| 1. |
- Finbråten, Hanne Søberg, 1972-
(författare)
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Measuring health literacy : Evaluating psychometric properties of the HLS-EU-Q47 and the FCCHL, suggesting instrument refinements and exploring health literacy in people with type 2 diabetes and in the general Norwegian population
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim was to measure health literacy (HL) in people with type 2 diabetes (T2DM) and in the general Norwegian population.Methods: Sampling 388 people with T2DM (papers I, II and IV) and 900 individuals (III) in the general Norwegian population a cross-sectional design was applied. Rasch modelling and confirmatory factor analysis were used to evaluate the psychometric properties of the 47 items HLS-EU-Q47 questionnaire (I and III) and the 14 items FCCHL scale (II), and to develop and evaluate a 12 item short version, HLS-N-Q12 (III and IV), based on HLS-EU-Q47. Descriptive and inferential statistics were used to describe HL and to investigate associations between HL and various independent variables.Main results: The HLS-EU-Q47 displayed psychometric shortcomings in both populations (I and III). A 12-dimensional model described the data best. Several items showed misfit to the Rasch model and statistical dependence. Aiming at meeting the requirements of objective measurement, the HLS-N-Q12 was suggested (III and IV). Evaluating the FCCHL in people with T2DM, the data fitted a three-dimensional model best (II). Several items showed misfit to the Rasch model and unordered response categories. However, a three-dimensional 12-item version of the FCCHL had acceptable psychometric properties. Education, good general health and empowerment were positively associated with HL in people with T2DM, explaining about 17% of the total variance in HL (IV).Conclusions: In both populations, the HLS-N-Q12 displayed solid psychometric properties and might therefore be used as a measure of HL for both clinical and research purposes. Nurses and other health professionals must be aware that HL influence individuals’ proficiency in managing their health. Hence, nurses and other health professionals should map HL in individuals and adapt health information accordingly.
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| 2. |
- Myhrene Steffenak, Anne Kjersti, 1955-
(författare)
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Mental Distress and Psychotropic Drug Use among Young People, and Public Health Nurses` Conceptions of Their Roles
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to study mental distress, health and lifestyle habits, social factors and psychotropic drug use by young people, and how PHNs conceive their roles in relation to this.Methods: Quantitative and qualitative methods were used. Study I included data from the Norwegian Youth Health Study (NYHS, 11 620 participants, aged 15-16 years) (2000–2003) linked to the Norwegian Prescription Database (NorPD) (2004–2009). Study II included prescription data on psychotropic drugs among 15-16 year olds from the NorPD (2006–2010). Eight young people were interviewed and qualitative content analysis was used to analyse the data (III). Study IV included interviews with 20 Public Health Nurses (PHN), and was analysed using a phenomenographic approach.Main results: Mental distress was reported among 15.5% of the adolescents non-users of psychotropic drugs, 75% of whom were girls. In both genders reporting mental distress, incident psychotropic use was higher one to nine years, up to 27.7% among girls, as compared with the rest of the participants. In addition, health, lifestyle habits and social factors were associated with incident use (I). Psychotropic drug use increased during 2006–2010, hypnotics and melatonin accounted for most of the increase. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010 (II). Young people experience both beneficial and undesired effects from psychotropic drugs. Access to professional support and follow-up was experienced as insufficient. Life with family, friends, school and work was influenced by psychotropic drug use, and they were afraid of being lonely and stigmatized (III). The PHNs conceived their roles in relation to young people as; the discovering PHNs who became aware of psychotropic drug use in the health dialogues and chose either to act or not to act in relation to this. Those PHNs who took action continued to be the cooperating PHNs who cooperated with the young people, their families, schools, and others. If cooperation was established, the supporting PHNs teach and support the young people in relation to psychotropic drug use (IV).Conclusions: Attention must be paid to poor mental health and increasing psychotropic drug use by young people. Advances in knowledge, treatment and follow-up are needed. The prevalence of mental distress among young people, with differences between the genders, as well as between socioeconomic groups, should have consequences for health promotion strategies. PHNs in Norway, working in health centres and schools, have responsibility and opportunity to identify and follow-up young people with mental health problems.
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| 3. |
- From, Ingrid, 1953-
(författare)
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Health and quality of care from older peoples' and formal caregivers' perspective
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I). The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.
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| 4. |
- Bjuresäter, Kaisa, 1970-
(författare)
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Home enteral tube feeding - from patients’, relatives’ and nurses’ perspectives
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.
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| 5. |
- German Millberg, Lena, 1958-
(författare)
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Akademisering av specialistsjuksköterskans utbildning i Sverige : Spänningsförhållanden med anledning av utbildningsreform i enlighet med Bologna
- 2012
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Licentiatavhandlingens övergripande syfte var att studera konsekvenser av ökad akademisering och akademiskt lärande inom Svensk specialist-sjuksköterskeutbildning efter genomförande av ny utbildningsreform enligt Bologna.Bakgrund: Specialistsjuksköterskor förväntas i dagens hälso– och sjukvård att kunna bedriva en patientsäker och evidensbaserad vård, vilket kräver akademisk kompetens. Utbildningen till specialistsjuksköterska fördes i och med Bolognaprocessens införande i Sverige 2007 till avancerad utbildningsnivå. Både yrkesexamen och akademisk examen (magisterexamen) skulle inkluderas och integreras i samma utbildning. Detta medförde en förändring från en ämnesinriktad (samlingskodsinriktad) läroplan till en läroplan som syftar till att integrera ämnen (integrationskodsinriktad). Förutom ämnesintegrering skulle yrkesspecifika mål integreras med akademiska mål.Metod: Artikel I genomfördes i form av ett didaktiskt aktionsforskningsprojekt som pågick under 2½ år. En projektledningsgrupp (n=15-18) från fem lärosäten bildades. Denna grupp har aktivt deltagit i hela aktionsforskningsprocessen och vid projektmöten. Vid varje lärosäte utsågs en projektansvarig som ansvarade för den lokala aktionsforskningsprocessen. Dessa personer samlande in data i form av kursplaner, utbildningsplaner, studiehandledningar, minnesanteckningar från lärarmöten och möten med vårdverksamheter samt minnesanteckningar från forskargruppensmöten. Analys har gjorts med hjälp av konstant komparativ analysmetod. I artikel II användes konstruktivistisk Grounded Theory för att samla in och analysera data. Datainsamlingen påbörjades utifrån specialistsjuksköterskestudenters svar på en enkäts öppna fråga (n=120) i samband med utbildningens avslutning 2009 och 2010. Enkätsvaren reste frågor om specialistsjuksköterskans akademiska lärande. För att inhämta en djupare förståelse genomfördes intervjuer med specialistsjuksköterskor (n=12) som yrkesarbetat mellan 5 och 12 månader efter sin examen. Intervjuerna genomfördes från juni till oktober 2011. Avslutningsvis jämfördes svaren på den öppna enkätfrågan med analysen av intervjuerna.Resultat: Vid utbildningsreformens införande fanns pedagogiska motsättningar och didaktiska svårigheter som gav upphov till spänningsförhållanden mellan vårdutveckling, forskning, yrkesspecifika mål och akademiska mål. Spänningsförhållanden framkom också när specialistsjuksköterskorna inte erfor att deras akademiska kompetens tillvaratogs och värderades i vårdverksamheten. När stöd inte fanns för akademiskt lärande uppkom villrådighet och specialistsjuksköterskorna blev ambivalenta över om akademiskt lärande var meningsfullt. För att främja meningsfullt akademiskt lärande framhåller deltagarna betydelsen av samverkan och gemensamma arenor mellan lärosäten och vårdverksamhet där nyttoaspekten med akademiskt lärande tydliggörs. De spänningsförhållanden som framkommer var av både positiv och negativ karaktär.
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| 6. |
- Göransson, Katarina, 1974-
(författare)
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Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process. In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country. The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences. The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings. In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.
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| 7. |
- Rosengren, Kristina, 1963-
(författare)
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Hälso- och sjukvårdsorganisation i förändring : Från distanserat till delat ledarskap
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syfte: Avhandlingen syftar till att följa upp, beskriva samt generera tentativ teori om pågående förändringsprocesser inom hälso- och sjukvården på såväl makronivå genom studier av sjukhusfusioner som mikronivå genom studier av delat ledarskap. Metod: ”Sjukhusfusioner” beskriver två genomförda sjukhussammanslagningar utifrån en kvalitativ ansats, Grounded Theory med intervjuer av vårdpersonal (I, II). ”Delat ledarskap” utgår från en förändrad ledarskapsmodell på en intensivvårdsavdelning med intervjuer (III-IV) samt frågeformulär (V) som datainsamlingsmetod. Vårdpersonalens uppfattningar av ledarskap redovisas genom en fenomenografisk ansats (III). Vidare beskrivs två avdelningschefers upplevelser av att ha arbetat i ett delat ledarskap genom Grounded Theory (IV). I den sista delstudien (V) används en kvantitativ metod i form av ett frågeformulär. En del av dessa frågor ingår i instrumentet QPSNordic som belyser vårdpersonalens åsikter om arbete, ledarskap och delat ledarskap. Resultat: Vårdpersonalen uttryckte behov av delaktighet och balans mellan olika behov och krav i ett förändringsarbete. Ledarskapets betydelse lyftes fram som en framgångsfaktor för att utveckla hälso- och sjukvårdsorganisationer i förändring. Vårdpersonalens idealbild av sjuksköterskans ledarskap utgjordes av en chef som var närvarande och tillgänglig i den dagliga verksamheten. Begreppet stödjande tvåsamhet lyftes fram som kärnan i delat ledarskap. Stödjande tvåsamhet, en tillitsfull relation mellan avdelningscheferna, bidrog till en god arbetsmiljö då ansvar och befogenheter delades av aktuellt ledarpar. Vårdpersonalen hade en positiv syn på sitt arbete och ledarskapet. De ansåg att det delade ledarskapet ökade avdelningschefernas möjligheter att vara engagerade och tillgängliga i det dagliga arbetet. Konklusion: Resultatet har bildat underlag för två empiriskt grundade modeller; engagerat ledarskap och stödjande tvåsamhet. Engagerat ledarskap utgår från begreppen delaktighet och stöd i en vårdande kultur. Stödjande tvåsamhet bygger på en gemensam värdegrund och olikheter i kompetens hos ledarparet som ligger till grund för utveckling av en tillitsfull relation. Vidare har teorin om det caritativa ledarskapet vidareutvecklats genom begreppet stödjande tvåsamhet som belyser relationen chef till chef i en vårdande kultur.
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| 8. |
- Wangensteen, Sigrid, 1954-
(författare)
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Newly graduated nurses' perception of competence, critical thinking and research utilization.
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sigrid Wangensteen has the recent years been engaged in doctoral studies at Karlstad University in combination with teaching at the bachelor program in nursing at Gjøvik Universtity College.This doctoral thesis is focused on newly graduated nurses, their perception of competence, critical thinking dispositions, research use and their experiences of being a nurse during their first year as a nurse. Qualitative and quantitative methods were used.The very first period of time was experienced as tough but when looking back the newly graduated nurses appreciated the tough time. They described the need for a supportive environment, and gaining competence through managing challenging situations. The leadership role constituted the main difference between being a student and being a nurse. In the quantitative study the nurses perceived their competence as good, rating the Helping role competence category highest and the Ensuring quality competence category lowest. With respect to critical thinking the CCTDI total scores indicated a positive disposition. As regards the CCTDI subscale scores the nurses reported highest values for intellectual curiosity (Inquisitiveness) and lowest for intellectual honesty (Truth-seeking). The nurses reported a positive attitude towards research, but only 24% were classified as research users. Supportive environment was a significant predictor for research use. Critical thinking was a prominent predictor for attitude towards research, for research use and perception of competence.Nurse leaders in clinical practice and nurse educators in nursing education and clinical practice play an important role in nurturing student nurses and newly graduated nurses with respect to critical thinking. There is a need to assess whether teaching strategies meet the requirements of critical thinking and EBP in nursing education.
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| 9. |
- Wikehult, Björn, 1950-
(författare)
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Use of Healthcare, Perceived Health and Patient Satisfaction in Patients with Burns
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn. The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire. Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity. Social desirability was lower among care utilisers and was associated with burn-related health aspects. The participants reported a low level of negative care experiences, the most common of which was Powerlessness. Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R2 was 0.25. In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R2 was 0.19. The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.
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| 10. |
- Arakelian, Erebouni, 1973-
(författare)
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Operating Room Efficiency and Postoperative Recovery after Major Abdominal Surgery : The Surgical Team’s Efficiency and the Early Postoperative Recovery of Patients with Peritoneal Carcinomatosis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In selected patients, surgical treatments such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have enabled curative treatment options for previously incurable diseases, such as peritoneal carcinomatosis (PC). The introduction of resource demanding surgery could affect the work process, efficiency, and productivity within a surgical department and factors influencing patient postoperative recovery processes may have an impact on the efficiency of patient care after major surgery.The aim of this thesis was to investigate operating room efficiency from the perspective of both staff and leaders’ in two different settings (Papers I and II) and the early postoperative recovery of patients with peritoneal carcinomatosis (Papers III and IV).Interviews were held with 21 people in a county hospital and 11 members of the PC team in a university hospital, and a phenomenographic approach was used to analysis the data (Papers I and II). The patients’ postoperative recovery and pulmonary adverse events (AE) were determined from data retrieved from the electronic health records of 76 patients (Papers III and IV).The concept of efficiency was understood in different ways by staff members and their leaders (Paper I). However, when working in a team, the team members had both organisation-oriented and individual-oriented understanding of efficiency at work that focused on the patients and the quality of care (Paper II).The patients with PC regained gastrointestinal functions and could be mobilised during early postoperative recovery phase, although many patients suffered from psychological disturbances, sleep deprivation, and nausea (Paper III). Postoperative clinical and radiological pulmonary AE were common, but did not affect the early recovery process (Paper IV).In conclusion, leaders who are aware of the variation in understanding the concept of efficiency are better able to create the same platform for staff members by defining the concept of efficiency within the organisation. In a team organisation, the team members have a wider understanding of the concept of efficiency with more focus on the patients. The factors affecting postoperative recovery and pulmonary AE should be considered when designing individualised patient care plans in order to attain a more efficient recovery.
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