| 1. |
- Andersson, Anna-Karin, et al.
(författare)
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Triage in the emergency department : A qualitative study of the factors which nurses consider when making decisions
- 2006
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Ingår i: Nursing in Critical Care. - 1362-1017 .- 1478-5153. ; 11:3, s. 136-145
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Tidskriftsartikel (refereegranskat)abstract
- Triage, as a concept, is relatively new in Sweden and means 'sorting'. The triage process was developed to grade patients who needed immediate care. Triage is currently important for the emergency treatment system, and nurses are expected to work with it professionally. The aim of this study is to describe how nurses implement triage when patients arrive at the emergency department of a county hospital, situated in a rural area of Sweden, as well as to highlight the factors considered when prioritizing, in connection with nurses' decision-making. The method used was observations of 19 nurses, with minimal disturbance in their triage work, followed by a short tape-recorded interview, during which the nurses were asked to reflect upon their decision of priorities. Qualitative content analysis of data has been used. The results were divided into two areas, internal factors and external factors. The internal factors reflect the nurse skills and personal capacity. The external factors reflect work environment, including high workload and practical arrangements, and should always be perceived and taken into consideration. Using these factors as a basis, the patients' clinical condition, clinical history, various examinations and tests form an assessment, which subsequently results in a prioritization.
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| 2. |
- Björkman Randström, Kerstin, et al.
(författare)
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Activity and participation in home rehabilitation : Older people's and family members perspectives
- 2013
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 45:2, s. 211-216
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the experiences of older people and their supporting family members in relation to home rehabilitation, with a focus on activity and participation. Methods: Qualitative interviews were carried out with 6 older people and 6 family members at 1 and 6 months after the older person’s discharge to their home. Qualitative content analysis of the data was carried out. The International Classification of Functioning, Disability and Health provides a guiding framework for rehabilitation. Results: Informants’ experiences of home rehabilitation contributed to the formation of 6 categories: (i) living with a frail body; (ii) striving for well-being in daily life; (iii) being close at hand; (iv) feeling dependent in daily life; (v) struggling to carry on; and (vi) striving to be at home. Conclusion: Older people’s goals were to return to daily routines and to perform meaningful activities without feeling dependent on other people. Family members’ participation was crucial. Psychosocial support and autonomy were essential for facilitating activity and participation. Healthcare professionals should consider each individual’s unique experiences along with the significance of being at home.
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| 3. |
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| 4. |
- Björkman Randström, Kerstin
(författare)
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Hemmet som arena för äldres rehabilitering
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingens övergripande syfte var att studera multidisciplinära teams, äldre personers och familjemedlemmars erfarenheter av hemrehabilitering. Avhandlingen baseras på fyra studier (I-IV). Alla studierna har en kvalitativa beskrivande design. Datamaterialet utgjordes av fokusgruppsintervjuer med personal arbetande i team i kommunal hälso- och sjukvård (I), intervjuer med äldre personer, över 65 år, som vårdats på sjukhuset och därefter fortsatt rehabilitering i hemmet (II,III,IV), samt familjemedlemmar involverade i de äldres rehabilitering (II).Studie I visade på betydelsen av att möta äldres individuella behov och att arbeta utifrån ett rehabiliterande förhållningssätt i avsikt att ge en hjälp som inte innebär att ta över handlingar från den äldre. Väsentligt var att i teamet reflektera över hur man agerar utifrån den egna professionen för att kunna utveckla ett rehabiliterande förhållningssätt i det dagliga arbetet. I resultatet framkom att teamen uppfattade hemrehabilitering som positiv för de äldre, men mindre lämpligt om de äldre var svårt sjuka och de kände sig otrygga i sitt hem. Respekt för de äldres integritet i deras hem och att göra de närstående delaktiga i rehabiliteringen betonades. Resultatet visade på att för att kunna utveckla samarbetet i teamet finns behov av att diskutera varje professions ansvarsområde och klargöra gränser mellan varandras ansvarområden. Behovet av att tillföra psykosocial kompetens i teamet framhölls för att möta de äldres behov. I studie II framkom att de äldre upplevde rehabiliteringen vara en balansgång i att känna av vad kroppen orkar med för dagen och vad som är realistiskt att uppnå för att känna välbefinnande. Tryggheten i att ha någon i familjen nära sig i hemmet var oumbärligt för att våga utföra träning och vardagliga aktiviteter. Resultatet visar på de äldres upplevelse av otillfredsställelse med att vara beroende av andra. Familjemedlemmar var engagerade i de äldres rehabilitering genom att finnas till hands, hjälpa till och vara stödjande, vilket var en självklar handling men också utmanande i att kunna hjälpa på rätt sätt. Bristande information om hjälpmedels funktion och användning skapade frustration. Resultatet visar att både de äldre och deras familjemedlemmar ser hemmiljön bidra till att underlätta rehabilitering. Det som försvårar är när gränsen för det egna hemmet inskränkts i och med att och personal ofta gick "in och ut" i det egna hemmet.Studie III visar på ett flertal faktorer i de äldres vardag och i det omgivande samhället som inverkat underlättande eller hindrande på aktiviteter och delaktighet vid hemrehabilitering. Resultatet beskrivs utifrån Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) i 19 kategorier i domänen omgivningsfaktorer. Som underlättande faktorer framträder bl.a. tillgång till hjälpmedel, en fysisk miljö tillgänglig för aktiviteter samt att få stöd från närstående, vänner och personal i hälso- och sjukvård och omsorg. I resultatet framkom betydelsen av ett empatiskt förhållningssätt när personal möter den äldre personen i dennes hem. Resultatet indikerar att hemrehabilitering inte till fullo tillgodoser äldres behov av rehabilitering. I studie IV framkommer personliga faktorer som inre styrka, motivation, engagemang och tålamod för att nå positiva resultat i en rehabilitering som sträcker sig över flera år. Rehabilitering beskrivs i fysiska och psykiska faser som övergick i att hantera en fysisk funktionsnedsättning med svårigheter att gå i dagligt liv. Resultatet visar på betydelsen av adekvat information, vikten av socialt stöd och tillgänglighet till hälso- och sjukvårdspersonal under rehabiliteringsprocessen.Avhandlingen bidrar till en ökad kunskap om hur multidisciplinära team, äldre personer och familjemedlemmar upplever rehabilitering i hemmiljö. Nyttan med avhandlingen kan medföra att hemrehabilitering som vårdform kan bli föremål för diskussioner om hur det utformas och organiseras för att på bästa sätt stödja de äldre och närstående med utgångspunkt från de äldres och närståendes erfarenheter och upplevelser. Detta kan ses gagna deltagarna på individnivå men även för utveckling inom yrkesprofessionen. Avhandlingen har även visat på möjligheten att implementera ICF i rehabiliterande omvårdnad.
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| 5. |
- Björkman Randström, Kerstin, et al.
(författare)
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"I have to be patient" - A longitudinal case study of an older man's rehabilitation experience after a hip replacement surgery
- 2013
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Ingår i: Journal of Nursing Education and Practice. - : Sciedu Press. - 1925-4040 .- 1925-4059. ; 3:8, s. 160-169
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Tidskriftsartikel (refereegranskat)abstract
- Background: Aging can bring about an increased risk of disability. Following illness or injures, rehabilitation is essentialif the individual affected is to attain and maintain independence. Performing rehabilitation with a person-centeredapproach is vital for positive outcomes. Health providers are increasingly interested in developing rehabilitation servicesin outpatient settings for older people in their own homes. Aim: The aim of this study was to describe an older man’s rehabilitation experience after a hip replacement surgery.Design: A longitudinal qualitative descriptive single case study.Methods: Interviews were conducted on four occasions with the participant in his own home. The interviews wereconducted one month, seven months, one year, and five years after the patient was discharged from the hospital. The datawere analyzed using qualitative content analysis.Results: Three categories emerged: (i) having feelings of despair, (ii) being in charge, and (iii) having rehabilitative support. The results demonstrate the participant’s decreased ability to walk after a complicated hip surgery, and his physical and psychological struggle for well-being in everyday life. A strong motivation to return to as normal a life aspossible facilitated the rehabilitation. Also, a supportive family and accessible health care professionals were essential tothe positive outcome of the home rehabilitation.Conclusion: Rehabilitation can extend over a long period to maintain and improve mobility. Also, living with a disability causes feelings of despair. The home can be a source of energy but also a place of challenges during rehabilitation. To support older people in achieving their rehabilitation goals and engaging in meaningful activities, professionals should focus on personal factors, psychosocial support and on influential factors in the home environment and in society in general.
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| 6. |
- Björkman Randström, Kerstin, et al.
(författare)
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Impact of environmental factors in home rehabilitation − a qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers
- 2012
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 34:9, s. 779-787
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.
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| 7. |
- Björkman Randström, Kerstin, et al.
(författare)
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Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people
- 2014
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Ingår i: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 9:1, s. 25-33
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people.AimThe aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people.MethodsFive focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis.ResultsTwo main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: ‘giving ‘hands-off’ support’ and ‘being in a home environment’. The second main category, working across professional boundaries, consisted of the subcategories: ‘coordinating resources’ and ‘learning from each other’.ConclusionCommon goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation.Implications for practiceTeam performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on ‘hands-off’ support in order to incorporate an individual's everyday activities as a part of their rehabilitation.
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| 8. |
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| 9. |
- Bosse, Ek, 1951-, et al.
(författare)
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Registered nurses’ experiences of their decision-making at an Emergency Medical Dispatch Centre
- 2015
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 24:7-8, s. 1122-1131
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To describe registered nurses experiences at an Emergency Medical Dispatch Centre.Background: It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patients arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses.Design: A qualitative design was used for this study.Methods: Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used.Results: Two themes emerged during the analysis: ‘Having a profession with opportunities and obstacles’ and ‘Meeting serious and difficult situations’, with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned.Conclusions: Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses.Relevance to clinical practice: Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame-free culture are important factors to attract and retain employees.
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| 10. |
- Ek, Bosse, 1951-, et al.
(författare)
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Reliability of a Swedish pre-hospital dispatch system in prioritizing patients
- 2013
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 21:2, s. 143-149
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Tidskriftsartikel (refereegranskat)abstract
- The need of emergency help often begins with a call to a dispatch center. The operator uses a medical index to prioritize dispatches. Since the resources of ambulances are limited, it is important that the priority grading decided by the operator at the dispatch center is as adequate as possible. In the county of Jamtland in Sweden, a system for triage named METTS-A (Medical Emergency Triage and Treatment System-A) has been in use since 2009, when the patient is coded according to priority level. The aim of this study was to analyse the sensitivity and specificity of the priority grading made by the dispatch center in comparison with the METTS-A priority assessed by the ambulance nurse. Statistics from a data-base in northern Sweden were analyzed. The material covered every ambulance that was dispatched, 6986 times during the period of data collecting. The results show a high sensitivity but low specificity in the dispatch system. The results also indicate that over prioritization exists since most of the patients with a high acute need of an ambulance are correctly identified, while many patients without that need are also given a high priority ambulance service. Therefore the conclusions were that both over- and under prioritizations were made.
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