| 1. |
- Berg, Marie, 1955, et al.
(författare)
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Evidence-based care and childbearing - A critical approach
- 2008
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; :3, s. 239-247
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Tidskriftsartikel (refereegranskat)abstract
- Developing the best care for clients and patients is a paramount aim of all health care practices, which therefore, should be based on best evidence. This is also crucial for care during the childbearing period here defined as pregnancy, childbirth, and infancy. However, due to dominance of the evidence-based medicine (EBM) model, health care practice has encountered problems especially regarding its relationship to qualitative research. In this article, we analyze and discuss how research based on a lifeworld perspective fits with evidence-based care (EBC), and how a circular model instead of a hierarchy is suitable when attributing value to knowledge for EBC. The article focuses on the history of EBM and EBC, the power of the evidence concept, and EBC from a narrow to a broad view. Further qualitative research and its use for developing EBC is discussed and examples are presented from the authors’ own lifeworld research in the Nordic childbearing context. Finally, an alternative circular model of knowledge for EBC is presented. In order to develop evidence-based care, there is need for multiple types of scientific knowledge with equal strength of evidence, integrated with clinical experience, setting, circumstances and health care resources, and incorporating the experiences and clinical state of the childbearing woman and her family.
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| 2. |
- Bondas, Terese, et al.
(författare)
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A decade of metasynthesis research in health sciences : a meta-method study
- 2007
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Co-Action Publishing. - 1748-2623 .- 1748-2631. ; 2:2, s. 101-113
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this study was to analyze the methods applied in previous metasynthesis research and to inform future researchers of epistemological and methodological issues based on this analysis. Meta-method analysis was applied to a decade of 45 published metasynthesis studies that pertain to nursing and allied health studies. The findings show that the metasynthesis research can be classified into three areas: (1) health, illness and suffering, (2) care and support, and (3) parenting, newborn and childcare. Meta ethnography dominates the research area. Metastudy, metasummary, qualitative metasynthesis, and grounded formal theory are emerging methods. The metasynthesis studies suffer from modifications without explications, use of secondary method references, missing sample and search data and differences in the type of findings and the meta-concepts depicting the findings. The worth of metasynthesis research is questioned when the core ideas of qualitative meta studies, theoretical and/or methodological development (‘‘synthesis’’) combined with the potential of going beyond and behind the studies (‘‘meta’’), is missing. Metasynthesis research requires knowledge in both the substance and the various qualitative methods, and systematic attendance to the method accompanied by the openness and the creativity of a qualitative approach. Conclusions and recommendations are presented as epistemological reflections and a guide for future metasynthesis research in health sciences.
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| 3. |
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| 4. |
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| 5. |
- Bondas, Terese, et al.
(författare)
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Challenges in approaching metasynthesis research
- 2007
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Ingår i: Qualitative Health Research. - : Sage Publications, Inc. - 1049-7323 .- 1552-7557. ; 17:1, s. 113-121
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Tidskriftsartikel (refereegranskat)abstract
- The overall aim of this study was to contribute to the development of metasynthesis through an analysis of the challenges involved. The study grew out of the critique of qualitative metaresearch raised by current developers of metamethodologies. Different views on the application of methodologies have emerged in the literature, contributing to confusion and ambiguity concerning the challenging questions of what, why, how, and who in metasynthesis research, which might increase the risk of misunderstanding. The roots of metasynthesis research are seen as multifaceted and influencing the development of the methods in different directions. The primary worth of metasynthesis is theoretical and/or methodological development (synthesis) combined with the potential for reflection: going beyond and behind the studies (meta). Metasynthesis research has also the potential to raise questions of research collaboration, culture, and language.
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| 6. |
- Bondas, Terese
(författare)
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Det caritativa ledarskapet
- 2008
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Ingår i: Vård i fokus. - : SSY - Sjuksköterskeföreningen i Finland. - 0781-495X. ; 3:1, s. 5-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Bondas, Terese
(författare)
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Förenande ledarskap
- 2007
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Ingår i: LIV. ; :4, s. 29-31
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 8. |
- Bondas, Terese
(författare)
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Olika former av vårdande gemenskap
- 2003
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Ingår i: Gryning II : Klinisk vårdvetenskap. - : Institutionen för vårdvetenskap, Åbo Akademi, Vasa. - 9521212373
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Bondas, Terese
(författare)
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Paths to Nursing Leadership
- 2006
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Ingår i: Journal of Nursing Management. - 0966-0429 .- 1365-2834. ; 13:5, s. 1-8
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Tidskriftsartikel (refereegranskat)
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| 10. |
- Bondas, Terese, et al.
(författare)
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Photography as a Data Collection Method in Intensive Care
- 2009
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Konferensbidrag (refereegranskat)abstract
- The suffering patient is thrown into a strange and unfamiliar environment of different technological devices in an Intensive care unit. The intensive room is a place for care and treatment, for rest and recovery, a visiting room, and a working place for the staff. In this context patients and relatives are very vulnerable and are in a need of support. Patients may suffer from unreal experiences, often very traumatic during their stay in ICU and many patients also suffer from unpleasant memories, and some develop post traumatic stress after their discharge. In order to design optimal rooms in ICU it would be important to identify factors which are meaningful for the patients and relatives. The aim of this study, as part of a larger research project, is to illuminate patients’ and relatives’ experiences of the physical room, the design and the interior in the ICU. Photographs combined with interviews are used as data collection methods within the ICU-context. Relatives and former patients are asked to photograph different aspects of the room that they remember or associate with a feeling. The pictures were used later during an interview with the informants. In total the researcher meets the informants three times, first time to inform, the second time to take the photos and a third time for the interview. This method gives the researcher opportunity to deepen the understanding and capture aspects of the room that otherwise might have been hidden. The presentation will focus on photography as a research method.
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| 11. |
- Bondas, Terese
(författare)
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Preparing the Air for Nursing Care : A Grounded Theory Study of First Line Nurse Managers
- 2009
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Ingår i: Journal of Research in Nursing. - : Sage Publications Ltd.. - 1744-9871 .- 1744-988X. ; 14:4, s. 351-362
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Tidskriftsartikel (refereegranskat)abstract
- The first line nurse managers’ opportunities to lead nursing care seem to be diminishing. The aim of this study was, therefore, to gain an understanding of the first line nurse managers in their experiences in the development of nursing care as part of a wider research programme. Finnish nurse managers wrote narratives at the beginning of five different leadership courses in this grounded theory study. ‘Preparing the Air for Nursing Care’ emerged as a core category. It was formed by two major categories. ‘Being Concerned about Nursing Care’ describes the nurse managers’ focus on the development of nursing care, the nursing caregivers’ health and knowledge and a concern for the whole organisation. The second major category ‘Creating the Direction and Content of Nursing Care’ describes the nurse manager working together with the staff to create individual and family-centred best practice, initiating relationships and dialogues for nursing care, and a culture of caring. A typology was created that explained the four main modalities to emerge from the data: ‘the Active Developer’, ‘the Passive Thinker’, ‘the Impulsive Creator’ and ‘the Routine Manager’.
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| 12. |
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Forslund, Kerstin, 1953-
(författare)
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Challenges in prehospital emergency care : patient, spouse and personnel perspectives
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Prehospital emergency care (PEC) with the emergency call to the Emergency Medical Dispatch (EMD) centre is an essential part of the health-care system. It is important to obtain knowledge about the links in the PEC chain from the perspectives of those providing the service and those receiving it. The overall aim of this thesis was to describe the challenges surrounding PEC based on the experiences of patients, spouses and personnel. A qualitative descriptive design was used in the five papers included. The data analysis methods were phenomenological-hermeneutics (I–III), qualitative content analysis (IV–V) and descriptive statistics (V). Interviews with thirteen patients who had called the EMD-centre due to acute chest pain (I) revealed a general satisfaction with PEC. They were aware of the number to call in an emergency but were uncertain when to call. The potentially life threatening emergency situation was marked by vulnerability and dependency and was fraught with pain, fear and a sense of aloneness. An overall theme of aloneness emerged from the interviews with nineteen spouses who had placed an emergency call for their husband or wife that was experiencing acute chest pain (II). The challenges in being a spouse to a person in need of PEC were associated with: “Being responsible and trying to preserve life” and “Being able to manage the uneasiness and feel trust in an uncertain situation”. The spouses were in an escalating spiral of aloneness, worry, uncertainty, stress, fear of loss and desperation. Interviews with sixteen emergency operators dealt with situations they considered difficult to deal with and their reflections on how they managed such situations (III). Uncertainty, communication difficulties and insufficient resources characterized those situations. Skills, knowledge, experience, as well as personal qualities such as sensitivity, self-insight, empathy and intuition were regarded as important when handling them. Interviews with four nurses and fifteen emergency operators related to their experiences of working together for two years at an EMD-centre were conducted after the nurses were added to the EMD-centre to increase medical and nursing competence (IV). Initial frustration and scepticism changed to positive experiences with improved cooperation and service. The nurses voiced difficulties dealing with the more medically urgent calls and the emergency operators with the more complicated and diffuse medical cases. A total of 336 questionnaires related to alarms involving acute chest pain and given the highest priority by the emergency operator were collected in a study aimed at describing the ambulance personnel’s perceptions of the quality of the information received from the EMD-centre (V). The ambulance personnel perceived most of the information such as patient assessment, condition, history, preparedness and in particular pain status to be of high quality. In summary: In PEC there is many interdependent complexities that present demands and challenges to the actors involved (I–V). In general those who received emergency assistance from PEC were satisfied, but the margins between success and failure are small. Risks for errors exist throughout the PEC chain and time poses a challenge. Understanding is crucial for all involved, and the same situation can be experienced differently. Challenges inherent in PEC are the communication problems, unpredictability and uniqueness along with daring to be in the acute situation and dealing with a sense of aloneness, uncertainty and dependency. The personnel that do not have the ability to see the person they are helping are even more challenged. Important attributes for PEC personnel are caring attitudes, personal skills, experiences and professional knowledge. PEC personnel have the authority and power to act and make decisions, in which responsibility, sensitivity, and human dignity must be addressed. Lives are saved with PEC despite all the challenges and possibilities for error, such as those that exist between the different actors. It is vital that the PEC chain is as strong as possible.
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| 17. |
- Frank, Catharina, 1961-
(författare)
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Tillfället gör delaktighet : Patienters och vårdares erfarenheter av patientdelaktighet på akutmottagning. En deskriptiv, metodutvecklande och utvärderande studie
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the present thesis was to examine, develop and evaluate patient participation in emergency department (ED) for promoting the relief of suffering for patients in care relations, from the perspective of patients and caregivers.Method: The explorative studies (I, II) were based on reflective lifeworld approach and analyzed by phenomenographic method. Data were collected from interviews by patients (9) and caregivers (11) about their conception of patient participation in ED. The methodological study (III) performed analyses and were tested for content, construct and criterion validity as well as homogeneity and stability reliability. The sample for study (III, IV) consisted of 356 patients consecutively cared for in EDs in Sweden. In the evaluating study (IV) the questionnaire Patient Participation Emergency Department (PPED) was used. The statistical methods handled were Student’s t-test, one-way ANOVA and Spearman correlation.Findings: The patients’ conception of patient participation means: being acknowledged; struggling to become involved; and having a clear space (I). The caregivers’ conceptions of patient participation can be divided into three different descriptive categories: Caregivers offer the opportunity for participation, Patients demand participation and Mutual participation (II). A 17- item questionnaire was developed. Two separate factor analyses revealed a distinct four- factor solution which was labelled: Fight for participation, Requirement for participation, Mutual participation and Participating in getting basic needs satisfied. Criterion validity presented showed 9 out of 20 correlations equal or above 0.30. Cronbach’s alpha coefficient ranged from 0.63 - 0.84 and test- retest varied between 0.59 and 0.93(III).The results show that patient participation is low in two dimensions (Fight for participation, Participation in getting basic needs satisfied), reasonable in one dimension (Mutual participation), and high in one dimension, Requirement for participation (IV).Conclusions: Participation does occur on occasion when the circumstances are right despite international and national guidelines that lay down the need for patient participation. Patient participation in EDs is perceived when patients are in contact with caregivers and there is space for collaboration in situations of consistency. However, patient participation cannot be offered in a one-sided caring action. In collaboration patient participation contributes to the relief of suffering in the process of health and patients participate when they are allowed to be the point of departure for caring. However, the results point to a lack of strategy for patient participation and for increased patient participation to take place improvements in external organization requirements are required. The results indicate an amplified clarity in how patient participation can be understood for EDs, in education and community and a scientific tested instrument has made it possible to evaluate patient participation.
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| 18. |
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| 19. |
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| 21. |
- Gross, Mechthild M., et al.
(författare)
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Women's experiences on VBAC: results of a metasynthesis
- 2014
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Ingår i: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: More and more women experience a caesarean section with their first, or later, birth. During a subsequent pregnancy they experience a challenging period of decision making on the mode of birth. Vaginal birth after caesarean section (VBAC) is a relevant option for a large number of women. Despite lots of quantitative studies on VBAC there is a lack of studies that report the experiences of women. Aim of review: To report the main themes of women’s experiences of VBAC. Search strategy: The following databases were searched: CINAHL, EBSCO, Journals@ OVID, Pubmed, PSYCHINFO, using the keywords VBAC, vaginal birth after caesarean section, qualitative study, experiences, qualitative and women´s experiences in various combinations. Review methodology: In total, 1981 papers were identified; of these, 1959 had to be excluded. From the remaining 22 papers eleven were excluded at this stage, as not focusing on women´s experiences, or only focusing on experiences of CS in relation to VBAC. A metasynthesis based on the interpretative meta ethnography method was conducted. Main findings: Four final themes became obvious: ‘to be involved in decision about mode of delivery is difficult but important,’ ‘vaginal birth has several positive aspects mainly described by women,’ ‘vaginal birth after CS is a risky project,’ and ‘own strong responsibility for giving birth vaginally’. The papers discussed issues such as the women´s experience in relation to different aspects of VBAC, decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. Conclusion: It became obvious that women may feel as though they are in a fog when preparing for a VBAC. Women need evidence-based information not only about the risks involved but also about positive aspects of VBAC.
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| 22. |
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| 23. |
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| 24. |
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| 25. |
- Larsson, Åsa, et al.
(författare)
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Fördjupad hälsa – kvinnors upplevelse av att planera och föda sitt barn hemma
- 2014
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Ingår i: HOITOTIEDE. - 0786-5686. ; 26:1, s. 2-10
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Tidskriftsartikel (refereegranskat)abstract
- In Finland, 12 planned and 81 unplanned homebirths took place according to the official Health Statistics 2012. In a Nordic neighbor country, Sweden, like in many high-income countries almost all women give birth at hospital, and only about 100–200 women each year choose to plan and give birth at home. It is a controversial decision because it is often associated with risks, and not supported by the public health care system. The aim of this study was to describe Swedish women’s experience of planning and giving birth at home. Ten women who have had between one to three homebirths were interviewed. The data were analyzed with a phenomenological hermeneutical method. Five themes were identified, and an overall interpretation was discussed in relation to an ontological theory of health. Findings show that women who choose homebirth are aware of their needs and have the strength to go through with their decision in spite of resistance. Childbirth at home was for the women an opportunity for enrichment and health, and a new experience of wholeness as a person.
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| 26. |
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| 27. |
- Lindberg, Elisabeth, et al.
(författare)
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'The responsibility of someone else' : a focus group study of collaboration between a university and a hospital regarding the integration of caring science in practice.
- 2012
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell Publishing Ltd.. - 0283-9318 .- 1471-6712. ; 26:3, s. 579-86
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to develop insights into how nurses, senior preceptors and head nurses experience the integration of caring science in practice and how they value the contributions of nursing students to the integration of caring science in practice. BACKGROUND: Research still reveals differences between theory and practice by nursing students. In Sweden, clinical education units have become one way of creating consistency between university and health care practices on values of caring. METHOD: The study is hermeneutic in design comprising data from three focus group interviews. The participants include registered nurses, senior preceptors and head nurses. RESULT: The study shows that roles and mandates are not clearly defined between the different actors. The university and hospital collaboration in caring science integration was regarded as 'someone else's responsibility'. Research and development seemed excluded from the everyday life of the hospital units. The students seemed to fall somewhere between the hospital 'practice and concrete world of production' and the university 'theory world of education and research'. Three themes emerge: 'integration--someone else's responsibility', 'the hospital--a culture of production' and 'the hospital and the university--different realities'. DISCUSSION: The results suggest the need for professionals within health care and university to reflect on their responsibilities in terms of research and development. The ethos of caring science implies the alleviation of suffering and caring for vulnerable patients including research and development.
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| 28. |
- Lundgren, Ingela, 1957, et al.
(författare)
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'Groping through the fog': a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section)
- 2012
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences. Aim: To integrate qualitative findings and deepen the understanding of women's experiences of VBAC. Method: A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis. Results: The included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: 'to be involved in decision about mode of delivery is difficult but important,' 'vaginal birth has several positive aspects mainly described by women,' 'vaginal birth after CS is a risky project,' and 'own strong responsibility for giving birth vaginally'. Conclusion: In order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC.
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| 29. |
- Lundgren, Ingela, et al.
(författare)
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Long-Term Memories and Experiences of Childbirth in a Nordic Context : A Secondary Analysis
- 2009
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Co-Action Publishing. - 1748-2623 .- 1748-2631. ; 4:2, s. 115-128
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Tidskriftsartikel (refereegranskat)abstract
- The experience of childbirth is an important life experience for women. However, in-depth knowledge about long-term experiences is limited. The aim of the study was to describe women’s experiences two to 20 years after birth. This study is a part of a meta-synthesis project about childbearing in the Nordic countries. Methodologically, the study was a secondary analysis performed on original data from three selected qualitative studies by the authors, in three Nordic countries, Finland, Iceland and Sweden, and in two different forms of care, birth centre care and standard maternity care. There were 29 participants, both primipara and multiparous women. The result from this study shows that women, in a long-term perspective describe childbirth as an encounter with different participants and the most important is with the midwife. The midwife is also important in connection to the atmosphere experienced during birth. The childbirth experience has a potential to strengthen self-confidence and trust in others or, on the contrary, it can mean failure or distrust. Impersonal encounters linger feelings of being abandoned and alone. This dimension is in particular demonstrated in the description of the woman who had given birth at standard maternity care. The conclusion of this study is that childbirth experience has a potential to strengthen self-confidence and trust in others or on the contrary failure or distrust. Maternity care should be organized in a way that emphasis this aspects of care.
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| 30. |
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| 31. |
- Lundgren, Ingela, 1957, et al.
(författare)
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Women’s experiences of childbirth, care and support – a metasynthesis
- 2009
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Ingår i: 15th Qualitative Health Research, International Institute for Qualitative Methodology's, University of Alberta, Vancouver, Canada, 4-6 October 2009.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Physical indicators have been the measure of the success of childbirth by professionals educated in a medical perspective, while the experiences of the childbearing families in different cultures have been considered of minor importance. The medicalization has the consequence of regarding every birth as potentially risky and abnormal, and requiring medical interventions. However, life changes for good, especially for women embodied through their childbirth, and the memories of the events and caring and uncaring encounters are well kept. The childbirth experiences also influence the relationships with their baby and their partner in the postpartum period, and the onset of postnatal depression, anxiety and PSTD. Several qualitative studies have described women’s experiences of childbirth, care and support in varied ways and a metasynthesis is warranted to integrate the findings. The aim is also to reflect on the findings and the theories and the methods that implicit or explicit have guided the research. The intention is to influence clinical practice, and also to push the theory and the research designs, and ask new meaningful research questions. The threefold interpretative metastudy developed by Paterson and colleagues was chosen for this collaborative metasynthesis research program in childbearing. Inclusion and exclusion criteria were developed, and seven health related databases were searched in different disciplines and findings from different cultures with the chosen keywords. Previous literature reviews were reviewed, and author and ancestry search was performed to access studies not identified through the database search. The presentation will focus on the preliminary findings from this study.
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| 32. |
- Nilsson, Christina, 1959-
(författare)
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Förlossningsrädsla : med fokus på kvinnors upplevelser av att föda barn
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this study is to describe experiences of, and the association between, fear of childbirth and birth experiences of women with fear ofchildbirth.Methods: In studies I, II, and IV, a reflective lifeworld approach based on phenomenological philosophy was used to describe women’s experiences of fear of childbirth (I), previous birth experiences (II), and fear of childbirth and of birth experience in a long-term perspective (IV). In study III, differences between women who reported fear of childbirth and those who did not were calculated using risk ratios with a 95 % confidence interval and multivariate logistic regression analysis. Data were collected from interviews with eight (I) and nine (II) pregnant women with intense fear of childbirth, and with six women who had sought care for intense fear of childbirth 7 to 11 years prior to the interview (IV), and via questionnaire from a sample of 763 women during pregnancy and again one year following birth (III).Findings: Fear of childbirth was described as “to lose oneself as a woman into loneliness” (I). Previous birth experience was described as “a sense of not being present in the delivery room and an incomplete childbirth experience” (II). Fear of childbirth was associated with a previous negative birth experience and a previous emergency caesarean section (III). From a long-term perspective, fear of childbirth and birth experience was described as “an effort to make all the pieces come together” (IV).Conclusions: This thesis generates evidence on the importance of previous birth experience for women with fear of childbirth, from both qualitative and quantitative perspectives. These perspectives illustrate the complexity where women´s experiences in the delivery room are central. To avoid creating fear of childbirth, it is important that maternity care services focus on women’s birth experiences and critically evaluate care in relation to childbirth.
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| 33. |
- Nilsson, Christina, et al.
(författare)
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Previous birth experience in women with intense fear of childbirth
- 2010
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Ingår i: Journal of Obstetric, Gynecologic and Neonatal Nursing. - : Wiley-Blackwell. - 0884-2175 .- 1552-6909. ; 39:3, s. 298-309
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives.Design: A descriptive phenomenological study. Setting: A maternity clinic for women with fear of childbirth in the western part of Sweden. Participants: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative.Methods: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach.Results: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women’s minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense.Conclusions: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/ midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.
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| 34. |
- Nyman, Viola, 1961, et al.
(författare)
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Insider Action research as an approach and a method – Exploring institutional encounters from within a birthing context
- 2016
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Ingår i: Action Research. - : SAGE Publications. - 1476-7503 .- 1741-2617. ; 14:2, s. 217-233
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this paper was to describe the first person perspective of being a peer midwife and a novice researcher initiating collaborative AR in her own organization to develop knowledge about the first encounters between the labouring woman and her care-givers in a hospital birthing context. It was motivated by the author’s longstanding professional clinical experience of observing and hearing parents’ stories of vulnerability and fear of childbirth, and how staff’s attitudes affected the childbirth experience negatively. Data were collected between 2010 and 2013 and included the researcher’s log with reflections from clinical work, as well as interviews, participant observation, and research group communications. A reflective interpretative lifeworld research approach was used to analyze the data. The experience of being a novice insider action researcher (IARr) consisted of three thematic meanings: “the struggle to initiate a clinical insider action research project,” “standing alone at the messy front line,” and “being a catalytic counterbalance to the prevailing medico technical focus.” The comprehensive understanding was “learning how to clinically reflect on and to voice the tacit components of care.” The strategy used in undertaking this study was influenced by the philosophies of both midwifery care and AR.
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| 35. |
- Nyman, Viola, 1961, et al.
(författare)
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Midwives´ experiences of action research and the nature of the first encounter on a hospital based labour ward in Sweden
- 2014
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Ingår i: Optimizing childbirth across Europe - an intedisciplinary maternity care conference. 9-10 April 2014, Brussels. Part of COST Action IS0907: Childbirth Cultures, Concerns & Consequences: Creating a dynamic EU framework for Optimal maternity care..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: An Action research study was undertaken with midwives based on one Swedish labour ward, to improve the quality of the first encounter with women and their partners. Aim of presentation: To describe 1) the Ar process 2) midwives' responses to a changed approach in the initial labour ward encounter. Research methodology: An insider action research design included several planning meetings with the midwives, agreeing on change, implementing the changes together, and evaluating the effects. To meet the woman's and partner's need for support even in the first encounter the ambition was to stay with the woman and partner while the fetal heart monitoring was running. The researcher kept a research journal documenting thoughts, reactions, reflections and the development of the Ar process. Thirty seven out of 57 midwives working on the labour ward were interviewed about their experiences. Interviews were tape recorded, transcribed and analysed using interpretive description. Ethical approval Ethical approval was received Study findings: The Ar started 2010. Initially, midwives found it most difficult to change their routine of starting the fetal heart monitoring when women first arrived in labour, and then leaving to read the woman's medical record and notes. Through the debates in the Ar meetings, more midwives moved towards spending time in the room with the woman and partner, talking with them, thereby creating meaningful relationships from the outset. The midwives' reflexive responses in the interviews illuminate their initial reluctance to respond to the Ar process, but also, the value of reflecting beyond routines to build a lingering presence in the first labour encounter. Conclusions: Examination of the three years of insider Ar process through qualitatively analyse clinical documents, the researcher's journal including notes of observations and interviews revealed the complexity and the difficulty of providing time to manage reflection in a large organization. To a greater or lesser extent, midwives had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviors. The Ar study design enabled midwives reflect on routines and start the transformation of tacit use-inaction to reflection-in-action.
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| 36. |
- Nyman, Viola, 1961, et al.
(författare)
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Routine interventions in childbirth before and after initiation of an Action Research project : Sexual & Reproductive Healthcare
- 2017
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Ingår i: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 11, s. 86-90
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 Elsevier B.V.Background Unnecessary routine interventions in uncomplicated labour and birth, like cardiotocography (CTG), amniotomy, use of scalp electrode and oxytocin treatment, are associated with further interventions that could harm the woman and the infant. A four year Action Research (AR) project was done on a labour ward to enhance the capacity of local midwives in the promotion of physiological labour and birth. Aim To describe the use of interventions during labour and birth in healthy women at term with spontaneous onset of labour, before and after initiation of an Action Research project. Methods A retrospective before and after comparative study of clinical records from 2009 (before) and 2012 (after), based on a random selection of records from primiparous and multiparous women. Outcome measures were duration of admission CTG, frequency of admission CTG over 30 min, frequency of amniotomy, use of scalp electrode, and frequency of oxytocin augmentation in spontaneous labour. Results 903 records were included. The duration of admission CTG (p = 0.001), frequency of admission CTG duration over 30 min (p = <0.001), the use of scalp electrodes (p = <0.001), and use of oxytocin augmentation of spontaneous labour (p = 0.014) were reduced significantly after initiation of the AR project. There were no significant differences in frequency of amniotomy, duration of total CTG, postpartum bleeding, sphincter tears, Apgar score <5 at 5 min, and mode of birth. Conclusion Following an AR project, several interventions were reduced during labour and birth. Controlled studies in other settings are needed to assess the impact of collaborative action on decreasing unnecessary interventions.
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| 37. |
- Pajalic, Zada, 1967-
(författare)
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Matdistribution till hemmaboende äldre personer ur flera perspektiv
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this study was to gain insight into municipal food distribution from several perspectives: that of the clients, mainly elderly people, and also from the perspectives of different professionals and decision makers. An action research approach was chosen, as the characteristics of this method were deemed to be correct in relation to the basic aim of the study. This thesis is based on four empirical studies. Study I aimed to explore various professionals’ experiences of involvement in food distribution (FD) in order to get a comprehensive understanding of the organization, responsibilities and roles. The results showed that FD is a fragmentary intervention where a comprehensive perspective and clear roles of responsibility are lacking. Study II aimed to gain insight and to describe the experiences of home-living elderly people who receive hot meals distributed by their municipality. The results showed that there were feelings of dependency, and loneliness among the elderly participants, however they also expressed gratitude for the opportunity to have their meals delivered to their home. Study III aimed to describe how the professionals can identify needs for improvement and improve the municipal FD service to home living elderly people. The need to update and increase the FD recipient’s knowledge in nutrition by sending information letters was found to be an important area to focus on. Evaluation of letters resulted in the decision to continue preparing and distributing information letters to all FD recipients twice a year and to make the information letters assessable on the websites of the six municipalities and county councils involved. Study IV aimed to describe the decision maker’s views on FD and to report their suggestions for which areas reported from studies I-III should be taken into consideration as starting points to improve the municipal FD. The findings resulted in the decisions to monitor the elderly’s health and wellbeing while providing FD and to increase the professionals’ competence and to create a forum for inter-professional communication. In conclusion, this thesis illustrates that there is a necessity to identify the needs for general improvement of FD by involving the participants and to start out from their personal experiences and in their own context.
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| 38. |
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| 39. |
- Petersson, Pia, 1961-
(författare)
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Att göra abstrakta begrepp och komplexa situationer konkreta : en avhandling om deltagarbaserad aktionsforskning i svensk vård och omsorg
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.
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| 40. |
- 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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| 41. |
- Rosengren, Kristina, 1963-, et al.
(författare)
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Nurses' views of shared leadership in ICU : A case study
- 2010
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 26:4, s. 226-233
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Tidskriftsartikel (refereegranskat)abstract
- New management models develop; one of them is shared leadership where two nurse managers share tasks and responsibility for a unit. The overall aim of this study was to describe staff’s views about shared leadership at an ICU in Sweden, and to study if there were any differences in perceptions between staff groups. This unit had changed the management organization from single leadership (one nurse manager) to shared leadership (two nurse managers). Sixty four (79%) registered nurses and assistant nurses responded to a 72 item questionnaire measuring social and organizational factors at work, especially leadership and shared leadership. The results showed that staff reported positive views in relation to the dimensions ‘Organizational culture’, ‘Social interactions’, ‘Work satisfaction’, ‘Leadership’, ‘Shared leadership’ and ‘Work motives’. Registered nurses reported more positive views than assistant nurses in relation to the dimensions: ‘Organizational culture’, ‘Social interactions’, ‘Work satisfaction’ and ‘Leadership’. Further, females had more positive views than males on the dimension ‘Social interactions’. Staff described that shared leadership positively influenced the work in terms of confidence. In conclusion, staff reported positive views of work and the model shared leadership in the investigated ICU. One implication is that nurse managers have to be conscious of different health professionals in the unit and it is important to offer a good working environment for all staff. However, more research is needed within the area of shared leadership. A future research project could be to add a qualitative research question about how work and shared leadership affects different health professionals in the day to day practice both at the managerial as well as the team level to improve health care.
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| 42. |
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| 43. |
- Rosengren, Kristina, 1963-, et al.
(författare)
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Supporting 'two-getherness' : Assumption for nurse managers working in a shared leadership model
- 2010
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 26:5, s. 288-295
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Tidskriftsartikel (refereegranskat)abstract
- New leadership models are developing; one of them is shared leadership, which is often described at the team level. In this study, shared leadership is explored at the managerial level. The aim of this case study was to describe two nurse manager’s experiences of working together as equal partners within a shared leadership model at an intensive care unit in Sweden. The study comprised a total of 12 interviews collected over three years with two nurse managers who worked together in shared leadership. ‘Developing active influence to improve care’ was identified as the core category, which was related to five subcategories ‘Safeguarding leadership’, ‘Enabling leadership’, ‘Supporting ‘two’-getherness’, ‘Transparent determination’ and ‘Balancing power’. A new construct ‘two’-getherness’ was created, this means that two equal nurse managers within a trustful relationship share responsibility and tasks by using the couples’ strengths and minimizing their weaknesses. Nurse managers experienced increased opportunities to improve work standards and do the very best for the ward. Moreover, the shared leadership model balanced the burden of day-to-day management. A model of shared leadership was created for further research.
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| 44. |
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| 45. |
- Skytt, Bernice, 1957-
(författare)
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First-line Nurse Managers' Preconditions for Practise : The Important Interplay between Person and Organization
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to study personal and organizational conditions for first-line nurse managers and to identify and assess the skills and abilities important for leadership and management. Interviews were conducted with 5 first-line nurse managers, 5 registered nurses, 5 assistant nurses and one head of department delineating their perceptions of current and ideal roles of first-line nurse managers. Factor analysis was conducted to estimate validity and reliability of the Leadership and Management Inventory, developed in the context of this thesis, in one sample of 149 registered nurses and one sample of 197 health care personnel. Interviews and questionnaires to study expectations, experiences and outcomes of two different development programmes for 13 first-line nurse managers in a Training Programme, 14 in a Leadership Development Programme and 14 in a Comparison group were conducted. Letters and questionnaires from 32 former first-line nurse managers were analysed to describe their reasons for leaving their posts. First-line nurse managers, registered nurses and assistant nurses’ descriptions of the first-line nurse manager’s role were corresponding; the main focus was on service on the ward. The head of department described the first-line nurse manager’s responsibility towards the staff with focus on development and co-operation. Analysis of the Leadership and Management Inventory resulted in three factors: “interpersonal skills and group management”, “achievement orientation” and “overall organizational view and political savvy”. Validity and reliability were considered acceptable. Expectations concerning the development programmes were generally met; improvements corresponding to the content of the programmes were reported. Reasons to leave were personal, organizational and linked to the relationship with the head of department. Conclusion: The first-line nurse managers’ individual experiences, skills, abilities and ambitions are important, but so are the conditions in which she/he practices her/his leadership and management. It is important that the interplay between person and organization functions well.
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| 46. |
- Solbakken, Rita, et al.
(författare)
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International Nursing : Caring in Nursing Leadership : A Meta-ethnography From the Nurse Leader's Perspective.
- 2018
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Ingår i: Nursing Administration Quarterly. - : Lippincott Williams & Wilkins. - 0363-9568 .- 1550-5103. ; 42:4, s. E1-E19
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Tidskriftsartikel (refereegranskat)abstract
- To explore and derive new conceptual understanding of nurse leaders' experiences and perceptions of caring in nursing.RESEARCH QUESTION: What is caring in nursing leadership from the nurse leaders' perspectives? There is a paucity of theoretical studies of caring in nursing leadership. Noblit and Hares interpretative meta-ethnography was chosen because of its interpretative potential for theory development. Caring in nursing leadership is a conscious movement between different "rooms" in the leader's "house" of leadership. This emerged as the metaphor that illustrates the core of caring in nursing leadership, presented in a tentative model. There are 5 relation-based rooms: The "patient room," where nurse leaders try to avoid patient suffering through their clinical presence; the "staff room," where nurse leaders trust and respect each other and facilitate dialogue; the "superior's room," where nurse leaders confirm peer relationships; the "secret room," where the leaders' strength to hang on and persist is nurtured; and the "organizational room," where limited resources are continuously being balanced. Caring in nursing leadership means nurturing and growing relationships to safeguard the best nursing care. This presupposes that leaders possess a consciousness of the different "rooms." If rooms are not given equal attention, movement stops, symbolizing that caring in leadership stops as well. One room cannot be given so much attention that others are neglected. Leaders need solid competence in nursing leadership to balance multiple demands in organizations; otherwise, their perceptiveness and the priority of "ministering to the patients" can be blurred.
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| 47. |
- Vaismoradi, Mojtaba, et al.
(författare)
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Normalizing suffering : A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative metaethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of "identity of pain," "recognition of pain," and "response to pain." The metaphor of "normalizing suffering" was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society-among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain-must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain.
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| 48. |
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| 49. |
- Wikberg, Anita, et al.
(författare)
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A patient perspective in research on intercultural caring in maternity care : A meta-ethnography
- 2010
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - 1748-2623 .- 1748-2631. ; 5:1, s. 1-15
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare’s meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.
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| 50. |
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