, final team reports, focus-group interviews, and team members’ experiences were analysed and triangulated.The studies shows that QICs which are supported by national quality registries helped teams to close a number of gaps between ordinary clinical practice and evidence-based guidelines, thereby contributing to the provision of better care and better clinical outcomes (Study I, Study II, and Study III). Important factors for success included stakeholders’ learning andunderstanding of the organisational context; structures that supported improvement efforts; and team members’ and managers’ commitment to improvement (Study IV). Furthermore, support by an internal team coach also promoted success (Study IV).This thesis shows how national quality registries can be used in combination with systematic improvement efforts to produce better clinical results. It concludes that different areas of QIC application pose different challenges; for example, addressing care for acute disease versus chronic disease and evaluating professionally influenced process measures versus patient dependent outcome measures. While different organizational contexts and care characteristics can pose challenges to QIC efforts, the formation of “Communities of Practice” during QICs enhanced the learning for improvement with and from others.
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