| 1. |
- Jansson, Inger, 1964, et al.
(författare)
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Documentation of person-centred health plans for patients with acute coronary syndrome.
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 17:2, s. 114-122
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Tidskriftsartikel (refereegranskat)abstract
- Personalised care planning is argued for but there is a need to know more about what the plans actually contain.To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome.Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients' own resources and support needed.The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation.In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work.
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| 2. |
- Ulin, Kerstin, 1963, et al.
(författare)
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Flip focus and emphasise patient resources in person-centred care over the telephone-A retrospective descriptive study
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 37:3, s. 797-804
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The study aim was to describe the content of person-centred health plans, formulated via telephone conversations between registered nurses and patients with chronic obstructive pulmonary disease and/or chronic heart failure. Method: Patients who had been hospitalised due to worsening chronic obstructive pulmonary disease and/or chronic heart failure were enrolled. After hospital discharge, the patients received a person-centred telephone support where a health plan was co-created with registered nurses who had received training in the theory and practice of person-centred care. A retrospective descriptive review of 95 health plans using content analysis was conducted. Results: The health plan content revealed personal resources such as optimism and motivation in patients with chronic obstructive pulmonary disease and/or chronic heart failure. Although patients reported severe dyspnoea symptoms, the most common goals were to engage in physical activity and to be able to manage social life and leisure activities. Additionally, the health plans illustrated that patients were capable of using their own interventions to reach their goals rather than accessing municipal and health care support. Conclusion: The focus on listening, that person-centred telephone care affords, promotes the patient's own goals, interventions, and resources, which can be used to tailor support and engage the patient as an active partner in their care. The flipped focus from patient to person highlights the person's own resources, which in turn may contribute to a reduced need for hospital care.
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| 3. |
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| 4. |
- Bjurling-Sjöberg, Petronella, 1968-, et al.
(författare)
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Action research improved general prerequisites for evidence-based practice
- 2021
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Ingår i: Heliyon. - : Elsevier BV. - 2405-8440. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- The present study was part of an action research project that was performed to implement a clinical pathway for patients on mechanical ventilation and simultaneously explore the implementation process in a Swedish intensive care unit. The aim of this questionnaire study was to evaluate whether an action research methodology could affect the general prerequisites for evidence-based practice (EBP). Informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, the study included registered nurses, assistant nurses and anesthesiologists in the unit at start of the project (n = 50) and at follow-up (n = 44). Data was collected with the Evaluation Before Implementation Questionnaire and the Attitudes towards Guidelines Scale. The results revealed that the general prerequisites for EBP in the setting improved. Compared to baseline measurements, the staff at follow-up conversed significantly more about the importance of the patients' experiences, research utilization, context and facilitation, while changes with respect to clinical experiences were not significant. The attitudes towards guidelines were perceived as positive at baseline as well as at follow-up and did not significantly change. Longer professional experience was associated with a slightly lower probability of perceiving that the importance of research utilization was discussed and reflected upon, while belonging to a profession with longer education was associated with a higher probability of this perception. Compared to registered nurses and assistant nurses, the anesthesiologists perceived, to a greater extent, that the importance of clinical experience was discussed and reflected upon in the setting, while there was no significant association with the length of professional experience and/or specific professions regarding the other components. In conclusion, using action research to implement a clinical pathway methodology seems to set in motion various mechanisms that improve some but not all prerequisites that, according to the PARIHS framework, are advantageous for EBP.
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| 5. |
- Bjurling-Sjöberg, Petronella, et al.
(författare)
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Balancing intertwined responsibilities: A grounded theory study of teamwork in everyday intensive care unit practice
- 2017
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Ingår i: Journal of Interprofessional Care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 31:2, s. 233-244
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to describe and explain teamwork and factors that influence team processes in everyday practice in an intensive care unit (ICU) from a staff perspective. The setting was a Swedish ICU. Data were collected from 38 ICU staff in focus groups with registered nurses, assistant nurses, and anaesthetists, and in one individual interview with a physiotherapist. Constant comparative analysis according to grounded theory was conducted, and to identify the relations between the emerged categories, the paradigm model was applied. The core category to emerge from the data was balancing intertwined responsibilities. In addition, eleven categories that related to the core category emerged. These categories described and explained the phenomenon's contextual conditions, causal conditions, and intervening conditions, as well as the staff actions/interactions and the consequences that arose. The findings indicated that the type of teamwork fluctuated due to circumstantial factors. Based on the findings and on current literature, strategies that can optimise interprofessional teamwork are presented. The analysis generated a conceptual model, which aims to contribute to existing frameworks by adding new dimensions about perceptions of team processes within an ICU related to staff actions/interactions. This model may be utilised to enhance the understanding of existing contexts and processes when designing and implementing interventions to facilitate teamwork in the pursuit of improving healthcare quality and patient safety.
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| 6. |
- Bjurling-Sjöberg, Petronella, et al.
(författare)
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Factors affecting the implementation process of clinical pathways : A mixed method study within the context of Swedish intensive care
- 2015
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 21:2, s. 255-261
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives Clinical pathways (CPs) can improve quality of care on intensive care units (ICUs), but are infrequently utilized and of varying quality. Knowledge regarding factors that facilitate versus hinder successful implementation of CPs is insufficient and a better understanding of the activities and individuals involved is needed. The aim of this study was to explore the implementation process of CPs within the context of ICUs. Methods An exploratory design with a sequential mixed method was used. A CP survey, including all Swedish ICUs, was used to collect quantitative data from ICUs using CPs (n = 15) and interviews with key informants (n = 10) were used to collect qualitative data from the same ICUs. Descriptive statistics and qualitative content analysis were used, and the quantitative and qualitative findings were integrated. Results The CP implementation was conceptualized according to two interplaying themes: a process to realize the usefulness of CPs and create new habits; and a necessity of enthusiasm, support and time. Multiple factors affected the process and those factors were organized in six main categories and 14 subcategories. Conclusions Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation.
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| 7. |
- Bjurling-Sjöberg, Petronella, 1968-, et al.
(författare)
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Struggling for a feasible tool - the process of implementing a clinical pathway in intensive care: a grounded theory study
- 2018
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Ingår i: BMC Health Serv Res. - : Springer Science and Business Media LLC. - 1472-6963. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundClinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.MethodsThe setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.ResultsA conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as Struggling for a feasible tool,' was the core category that linked all categories. The phenomenon evolved from the Triggers' (Perceiving suboptimal practice' and Receiving external inspiration and support'), pervaded the Implementation process' (Contextual circumstances,' Processual circumstances' and Negotiating to achieve progress'), and led to the process Output' (Varying utilization' and Improvements in understanding and practice'). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.ConclusionsThe findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.
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| 8. |
- Björvell, Catrin, et al.
(författare)
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Creating Subsets of International Classification for Nursing Practice Precoordinated Concepts: Diagnoses/Outcomes and Interventions Categorized Into Areas of Nursing Practice
- 2024
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Ingår i: Computers, informatics, nursing : CIN. - 1538-9774. ; 42:1, s. 21-26
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Tidskriftsartikel (refereegranskat)abstract
- The International Classification for Nursing Practice is a comprehensive terminology representing the domain of nursing practice. A categorization of the diagnoses/outcomes and interventions may further increase the usefulness of the terminology in clinical practice. The aim of this study was to categorize the precoordinated concepts of the International Classification for Nursing Practice into subsets for nursing diagnoses/outcomes and interventions using the structure of an established documentation model. The aim was also to investigate the distribution of the precoordinated concepts of the International Classification for Nursing Practice across the different areas of nursing practice. The method was a descriptive content analysis using a deductive approach. The VIPS model was used as a theoretical framework for categorization. The results showed that all the precoordinated concepts of the International Classification for Nursing Practice could be categorized according to the keywords in the VIPS model. It also revealed the parts of nursing practice covered by the concepts of the International Classification for Nursing Practice as well as the parts that needed to be added to the International Classification for Nursing Practice. This has not been identified in earlier subsets as they covered only one specific area of nursing.
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| 9. |
- Calebrant, H., et al.
(författare)
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How the Nurse Anesthetist Decides to Manage Perioperative Fluid Status
- 2016
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Ingår i: Journal of Perianesthesia Nursing. - Maryland Heights, MO : Elsevier BV. - 1089-9472 .- 1532-8473. ; 31:5, s. 406-414
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine the factors that affect how nurse anesthetists in a county in Sweden decide how to manage perioperative fluid status. Design: A cross-sectional qualitative study was conducted at two surgical wards in a county hospital. Methods: Sixteen nurse anesthetists were interviewed to explore how nurse anesthetists assess patients' intraoperative fluid requirements and the subsequent measures adopted. Finding: Three categories emerged through content analysis: clinical criteria and the thought process that drives decision making, interdependence in decision making, and uncertainty in decision making. Conclusions: This study revealed differences with regard to fluid management among nurse anesthetists in a county in Sweden. For the assessments and subsequent measures that are carried out to ensure optimal fluid therapy, more research is needed to provide evidence, and evidence-based guidelines need to be developed in Sweden.
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| 10. |
- Eriksson, Elisabet, 1971-, et al.
(författare)
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Preceptors' experiences of supervising internationally educated nurses attending a bridging program: An interview study
- 2023
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Ingår i: Nurse Education Today. - : Elsevier. - 0260-6917 .- 1532-2793. ; 131
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInternationally educated nurses attending a bridging program must demonstrate clinical competence and meet requirements to apply for a nursing license in Sweden.ObjectivesTo describe preceptors' experiences of supervising internationally educated nurses undergoing clinical practice education during a bridging program.DesignA qualitative descriptive study.SettingsTwo universities offering the 1-year bridging program for nurses with a nursing degree from outside European Union/European Economic Area and Switzerland.ParticipantsFifteen preceptors, all registered nurses, who supervised internationally educated nurses were included.MethodsSemi-structured interviews were performed, and data were analyzed using qualitative content analysis.ResultsSupervising internationally educated nurses was not the same as supervising nursing students and raised feelings of both joy and frustration. Preceptors had to adapt supervision to the student's nursing knowledge and skills. They had to help students communicate in Swedish and form good relationships with other students, patients, and other professionals. Most preceptors requested more information about the student's nurse education, country of education/cultural background, and previous work experiences. Mixed experiences of support from the university, first-line managers, and colleagues were reported.ConclusionsBeing a preceptor for internationally educated nurses is a challenge, and supervision training is important for managing preceptorship. To supervise students based on their level of knowledge and skills, more information must be shared with the preceptor. Encounters with others are of importance in the training, where teamwork and person-centered care must be in focus, both in prior theoretical education and in clinical practice education.
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