| 1. |
- Steneberg, Pär, et al.
(författare)
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PAN-AMPK activator O304 improves glucose homeostasis and microvascular perfusion in mice and type 2 diabetes patients
- 2018
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Ingår i: JCI INSIGHT. - : American Society for Clinical Investigation. - 2379-3708. ; 3:12
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Tidskriftsartikel (refereegranskat)abstract
- AMPK activated protein kinase (AMPK), a master regulator of energy homeostasis, is activated in response to an energy shortage imposed by physical activity and caloric restriction. We here report on the identification of PAN-AMPK activator O304, which - in diet-induced obese mice - increased glucose uptake in skeletal muscle, reduced beta cell stress, and promoted beta cell rest. Accordingly, O304 reduced fasting plasma glucose levels and homeostasis model assessment of insulin resistance (HOMA-IR) in a proof-of-concept phase IIa clinical trial in type 2 diabetes (T2D) patients on Metformin. T2D is associated with devastating micro-and macrovascular complications, and O304 improved peripheral microvascular perfusion and reduced blood pressure both in animals and T2D patients. Moreover, like exercise, O304 activated AMPK in the heart, increased cardiac glucose uptake, reduced cardiac glycogen levels, and improved left ventricular stroke volume in mice, but it did not increase heart weight in mice or rats. Thus, O304 exhibits a great potential as a novel drug to treat T2D and associated cardiovascular complications.
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| 2. |
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| 3. |
- Bankel, Johan, et al.
(författare)
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The CDIO syllabus: a comparative study of expected student proficiency
- 2003
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Ingår i: European Journal of Engineering Education. - : Taylor & Francis. - 0304-3797 .- 1469-5898. ; 28:3, s. 297-315
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Tidskriftsartikel (refereegranskat)abstract
- Engineering students must graduate with command of a vast body of technical knowledge. They must possess personal, interpersonal and system-building skills to function in teams, and be prepared to produce products and systems. Their education must have been structured under a curriculum blending ability to combine technical expertise with ethical, innovative, philosophical and humanistic acumen. This paper describes a unique international collaboration among four universities to reform engineering education. The collaborators agreed to a statement of goals, which includes descriptions of knowledge, skills and attitudes vital to an effective education, and codifies proficiency levels expected of graduates. We developed and utilized unique stakeholder surveys both to validate our prototype and to determine desired proficiency levels. This collaboration resulted in The CDIO Syllabus, A Statement of Goals for Undergraduate Engineering Education. The syllabus is both a template and a process that can be used to customize the syllabus to others' programmes. It can define new educational initiatives/and be employed as the basis for rigorous assessment. This paper details how, with the input of industry, academia and others, we employed an engineering problem-solving paradigm to effect our redesign. It outlines the syllabus and the unique process employed to create it.
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| 4. |
- Bégat, Ingrid, 1942-, et al.
(författare)
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Australian nurse supervisors' styles and their perceptions of ethical dilemmas within health care
- 2003
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 11:1, s. 6-14
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To examine clinical nurse supervisors' styles, in terms of models, organization, focus on supervision and theories used in supervision, as well as their perceptions of ethical dilemmas within health care. BACKGROUND: The importance of clinical supervision in clinical practice has been reported. However, literature dealing with its implementation is rare. METHODS: This study is a descriptive-correlational study. Data were collected by means of a questionnaire from two groups of nurse supervisors randomly selected from a university (n = 55) and a hospital (n = 31). Data were analysed using descriptive and inferential statistics. RESULTS: The models most frequently used were 'case-oriented' and 'decision-making oriented'. The nurse supervision was reported as being organized on a one-to-one basis. The focus of supervision was on 'patient problems' and 'cooperation in team'. The theory most commonly used was the theory of reflection. The supervisors' perceptions of moral dilemmas were related to 'decision making' and actions impacting on quality of care resulting from their supervisor styles. CONCLUSION: By correlating the supervisors' styles and their perceptions of ethical dilemmas, we conclude that it is important to contribute to further research on supervisors' styles in order to ensure successful supervision.
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| 5. |
- Bégat, Ingrid, 1942-, et al.
(författare)
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Implementation of clinical supervision in amedical department: nurses' views of the effects
- 1997
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Ingår i: Journal of Clinical Nursing. - United Kingdom : Wiley Blackwell Publishing Ltd.. - 0962-1067. ; 6:5, s. 389-394
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this pilot study was to investigate nurses' views of the effects of clinical supervision in terms of its influence over their working situation, as well as their satisfaction with their working milieu. The nurses who took part in an education programme and a clinical supervision programme worked on two wards in a medical clinic. Nurses answered a questionnaire measuring the psychosocial environment. Data were analysed by means of descriptive statistics. Results showed that the nurses felt more confirmed in their work and more satisfied with the information given after 9 months of clinical supervision. Results point to the need for further investigations concerning clinical supervision as a method of achieving job satisfaction among nurses.
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| 6. |
- Berggren, Ingela, 1948-, et al.
(författare)
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Australian clinical nurse supervisors' ethical decision-making style
- 2002
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Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 4:1-2, s. 15-23
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Tidskriftsartikel (refereegranskat)abstract
- This paper explores clinical nurse supervisors' ethical styles with regard to supervision in healthcare. Eighty-six registered nurses, all with experience of supervising clinical nurses and students in nursing, completed a specifically designed questionnaire. A qualitative interpretative content analysis identified three core themes: (i) 'Is it safe?'; (ii) 'Is it right?'; and (iii) 'Is it kind?', describing the clinical nurse supervisors' ethical styles. The first core theme 'Is it safe?' covered the supervisors' rules, codes and values that guide their supervisory actions, as well as two sub-themes: (i) empowerment and (ii) integrity. The second core theme 'Is it right?' described the supervisors' responsibility and advocacy as well as the ethical dilemmas experienced in the supervisory process. The third core theme 'Is it kind?' included the supervisors' relationships with patients, professionals and supervisees. The results demonstrate the value of offering a support system, such as clinical supervision, which helps nurses to explore their professional identity for the benefit of the patients.
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| 7. |
- Berggren, Ingela, 1948-, et al.
(författare)
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Core ethical issues of clinical nursing supervision
- 2005
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Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 7:1, s. 21-8
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Tidskriftsartikel (refereegranskat)abstract
- Clinical nursing supervision enables supervisees to reflect on ethically difficult caring situations, thereby strengthening their professional identity, integrating nursing theory and practice, and leading to the development of ethical competence. The aim of this study was to develop an understanding of the core ethical issues of clinical nursing supervision, using previous research as well as philosophical analysis of the theories of three moral philosophers: Harald Ofstad, Richard Hare and Carol Gilligan. The ultimate aim of this study was to develop a general model for ethical decision-making and to establish its relevance for clinical nursing supervision. The findings highlight four important values for the development of a basis for ethical decision-making. These values are caring, dignity, responsibility and virtue.
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| 8. |
- Berggren, Ingela, 1948-, et al.
(författare)
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Decision making within a community provider organization
- 2010
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Ingår i: British Journal of Community Nursing. - 1462-4753 .- 2052-2215. ; 15:12, s. 611-617
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore community nurses' experiences of decision making within the community provider organization. Background: Recent changes in health care with an increasing number of patients being cared for outside of institutions can put considerable pressure on the nurse with respect to decision making. Methods: In-depth interviews were performed with 6 registered nurses in two communities. The interviews were analysed by means of phenomenological hermeneutics. Results: The community nurses' experiences of decision making were interpreted as spiders or octopuses, consultants and troubleshooters. The subthemes were; networking and structuring, responsibility, availability and knowledge, assessment power, information selection, avoiding rules and bypassing managers. In accordance with hermeneutical phenomenology, the findings were discussed and explained with reference to Ofstad's philosophy of freedom to make decisions. Conclusion: In their decision making, community nurses are committed to finding administrative solutions that satisfy patient needs.
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| 9. |
- Berggren, Ingela
(författare)
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Etisk undran i omvårdnadshandledning
- 2014
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Ingår i: Hermeneutik i vårdpraxis. - Malmö : Gleerups Utbildning AB. - 9789140681737 ; , s. 187-196
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Berggren, Ingela, 1948-
(författare)
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Etiska kärnbegrepp i omvårdnadshandledning
- 2009. - 1.
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Ingår i: Omvårdnadshandledning. - Lund : Studentlitteratur. - 9789144053233 ; , s. 193-209
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 11. |
- Berggren, Ingela, 1948-, et al.
(författare)
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Nurse supervisors' actions in relation to their decision-making style and ethical approach to clinical supervision.
- 2003
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 41:6, s. 615-22
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to explore the decision-making style and ethical approach of nurse supervisors by focusing on their priorities and interventions in the supervision process. BACKGROUND: Clinical supervision promotes ethical awareness and behaviour in the nursing profession. METHODS: A focus group comprised of four clinical nurse supervisors with considerable experience was studied using qualitative hermeneutic content analysis. FINDINGS: The essence of the nurse supervisors' decision-making style is deliberations and priorities. The nurse supervisors' willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors' ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors' interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings. CONCLUSION: Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees' professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.
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| 12. |
- Berggren, Ingela, 1948-
(författare)
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Omvårdnadshandledning i teori och praktik
- 2009. - 1.
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Ingår i: Omvårdnadshandledning. - Lund : Studentlitteratur. - 9789144053233 ; , s. 23-43
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 13. |
- Berggren, Ingela, et al.
(författare)
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The influence of clinical supervision on nurses' moral decision making.
- 2000
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Ingår i: Nursing Ethics. - London : Edward Arnold. - 0969-7330 .- 1477-0989. ; 7:2, s. 124--133
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the influence of clinical supervision on nurses´ moral decision making. The sample consisted of 15 registered nurses who took part in clinical supervision sessions. Data were obtained from interviews and analysed by a hermeneutic transformative process. The hermeneutic interpretation revealed four themes: increased self-assurance, an increased ability to support the patient, an increased ability to be in a relationship with the patient, and an increased ability to take responsibility. In conclusion, it seems that clinical supervision enhances nurses´ ability to provide care on the basis of their decision making. However, the qualitative and structural aspects of clinical supervision have to be investigated further in order to develop professional insight into the way that nurses think and react.
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| 14. |
- Berggren, Ingela, 1948-, et al.
(författare)
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The significance of nurse supervisors' different ethical decision-making styles
- 2006
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 14:8, s. 637-43
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The role of the nurse supervisor is very important, because of his/her ability to influence the atmosphere within the clinical nursing supervision group. AIM: To present and interpret nurse supervisors' different ethical decision-making styles. METHOD: A hermeneutic interpretation of three studies on nurse supervisors' different ethical decision-making styles. RESULTS: The significance of the nurse supervisor's ethical decision-making style is reflected in the awareness of their responsibility for creating a relationship with the supervisee. The supervisors focus on ensuring safety, integrating theoretical knowledge and clinical practice, willingness and preparedness to supervise on the substance of nursing, sharing the supervisees' feelings and challenging them, reflecting on the content of clinical nursing supervision as well as promoting justice and integrity in clinical nursing supervision. CONCLUSIONS: The interpretation highlights the importance of the nurse supervisor's style for the outcome of clinical nursing supervision, as they are role models for the supervisees. There is a need for further research to explore the advantages and disadvantages of nurse supervisors' different ethical decision-making styles, especially in relation to the influence of clinical nursing supervision on the quality of care and various support systems.
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| 15. |
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| 16. |
- Berggren, Ingela, 1948-
(författare)
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Vårdandets etik
- 2010. - 1
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Ingår i: Att bli sjuksköterska. - Lund : Studentlitteratur. - 9789144054117 ; , s. 125-144
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 17. |
- Berggren, Ingela, 1948-
(författare)
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Vårdandets etik
- 2019. - 3.
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Ingår i: Att bli sjuksköterska. - Lund : Studentlitteratur AB. - 9789144125350 ; , s. 151-171
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 18. |
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| 19. |
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| 20. |
- Berggren Palme, Ingela
(författare)
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Tuberculosis and HIV interaction in Ethiopian children : aspects on epidemiology, diagnosis and clinical management
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates the influence of HIV on childhood tuberculosis (TB) in a high TB and HIV endemic setting. It is based on four studies involving the same study population of 522 tuberculous children and their 25 3 non-tuberculous controls, consecutively enrolled as out- and inpatients at the major paediatric hospital in Addis Ababa, Ethiopia. The first study identifies HIV as a major risk factor for TB. HIV prevalence among tuberculous children in Addis Ababa was 12.5%, compared with 1.6% among the controls (AOR 12.7; 95% Cl 2.9,55). The second study explores possible background features associated with dual infection. These were young age, high educational level of mothers, having lost one or both parents and being BCG vaccinated. The findings have implications for the National Tuberculosis Control Programme, suggesting higher demands on hospital beds for the youngest, active case- finding in connection to adult smear positive cases, and preventive strategies beyond BCG vaccination, since the protective effect against TB is lost among HIV-positive children. Childhood TB is caused by recent transmission. Drug susceptibility testing and molecular typing of M. tuberculosis isolates from paediatric patients may thus add to the surveillance of adult strains of M. tuberculosis, since the latter tend to reflect a combination of newly acquired and older reactivated TB. In the third study, a positive culture of Mycobacterium tuberculosis was isolated from 191 out of 362 (53%) children with pulmonary manifestations. HIV infection was negatively associated with a positive culture (OR 0.3; 95% Cl 0.2, 0.6). Drug sensitivity testing was done in 167 and molecular strain typing, using the IS6110 (RFLP) and direct repeat (spoligotyping) genetic markers, in 163 of the isolates of Mycobacterium tuberculosis. Resistance to any of the standard anti-TB drugs was found in 13% of the isolates, isoniazid resistance (11 %) being the most important. No resistance to rifampicin was found. Two clusters included 29% of the bacterial isolates by RFLP. Spoligotyping reduced this figure to 26%. HIV was associated neither with drug resistance nor with any specific cluster within this sample frame. The fourth study presents results from the diagnosis and follow-up of the same 517 tuberculous children included in the second study. HIV-positive patients were more symptomatic and the very young severely underweight compared with the HIV-negative TB patients. The tuberculin test was less sensitive and chest radiography less specific in dually infected children. The diagnostic delay, counted as number of visits to a health institution before the diagnosis of TB, was also higher in this group (OR 2.1; Cl 1.2, 3.7). The children were followed until 6 months after treatment completion. Adherence to treatment was high (96%), only few side effects of TB drugs were noted and the cure rate was 58% for HIV-positive and 89% for HIV-negative patients. A fatal outcome was found in 40% of the HIVpositive compared to 7% in the HIV-negative TB patients (AOR 6.0; 95% Cl 3.0, 11.4) and HIV was the only identified predictor for death. Within the HIV-positive group, a low weight-for- age could be used to identify children at highest risk of a fatal outcome. The need for routine HIV screening, including counselling, of all TB patients is essential in order to diminish the risk of over- as well as under-diagnosis of dually infected children and to secure an adequate, safe treatment of TB as well as of other opportunistic infections. Possibly, such measures might reduce the high mortality among HIV-positive tuberculous children encountered in this study.
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| 21. |
- Brändström, Linnéa, et al.
(författare)
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Nurse collaboration in community and psychiatric care : a Swedish study
- 2015
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Ingår i: British Journal of Community Nursing. - : Mark Allen Group. - 1462-4753 .- 2052-2215. ; 20:6, s. 297-303
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of the study was to examine registered nurses’ (RNs) experiences of collaboration in the community health care and psychiatric inpatient care systems. Background RNs in one area in the west of Sweden have indicated the need for collaborative routines between the community health care and psychiatric inpatient care systems. Method Qualitative content analysis of focus group interviews. Results RNs felt the web-based health-care communication programme was a major obstacle to the development of a collaboration plan. The poor collaboration between RNs was due to the absence of knowledge about the duties of each nursing team. Conclusion The findings contribute to the understanding of the barriers to collaboration between RNs in community health care and psychiatric inpatient care, and highlight the need for nurse managers to ensure well-functioning routines.
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| 22. |
- Gillman, Anna, et al.
(författare)
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Primary tuberculosis infection in 35 children at a Swedish day care center
- 2008
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Ingår i: The Pediatric Infectious Disease Journal. - 0891-3668 .- 1532-0987. ; 27:12, s. 1078-82
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND METHOD: The decline of tuberculosis (TB) in the Swedish population since the middle of the 20th century resulted in decreased awareness of the disease. Increased migration from TB-endemic countries has resulted in new cases and risk of transmission. A day care provider was diagnosed with cavitary TB after being symptomatic for 5 months. We describe the contact tracing at the day care center, the clinical and radiographic findings, and treatment of the infected children. RESULTS: We stratified the children by contact with the source case and examined the most exposed first. Thirty-two of 53 attending and 3 of 84 visiting preschool children were infected. All of them had spent at least 3 days at the center. Symptoms were usually mild and nonspecific. Seventeen children had pulmonary radiographic changes compatible with primary TB, and one had miliary TB. The radiographic resolution was slow, with normalization in 50% after 12 months. Eighteen months after termination of treatment, there have been no relapses. The children with latent infection were treated with rifampin for 4 months and none has developed TB. CONCLUSIONS: The manifestations of primary TB in children today are similar to those described 50-70 years ago. The tuberculin skin test is an effective tool for contact tracing in an unvaccinated, previously nonexposed childhood population. Rapid detection of contagious patients and thorough contact investigation remain our most important means to reduce transmission.
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| 23. |
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| 24. |
- Holm, Anne Lise, et al.
(författare)
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Going around in a Circle : A Norwegian Study of Suicidal Experiences in Old Age
- 2014
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Ingår i: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437.
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Tidskriftsartikel (refereegranskat)abstract
- Depression has repeatedly been found to be a risk factor for completed suicide, particularly when coupled with a pervasive sense of hopelessness. The aim of this study was to evaluate depressed older persons’ suicidal experiences. Data were collected by means of individual in-depth interviews with nine informants living in two districts of Norway. A hermeneutic analysis was performed. Onemain theme: Going around in a circle and two themes: being alone without meaning in life and struggling to achieve reconciliation emerged from the analysis. An important implication for mental healthcare practice is the need to develop a person’s ability to shape and take control of her/his life. The healthcare organisation must be committed to a plan that sets out strategies enabling suicidal individuals to avoid the negative experience of meaninglessness. It was concluded that suicidal depressed elderly persons need helpto escape from their desperate situation. More research is urgently required in order to prevent suicide in depressed elderly persons whose emotional pain is unbearable.
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| 25. |
- Holm, Ann Lise, et al.
(författare)
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Older persons' lived experiences of depression and self-management
- 2013
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 34:10, s. 757-764
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Tidskriftsartikel (refereegranskat)abstract
- Mental ill-health, such as depression in the elderly, is a complex issue that is influenced by the life-world perspective of older persons. Their self-management ability should be strengthened based on an understanding of their situation, perspectives, and vulnerability. The aim of this study was to explore and increase understanding of old persons' lived experiences of depression and self-management using an interpretative explorative design. Understanding was developed by means of hermeneutic interpretation. One theme, Relationships and Togetherness, and four subthemes, A Sense of Carrying a Shoulder Bag, Walking on Eggshells, Holding the Reins, and Estrangement-a Loss of Togetherness, emerged. A collaborative approach can be important for empowering older persons through self-development and management. Although the findings of the present study cannot be considered conclusive or definitive, they nevertheless contribute new knowledge of older persons' lived experiences of depression in everyday life. © 2013 Informa Healthcare USA, Inc.
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| 26. |
- Holm, Anne Lise, et al.
(författare)
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Shadows from the past : The situated meaning of being suicidal among depressed older people living in the community
- 2014
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Ingår i: Crisis. - : Hogrefe Publishing Group. - 0227-5910 .- 2151-2396. ; 35:4, s. 253-260
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most depressed older people in a suicidal state have mixed feelings, where the wish to live and the wish to die wage a battle. Aims: To explore and describe depressed older people’s experiences of being suicidal and their search for meaning. Method: Data were collected from 29 participants resident in the Rogaland and Vestfold districts of Norway, by means of individual interviews, after which a thematic analysis was performed. Results: For the participants in this study, the lived experiences of the situated meaning of survival after being suicidal comprised a main theme—”shadows from the past”—and two themes—”feeling that something inside is broken” and ”a struggle to catch the light.” Conclusion: Mental health-care professionals might be able to reduce the risk of suicide and perturbation by helping depressed older people to explore, resolve, and ultimately come to terms with their unresolved historical issues. Additional valuable strategies in primary care settings include encountering patients frequently, monitoring adherence to care plans, and providing support to address the source of emotional pain and distress.
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| 27. |
- Holm, Anne Lise, et al.
(författare)
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Shared Decision-Making after Implementation of the Chronic Care Model (CCM)—An Evaluative Approach
- 2014
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Ingår i: Open Journal of Nursing. - USA : Scientific Research Publishing. - 2162-5336 .- 2162-5344. ; 04:12, s. 824-835
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Tidskriftsartikel (refereegranskat)abstract
- Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.
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| 28. |
- Holm, Anne Lise, et al.
(författare)
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Social Capital and Depressive Ill-Health : An Evaluative Approach to the Implementation of the Chronic Care Model (CCM)
- 2014
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 4:10, s. 683-694
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social capital has been described as a person's sense of belonging as a result of the number and type of relationships she/he has, in which trust and reciprocity are especially important. Aim: To illuminate older persons' experiences of social capital and depressive ill-health after implementation of the CCM. Methods: Data were collected from nine participants resident in two districts of Norway by means of individual in-depth interviews. A qualitative hermeneutic analysis was performed. Results: Two overall themes, desire for a guardian and a wish for independence despite being dependent, and two themes emerging from the analysis. The first theme—searching for protection was based on three sub-themes overwhelmed by the emotional pain of other people, a sense of exclusion and worries about the future, while the second theme—the need for a relationship with trustworthy persons comprised two sub-themes, namely, emotional pain was not understood and powerlessness to change the situation. The result of this study highlights the need for greater understanding on the part of healthcare professionals of how older persons manage their social relationships. Healthcare professionals require more knowledge about how negative self-beliefs held by older persons suffering from emotional pain, which can lead to reduced ability to trust other people. Another consequence is that fear of being dependent on other people can result in unwillingness to admit the need for help. Conclusion: This study highlights the lack of social capital in older persons who suffer from depressive ill-health. The implementation of the CCM does not appear to improve the situation. Older persons need to be more aware of their social needs and productive interactions in order to protect themselves and obtain support from their social network.
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| 29. |
- Johansson, Caroline, et al.
(författare)
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Child health nurses' experiences of language assessment in children : A Swedish study
- 2017
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Ingår i: Journal of Health Visiting. - London : Mark Allen Group. - 2050-8719 .- 2052-2908. ; 5:4, s. 187-195
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to discover Swedish child healthcare (CHC) nurses' experiences of language assessment in children who do not have Swedish as their mother tongue. A CHC nurse has qualifications in child health, and their role is to promote good health and prevent illness. As immigration to Sweden is at the highest level ever recorded (Statistics Sweden, 2014), there is an increasing need for language assessment. In this study, ‘mother tongue’ is defined as the language a child learns first, which is synonymous with the term ‘first language’ (Oxford Learner's Dictionaries, 2016). The CHC nurses in this study were Swedish-speaking, but conducted speech and language assessments among children who did not speak Swedish; for example, who had a mother tongue other than Swedish. It is important to acquire knowledge of CHC nurses' experiences of language assessment.
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| 30. |
- Karlsson, Christina, et al.
(författare)
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Dignified end-of-life care in the patients’ own homes
- 2011
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Ingår i: Nursing Ethics. - 0969-7330 .- 1477-0989. ; 18:3, s. 374-385
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Tidskriftsartikel (refereegranskat)abstract
- Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible.
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| 31. |
- Karlsson, Margareta, 1958-, et al.
(författare)
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A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care
- 2015
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Ingår i: International journal for human caring. - : Springer Publishing Company. - 1091-5710. ; 19:1, s. 40-48
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Tidskriftsartikel (refereegranskat)abstract
- This metasynthesis aimed to translate, interpret, and present a synthesis of qualitative studies from nurses' perspectives dealing with ethical dilemmas and ethical problems in end-of-life care and to gain a deeper understanding of the phenomena. Nurses and other care professionals need to gain a deeper understanding and alleviate the suffering of patients through evidence-based practice end-of-life care. The metasynthesis, inspired by Noblit and Hare, generated an overarching metaphor, The Loving Eye. The Loving Eye illustrates how nurses are deeply involved with patients as human beings and connotes an inner responsibility to struggle for patients' best interests and wishes at the end of life. With The Loving Eye, nurses can see and feel patients' need to be confirmed, comforted, and healed approaching the end of life.
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| 32. |
- Karlsson, Margareta, 1958-, et al.
(författare)
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Assessment and decision-making of Swedish primary care nurses in relation to the use of interpreters
- 2017
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Ingår i: Journal of Health Visiting. - London : MA Healthcare Ltd. - 2050-8719 .- 2052-2908. ; 5:9, s. 454-460
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Tidskriftsartikel (refereegranskat)abstract
- Communicating with immigrants in primary care can be a challenge for nurses who must assess language proficiency and decide whether to use an interpreter. The aim of this study was to examine primary care nurses’ experiences of assessment and decision-making in relation to the use of interpreters. A qualitative inductive research design was chosen and nurses with experience of professional interpreters were recruited for focus group interviews. The study results showed that primary care nurses respected immigrants as human beings and recognised their right to decline an interpreter in sensitive situations. The purpose of primary care nurses’ experiences of assessment and decision-making in relation to the use of interpreters was ensuring patient safety, the importance of reciprocal information and respect for patient autonomy.
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| 33. |
- Karlsson, Margareta, 1958-, et al.
(författare)
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Community nurses’ experiences of ethical dilemmas in palliative care : A Swedish study
- 2010
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Ingår i: International Journal of Palliative Nursing. - London : Mark Allen Group. - 1357-6321 .- 2052-286X. ; 16:5, s. 224-231
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care.Background: There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence.Method: Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis.Findings: The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals.Conclusion: The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.
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| 34. |
- Karlsson, Margareta, 1958-, et al.
(författare)
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Community nurses' experiences of ethical problems in end-of-life care in the patient's own home.
- 2013
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 27:4, s. 831-838
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To gain a deeper understanding of community nurses' experiences of ethical problems in end-of-life care in the patient's own home. METHOD: Ten female nurses from five different communities with experience of end-of-life care were interviewed. A hermeneutic approach inspired by Gadamer was used to analyse the qualitative data from the interviews. FINDINGS: In the first step of interpretation, two themes emerged: Uncomfortable feelings and Lack of cooperation and in the second step, one theme Lack of security emerged. Finally, the overall interpretation revealed the theme Feelings of loss of control in end-of-life care in the patient's own home. CONCLUSION: The nurses exhibited commitment and a desire to do good when caring for patients in the end-of-life phase, even if they sometimes experienced feelings of lack of control. This implies that, when confronted with care-related issues, they have the power to both act and react. This study aimed to increase understanding of ethical problems that arise in end-of-life care in the patient's own home and revealed the need to take the patients', relatives' and nurses' perspectives on health and suffering into consideration to ensure good end-of-life home care.
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| 35. |
- Kulane, Asli, et al.
(författare)
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"It is more than the issue of taking tablets" : The interplay between migration policies and TB control in Sweden
- 2010
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 97:1, s. 26-31
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Tuberculosis is re-emerging as a critical public health concern in Sweden among the immigrants. The aim of this study was to explore the experiences of the Somali community of TB care in the Stockholm area. Methods: Focus group discussions were conducted with 34 adult women and men by a Somali speaking moderator. Each group consisted of 6-9 participants men and women separately. The audio taped discussions were transcribed, translated and read many times and in the process patterns and codes were identified and migration emerged as important theme in the context of TB control. Results: Fear of being deported emerged as barrier to sharing of complete health information with the doctor. The routine contact tracing and follow-up of infected cases in TB control was expressed as a source of concern since it was feared the health care providers could share the information with the immigration authorities. Interpreter use was expressed as barrier particularly if of same female gender. Conclusion: It is important to be aware of how a country's immigration policies impact on. TB control activities among immigrants The existing TB control measures, such as contact tracing, assume new meanings for immigrants. Further research is therefore needed to understand this emerging complexity in order to make TB control more effective.
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| 36. |
- Lindblom, Anna-Karin, et al.
(författare)
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A quality registers impact on community nurses' in end-of-life care : a grounded theory study
- 2012
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 20:2, s. 206-214
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of the study was to identify the impact of a quality register in end-of-life-care, from community nurses' perspective. Background There is a lack of knowledge about the impact of such a register in end-of-life care. Method Data were collected by means of focus group interviews with a total of 12 nurses, from two communities in the western part of Sweden. Data analysis was based on grounded theory. Result Feedback is the core category that influences all other processes. Two main categories emerged: 'Becoming aware of' and 'Acting accordingly'. These influenced the nurses and led to improved quality of care. Conclusion A quality register gives the users (nurses) feedback on the care provided, which starts a process of change. Implications for nursing management The value of working with a quality register as a feedback system can be applicable to all professions working with quality assurance. The experiences will increase the motivation and understanding the value of using quality registers as a tool for enhanced quality. Further, nurse managers can use such a register as a feedback system, not only as a motivating tool when implementing a quality register, but in the evaluation of its outcomes. © 2012 Blackwell Publishing Ltd.
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| 37. |
- Lyberg, Anne, et al.
(författare)
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Depressed Older Patients’ Need for and Expectations of Improved Health Services : An Evaluative Approach to the Chronic Care Model
- 2015
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 5:4, s. 376-386
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Tidskriftsartikel (refereegranskat)abstract
- Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons' need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person's daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.
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| 38. |
- Lyberg, Anne, et al.
(författare)
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Older Persons’ Experiences of Depressive Ill-Health and Family Support
- 2013
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Ingår i: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437. ; , s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore experiences of the meaning of family support among older persons with depressive illhealth.Data were collected from twenty-nine participants through semistructured interviews and analysed using interpretative hermeneutic and reflective methodology. The findings revealed a main theme, hovering between feelings of belongingness and aloneness in relationships with family members, based on two themes: a sense of being worthy and a sense of being unworthy.Experiences of support and lack of support from family members were not opposites but connected in internal relationships andcan be pictured as a movement on a continuum of ambiguity. Family support promotes the emotional needs of older persons withdepressive ill-health to be confirmed. The family plays a vital role, not always by direct assistance, but indirectly by supporting theolder person's own "guiding principles" for managing her/his situation. The feelings of aloneness as well as shame and guilt at pooror absent family responsiveness should be adequately addressed. Innovative nursing care can lead to improvement by focusing on acquiescence to the older person's life situation.
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| 39. |
- Meyer, Jennie, et al.
(författare)
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A phenomenological study of living with a partner affected with dementia
- 2016
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Ingår i: British Journal of Community Nursing. - : Mark Allen Group. - 1462-4753 .- 2052-2215. ; 21:1, s. 24-30
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Caring for people affected by dementia is a collective effort that involves public health, primary care, and informal care. The third mainly comprises the efforts of spouses.Aim:This study aimed to describe spouses' experiences of living with a partner affected with dementia.Method:The study has a descriptive phenomenological approach based on a reflective life-world perspective. Seven in-depth interviews were conducted with spouses of persons affected with dementia. The interviews were audiotaped and analysed using the procedures described by Giorgi (2009).Findings: The essence of living with a partner affected by dementia formed a comprehensive theme: from togetherness to loneliness, which along with three descriptive categories—changes in their partner's behaviour, changes in everyday life, and a changed future—describes the phenomenon.Conclusion:The theme 'From togetherness to loneliness' reflects the spouses' descriptions of their life-world. Daily life changed gradually in line with their partners' personality, and their role became that of a care provider rather than a spouse. Information and knowledge about dementia should be provided at an early stage. Health care has a major responsibility to meet their needs, thus ensuring that all parties are satisfied.
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| 40. |
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| 41. |
- Rudolfsson, Gudrun, et al.
(författare)
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Experiences of Spirituality and Spiritual Values in the Context of Nursing : An Integrative Review
- 2014
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Ingår i: Open Nursing Journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 8, s. 64-70
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Tidskriftsartikel (refereegranskat)abstract
- Spirituality is often mistakenly equated with religion but is in fact a far broader concept. The aim of this integrative review was to describe experiences of the positive impact of spirituality and spiritual values in the context of nursing. The analysis was guided by Whittemore and Knafl’s integrative review method. The findings revealed seven themes: ‘Being part of a greater wholeness’, ‘Togetherness − value based relationships’, ‘Developing inner strength’, ‘Ministering to patients’, ‘Maintaining one’s sense of humanity’, ‘Viewing life as a gift evokes a desire to ‘give back’’ and ‘Achieving closure − life goes on’. It is difficult to draw definite conclusions, as spirituality involves many perspectives on various levels of awareness. However, spirituality was considered more inclusive, fluid and personal. Furthermore, it emerged that spirituality and spiritual values in the context of nursing are closely intertwined with the concept of caring.
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| 42. |
- Rudolfsson, Gudrun, 1948-, et al.
(författare)
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Nursing students' perspectives on the patient and the impact of the nursing culture : a meta-synthesis
- 2012
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 20:6, s. 771-781
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Tidskriftsartikel (refereegranskat)abstract
- AimTo explore and interpret how nursing students develop their understanding of the patient as a human being.BackgroundUnderstanding the patient is the main characteristic of good, caring performance. In addition, nurse leaders play an active role in creating a culture in which nursing students can flourish and improve.MethodThis meta-synthesis was based on Noblit and Hare's meta-ethnography.ResultsThe overarching metaphor was interpreted as the nursing students' capacity for compassion. Two central metaphors were revealed, based on how nursing students developed their understanding of the patient as a human being. These central metaphors were labelled ‘The open door’, comprising seven key metaphors and ‘The closed door’ based on two key metaphors.ConclusionDuring practical training, the students observed both virtuous and unkind nurses. Virtue is a skill that can be taught, but not all students were able to learn it. Some students acquired the ability to reflect on ethical issues, while others did not. Therefore, good role models are of major importance.Implication for nursing managementThe nurse leader should function as a facilitator in the students' efforts to gain the capacity to face the suffering patient and to develop an understanding of the patient's situation.
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| 43. |
- Rönnerhag, Maria, 1972-, et al.
(författare)
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A qualitative evaluation of healthcare professionals' perceptions of adverse events focusing on communication and teamwork in maternity care
- 2019
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 75:3, s. 585-593
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to explore healthcare professionals' perceptions of adverse events during childbirth with focus on communication and teamwork.BACKGROUND: Inadequate communication, a poor teamwork climate and insufficient team training are harmful to women. Reviews of reported adverse events can be used to develop a safety culture based on preparedness for preventing adverse events and strengthening patient safety.DESIGN: Action research principles were used to facilitate the implementation and evaluation of this study.METHODS: An interprofessional team of healthcare professionals comprising obstetricians, registered midwives and assistant nurses employed at a labour ward agreed to take part. Data were collected from multistage focus group interviews (March 2016 - June 2016) and analysed by means of interpretative thematic analysis.FINDINGS: Two analytical themes based on five sub-themes emerged; Promoting interprofessional teamwork and Building capabilities by involving healthcare professionals and elucidating relevant strategies. The findings reveal the importance of facilitating relationships based on trust and respectful communication to ensure a safe environment and provide safe maternity care.CONCLUSION: There is a need for formal and informal support for quality interprofessional teamwork. Research on patient safety may reduce adverse events related to miscommunication and poor teamwork. We recommend different forms of communication and teamwork training in interprofessional teams to increase the ability to provide feedback. Accumulated research is required for the evaluation of evidence-based models in the patient safety context. This article is protected by copyright. All rights reserved.
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| 44. |
- Rönnerhag, Maria, 1972-, et al.
(författare)
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Qualitative study of women's experiences of safe childbirth in maternity care
- 2018
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Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 20:3, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have focused on women's childbirth experiences in relation to patient safety. The aim of this study was to explore the meaning of safety as a process phenomenon by outlining women's positive and negative experiences of safety in childbirth. A descriptive explorative design was chosen and 16 interviews were conducted. Qualitative content analysis was used. One main theme emerged: safe childbirth through involvement and guidance, based on four subthemes. The characteristics of women's experiences of safe childbirth included the need to be informed and involved by sharing and receiving trustworthy information. Women's experiences of unsafe childbirth included lack of meaningful and trustworthy information that resulted in feelings of being misled or lulled into a false sense of security. Not being involved evoked feelings of being ignored. In conclusion, this study highlights issues of importance for safe maternity care. The perspectives of childbearing women can contribute to an understanding of how to achieve meaningful improvements to provide safer maternity care.
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| 45. |
- Rönnerhag, Maria, 1972-, et al.
(författare)
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Risk Management : evaluation of healthcare professionals reasoning about and understanding of maternity care
- 2019
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 27:6, s. 1098-1107
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate healthcare professionals' explanations of the prerequisites for safe maternity care and understanding of risk management, including the underlying reasons for decision‐making intended to ensure safe care.Background: Risk management focuses on maintaining and promoting safe care by identifying circumstances that place childbearing women at risk of harm, thus reducing risks.Methods: A hermeneutic action research approach was chosen. Through a series of focus group sessions we uncovered healthcare professionals' explanations of risk management.Results: One overriding theme emerged; The consequences of what managers do or fail to do constitute the meaning of taking responsibility for team collaboration to provide safe care. Inadequate support, resources and staff shortages have consequences, such as inability to concentrate on team communication and collaboration, leading to the risk of unsafe care.Conclusion: Communication constitutes a prerequisite for both team collaboration and risk management. Thus, communication is linked to the ability of managers and healthcare professionals to provide safe care.Implications for Nursing Management: In terms of safety management, nurse managers have a significant role in and responsibility for supporting communication training, developing guidelines and providing the prerequisites for interprofessional team reflection.
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| 46. |
- Severinsson, Elisabeth, et al.
(författare)
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Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context : An Integrative Review
- 2017
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 7:3, s. 378-398
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl's integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains; safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women's feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives' communication competence on the part of midwives is essential for supporting the birth and fulfilling the women's needs and expectations.
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| 47. |
- Severinsson, Elisabeth, et al.
(författare)
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Patient Safety, Adverse Healthcare Events and Near-Misses in Obstetric Care : A Systematic Literature Review
- 2015
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Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 5:12, s. 1110-1122
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Tidskriftsartikel (refereegranskat)abstract
- Systematic development of a patient safety culture is necessary because lack of quality care leads to human suffering. The aim of this review was to identify evidence of obstetric adverse events (AEs) and near-misses in the context of patient safety. We conducted a search of the published literature from Europe, Australia and the USA in the following databases: Cinahl, Cochrane, Maternity and Infant Care, Ovid, Pro-quest and PubMed, guided by PRISMA procedures. A total of 427 studies were screened, 15 full papers retrieved and nine studies included in the final thematic analysis. The selected papers address a broad spectrum of adverse patient safety events in obstetric care. The themes that emerged were: type of AEs, near-misses and their consequences, strategies to support and improve Patient Safety (PS) and domains related to the WHO Patient Safety competence outcomes. The findings of the first theme were grouped into the following categories: healthcare professionals' perspectives on ethical conflicts, attributing blame and responsibility, and patients' perspectives on lack of trust and involvement, as well as medication errors. The second theme, strategies to support interventions to improve PS, was based on two sub-themes: communicating effectively and gaining competence by learning from adverse events, while the third theme was domains related to the WHO Patient Safety competence outcomes. In conclusion, few studies have examined strategies for managing AEs despite the existence of programmes that target the implementation of changes, such as improved teamwork training. In addition to exploring strategies to make safety a priority for patients and healthcare professionals, it is of the utmost importance to improve communication with patients and between professionals in order to maintain and enhance safety. Efforts by organizations and individuals to continuously develop knowledge about the risk of AEs and the use of best practice guidelines are also essential.
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| 48. |
- Yin Kwan Ho, Agnes, et al.
(författare)
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Diabetes empowerment related to Pender's Health Promotion Model: A meta-synthesis
- 2010
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Ingår i: Nursing & Health Sciences. - : Blackwell. - 1442-2018 .- 1441-0745. ; 12:2, s. 259-267
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Tidskriftsartikel (refereegranskat)abstract
- Diabetes self-management is a challenge for both clients and health-care professionals. Empowerment plays a vital role in helping clients to achieve successful self-management. This study adopted a meta-ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self-management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines-of-argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health-care professionals need to understand and address modifiable behavior-specific variables. The study suggests that an effective empowerment strategy would be to use activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health-promoting behaviors
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