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1.
  • Emmesjö, Lina (författare)
  • Within an integrated home health care model : Registered nurses’, physicians’, patients’ and their next of kin’s perspectives
  • 2024
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Many older patients receive health care from several different healthcare organizations, which may lead uncertainty about the responsibility for their healthcare needs. Integrated care has been argued to aid the healthcare system by addressing the challenge of the complex care needs of older patients with multiple health problems. Previous research has stated that integrated care models often have been developed with a focus on a single diagnosis, which risks overlooking the extensive and complex care needs of older patients. Prior research has also expressed the need to deepen knowledge about how integrated care models influence health care professionals, patients and their next of kin. Moreover, it is important to understand how the COVID-19 pandemic affected integrated care models which may expand knowledge about integrated home health care in crisis situations.The overall aim is to study expectations, perceptions and experiences of integrated home health care through the perspective of registered nurses, physicians, patients and their next of kin.Inductive qualitative designs where data was collected through interviews and field notes in the setting of the mobile integrated care model with a home health care physician (MICM) with registered nurses, physicians and patients and next of kin. Analysis was conducted using qualitative content analysis, phenomenography, and thematic analysis.The emphasis on person-centered care in the MICM was evident in the perceptions of the healthcare professionals about the patients and their next of kin, whom they viewed as persons, not simply recipients of health care. Differences were found in the health care provided in the MICM and in comparison, to other healthcare organizations which did not align with the person-centered care ethics. However, providing health care to patients in their own home benefited the provision of person-centered care – the value base of the MICM. The MICM was created with the goal of implementing individually tailored and coherent health care with increased continuity. The healthcare professionals viewed individual medical healthcare plans as co-created with each patient, and yet no patient could recall participating in this co-creation. The coherency of the MICM was regarded as having been improved by teamwork between the registered nurse and the home healthcare physician. Collaborations with other healthcare professionals rarely occurred and should be improved in the future. Participants reported varying experiences of continuity in the MICM, which influenced the possibility of building relationships. Providing continuity with a home healthcare physician for patients is therefore preferable. The work described in this thesis was conducted during the COVID-19 pandemic. The thesis provides unique insights into an integrated care model during a crisis situation, which the healthcare system may face in similar or different ways in the future. The MICM was upheld as the best way to work in home health care, especially as patients and their next of kin regarded the model as making their daily lives easier.
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2.
  • Göras, Camilla, 1969- (författare)
  • Open the door to complexity : Safety climate and work processes in the operating room
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A complex adaptive system such as the operating room (OR), consists of different safety cultures, sub-cultures and ways of working. When measuring, a strong safety climate has been associated with lower rates of surgical complications. Teamwork is an important factor of safety climate. Discrepancies among professionals’ perceptions of teamwork climate exists. Hence it seems crucial to explore if diversity exists in the perception of factors related to safety climate and between managers and front-line staff in the OR. Complex work processes including multitasking and interruptions are other challenges with potential effect on patient safety. However, multitasking and interruptions may have positive impact on patient safety, but are not well understood in clinical work. Despite challenges a lot of things go well in the OR. Thus, the overall aim of this thesis was to evaluate an instrument for assessing safety climate, to describe and compare perceptions of safety climate, and to explore the complexity of work processes in the OR.To evaluate the Safety Attitudes Questionnaire-operating room (SAQ-OR) version and elicit estimations of the surgical team a cross-sectional study design was used. How work was done was studied by observations using the Work Observation Method by Activity Timing and by group interviews with OR professionals.The results show that the SAQ-OR is a relatively acceptable instrument to assess perceptions of safety climate within Swedish ORs. OR professionals´ perceptions of safety climate showed variations and some weak areas which cohered fairly well with managers' estimations. Work in the OR was found to be complex and consisting of multiple tasks where communication was most frequent. Multitasking and interruptions, mostly followed by communication, were common. This reflects interactions and adaptations common for a complex adaptive system. Managing complexity and creating safe care in the OR was described as a process of planning and preparing for the expected and preparedness to be able to adapt to the unexpected.
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3.
  • Arvidsson, Lisa (författare)
  • Healthcare personnel's working conditions relationship to risk behaviours for organism transmission
  • 2021
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Healthcare personnel (HCP) often experience undesirable working conditions. Risk behaviours for organism transmission can lead to healthcare associated infections and risk behaviours has been described to be influenced by working conditions. Research is lacking regarding HCPs working conditions and its relation to risk behaviours for organism transmission which this thesis aims to investigate. Methods: Study I had a mixed-methods convergent design. Observations and interviews were performed with 79 HCP, i.e., registered nurses (RNs) and assistant nurses (ANs). First-line managers were interviewed about the unit´s overall working conditions. The qualitative and quantitative data were analysed separately and then merged. Study II was a cross-sectional study with 417 RNs and ANs. The questionnaire included: self-efficacy to aseptic care, structural empowerment (SE), work engagement (WE) and work-related stress (WRS). Correlational analysis and group comparisons were performed. Results: In Study I risk behaviours frequently occurred regardless of measurable and perceived working conditions. The HCP described e.g. staffing levels and interruptions to influence risk behaviours. In the statistical analyses, risk behaviours were more frequent in interrupted activities and when the HCP worked together. In Study II the HCP rated high levels of self-efficacy to aseptic care. Differences were found between self-efficacy and some of the grouped working condition variables and definite but small relationships were found between self-efficacy to aseptic care and SE/WE/WRS. Conclusion: The HCP rated high levels of self-efficacy to aseptic care, but on the other hand, risk behaviours frequently occurred irrespective of working conditions. Healthcare managers are responsible for HCPs work environment and should continuously work to promote sufficient working conditions and to increase HCPs understanding of risk behaviours, which consequently also promote patient safety.
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4.
  • Lindblad, Marléne, 1963- (författare)
  • Exploring patient safety in home healthcare : a resilience engineering approach
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overall aim of the thesis is to increase knowledge and understanding of patient safety in home healthcare.This thesis has an explorative mixed-methods design, with both qualitative (Papers І and ІІ) and quantitative (Papers ІІІ, ІV and V) methods. Data for Papers І and ІІ were collected at three specialised home healthcare units. The aim for Paper І was to explore patient safety in home healthcare from the multidisciplinary teams and clinical managers’ perspective. Data collection for the study was done through seven individual and nine focus group interviews, a total of 51 participants, and analysed with qualitative content analysis. The aim of Paper ІІ was to explore the medication management process. The data collection was done by observing the medication management process for 27 days, 9 days per unit, and through interviews with the healthcare professionals who had been observed. Data was collected in iterative phases and analysed with grounded theory.The aim of Paper ІІІ was to develop a trigger tool for structured retrospective record review to identify adverse events and no-harm incidents and their preventability that affect adult patients admitted into home healthcare. Another aim was to describe how the development was conducted. During the development, the trigger tool was tested twice, using 60 and 600 records, respectively, from ten different organisations from nine different regions across Sweden. The same 600 randomised home healthcare records were used for Papers ІV and V. The aim of Paper ІV was to explore the incidence, types and preventability of adverse events using the trigger tool. For Paper V the aim was to explore cumulative incidence, preventability, types and potential contributing causes of no-harm incidents using the trigger tool. Studies ІІІ, ІV and V were analysed with descriptive statistics.The results showed that the clinical managers and the multidisciplinary teams considered patient safety as associated with their common mind-set of safe care, based on a well-established care ideology. This mindset included the establishment of a trustworthy relationship with patients and relatives. At the same time, provision of care in a home was characterised by weighing values against each other, between risks and patients’ and relatives’ autonomy and wishes. Other typical contradictory values were between collecting measurements for different quality registers (directives from policy-makers as a measure of quality and safety), or taking time for patient needs. Strategies and behaviours, such as not following routines, to get around problematic processes were the result of conflicting goals that either promoted or prevented patient safety (Papers І and ІІ). Results from Study ІІІ showed that the empirically tested triggers identified more triggers compared to several other studies and thus formed a rich material for validation. More than a third of the patients in home healthcare were affected by adverse events (37.7%), most of which were deemed preventable (71.6%). Most adverse events (69.1%) were temporary and led to that the patient required extra healthcare visits or led to a prolonged period of healthcare. The most common adverse events were “healthcare-associated infections, falls and pressure ulcers (Study ІV). Almost every third patient (29.5%) was affected by a no-harm incident, one-fifth of which were deemed preventable (21.2%). The most common types of no-harm incidents were “fall without harm,” “deficiencies in medication management,” and “moderate pain”. “Deficiencies in medication management” were deemed to have a preventability rate (98.4%) twice as high as “fall without harm” (40.9%) and “moderate pain” (50.0%). The most common potential contributing cause of “fall without harm” was “deficiencies in nursing care, i.e., delayed, erroneous, omitted or incomplete care”. For “deficiencies in medication management” and “moderate pain” the most common contributing cause was “delayed, erroneous, omitted or incomplete treatment”. Of the total number of no-harm incidents, the most common contributing causes were “deficiencies in nursing care, treatment or diagnosis” and “deficiencies in communication, information or collaboration” (Paper V).The conclusion is that patient safety is generally strengthened by the fact that clinical managers and multidisciplinary teams have a common approach to safety built on an internationally and national well-established care ideology, which forms a “dyad” with safe care. In home healthcare, patient safety is formed by the team creating a trustworthy relationship with patients and their families and involving them as partners in their own care. Additionally, the trigger tool and associated manual adapted for home healthcare may be a valid method for identifying cumulative incidence, types, preventability and contributing causes for adverse events and no-harm incidents. Such patient safety knowledge can be used to develop valid process indicators for systemic failures, as well as outcome indicators for structured evaluation and lead to proactive patient safety work in home healthcare.
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5.
  • Backåberg, Sofia, 1979-, et al. (författare)
  • Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults
  • 2020
  • Ingår i: Frontiers of Computer Science. - : Frontiers Media S.A.. - 2095-2228 .- 2095-2236 .- 2624-9898. ; 2
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Mobility and balance is essential for older adults’ well-being an independence and the ability tomaintain physically active. Early identification of functionalimpairmentmay enable early risk-of-fall assessments and preventivemeasures.  There is a need to find new solutions to assess functional ability in easy, efficient, and accurateways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.Methods: Fifty-four older adults (+65 years) were recruited through pensioners’ associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.
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6.
  • Ekstedt, Mirjam, Professor, et al. (författare)
  • ‘We just have to make it work’ : a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios
  • 2022
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.Design A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.Setting Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.Participants Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.Results Home care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.Conclusions Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.
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7.
  • Johnsson, Natali, et al. (författare)
  • Delineating and clarifying the concept of self-care monitoring : a concept analysis
  • 2023
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective.MethodsA systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016–September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers’ Evolutionary Method for Concept Analysis.ResultsThe following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: “Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action.” The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts’ consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being.ConclusionsThis concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.
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8.
  • Lincke, Alisa, 1989-, et al. (författare)
  • A comparative study of the 2D- and 3D-based skeleton avatar technology for assessing physical activity and functioning among healthy older adults
  • 2023
  • Ingår i: Health Informatics Journal. - : SAGE Open. - 1460-4582 .- 1741-2811. ; 29:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Maintaining physical activity (PA) and functioning (mobility, balance) is essential for older adults’ well-being and quality of life. However, current methods (functional tests, self-reports) and available techniques (accelerometers, sensors, advanced movement analysis systems) for assessing physical activity and functioning have shown to be less reliable, time- and resource-consuming with limited routine usage in clinical practice. There is a need to simplify the assessment of physical activity and functioning among older adults both in health care and clinical studies. This work presents a study on using Skeleton Avatar Technology (SAT) for this assessment. SAT analyzes human movement videos using artificial intelligence (AI). The study compares handy SAT based on 2D camera technology (2D SAT) with previously studied 3D SAT for assessing physical activity and functioning in older adults. Objective: To explore whether 2D SAT yields accurate results in physical activity and functioning assessment in healthy older adults, statistically compared to the accuracy of 3D SAT. Method: The mobile pose estimation model provided by Tensorflow was used to extract 2D skeletons from the video recordings of functional test movements. Deep neural networks were used to predict the outcomes of functional tests (FT), expert-based movement quality assessment (EA), accelerometer-based assessments (AC), and self-assessments of PA (SA). To compare the accuracy with 3D SAT models, statistical analysis was used to test whether the difference in the predictions between 2D and 3D models is significant or not. Results: Overall, the accuracy of 2D SAT is lower than 3D SAT in predicting FTs and EA. 2D SAT was able to predict AC with 7% Mean Absolute Error (MAE), and self-assessed PA (SA) with 16% MAE. On average MAE was 4% higher for 2D than for 3D SAT. There was no significant difference found between the 2D and the 3D model for AC and for two FTs (30 seconds chair stand test, 30sCST and Timed up and go, TUG). A significant difference was found for the 2D- and 3D-model of another FT (4-stage balance test, 4SBT). Conclusion: Altogether, the results show that handy 2D SAT might be used for assessing physical activity in older adults without a significant loss of accuracy compared to time-consuming standard tests and to bulky 3D SAT-based assessments. However, the accuracy of 2D SAT in assessing physical functioning should be improved. Taken together, this study shows promising results to use 2D SAT for assessing physical activity in healthy older adults in future clinical studies and clinical practice.
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9.
  • Lincke, Alisa, 1989-, et al. (författare)
  • Skeleton avatar technology as a way to measure physical activity in healthy older adults
  • 2021
  • Ingår i: Informatics in Medicine Unlocked. - : Elsevier. - 2352-9148. ; 24
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundNowadays, self-reported assessments (SA) and accelerometer-based assessments (AC) are commonly used methods to measure daily life physical activity (PA) in older adults. SA is simple, cost-effective, and can be used in large epidemiological studies, but its reliability and validity have been questioned. Accelerometer measurement has proven valid to provide accurate and reliable measurement of everyday life physical activities regarding frequency, duration, and intensity in older populations, but is expensive and requires a long-time measurement. Here is, furthermore, a lack of well-defined and reliable accelerometer cut-off points to measure PA among older adults. Therefore, there is a need to develop a simple and reliable method to complement/replace self-assessment methods of daily life physical activity and facilitate the future development of cut-off points to measure daily life physical activities among older adults. In this study, we explore how skeleton avatar technology (SAT) can be used to measure PA among older adults.Objectives1. To explore the association between accelerometer data and self-reported assessment data of daily life physical activities in older adults, and 2. To explore how the SAT of a standardized functional (balance) test can be used to measure daily life physical activity among older adults.MethodThe correlation analysis was used to explore the association between response variables, and deep neural networks were used to predict the response variables (AC and SA outcomes).ResultsThe results indicate that there is a moderate (r = 0.31) significant (p = 0.029) correlation between AC of PA and SA of PA. The functional balance test assessed with SAT was able to predict AC with 3.89% Mean Absolute Error (MAE), and SA with 11.07% MAE.ConclusionOverall, these results indicate that one functional balance test measured with SAT can be used to predict PA outcomes measured with accelerometer devices. SAT can predict PA outcomes better than SA outcomes within the same population. More research is needed to explore the ability of SAT predicting PA among older adults with various functional abilities, and how SAT can be developed using 2D recordings, such as mobile phone recordings, to predict PA efficiently.
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10.
  • Ljungholm, Linda, et al. (författare)
  • Measuring patients' experiences of continuity of care in a primary care context - Development and evaluation of a patient-reported experience measure
  • 2024
  • Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 80:1, s. 387-398
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundContinuity of care is viewed as a hallmark of high-quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs.AimTo develop and evaluate a patient-reported experience measure of continuity of care in primary care for patients with complex care needs.MethodThe study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test-retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation.ResultsThe Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability.Conclusion/ImplicationsThe PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs.Patient or Public ContributionPatients have participated in the content validation of the items.
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11.
  • Ljungholm, Linda (författare)
  • Patients’ experiences of continuity of care : What is needed and how can it be measured?
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: The overall aim for this thesis was to explore continuity of care through patients’, family carers’, and health care personnel’s perceptions, and to develop and evaluate a patient-reported experience measure of continuity of care.Method: This thesis consists of four studies; I have a qualitative explorative design and II have a qualitative descriptive design, whereas III and IV are methodological studies. In studies I and II, data were collected from four geographically disparate areas in Sweden; in studies III and IV, data were collected in one of these areas. Data were collected using individual (I, II, III), focus groups, pair interviews (II), and questionnaires (III, IV). Data were analyzed using constructivist grounded theory (I), conventional content analysis (II), and according to classical test theory (III), and Rasch measurement theory (IV).Results: For patients to experience continuity of care, all aspects were interconnected, as access to tailored information was essential for gaining mutual understanding regardless of who was performing a care task. This required clarity in responsibilities and roles, interprofessional collaboration, and a trusting relationship over time and space between each link in the patient’s care trajectory (I). Further, Study II showed that to achieve continuity of care, professional and cross disciplinary cooperation at micro, meso and macro levels were needed. Continuity of care is dependent on long-term and person-centered relationships, dynamic stability in the organizational structure, and shared responsibility for cohesive care enabling uniform solutions for knowledge and information exchange (II). Studies III and IV resulted in the Patient-Experienced Continuity of care Questionnaire (PECQ). The instrument contains 20 items measuring four dimensions of continuity of care: Information (four items), Relation (six item), Management (five item), and Knowledge (five item). Overall, the PECQ showed satisfactory measurement properties according to classical test theory and Rasch measurement theory (III, IV) regarding factor structure, unidimensional, local independence, response category function, differential item functioning for age and sex, and internal consistency reliability.Conclusion: Continuity of care is perceived as multidimensional, containing several important aspects working in synergy and varying over time. To achieve continuity of care, information and knowledge sharing need to cross disciplinary and organizational boundaries. Collaborative responsibility is needed, vertically through all levels of the system, instead of focusing on personal responsibility horizontally. The PECQ can provide information on different dimensions of continuity, useful for driving quality improvements in the primary care context. 
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12.
  • Strandberg, Susanna, et al. (författare)
  • Self-care management and experiences of using telemonitoring as support when living with hypertension or heart failure : A descriptive qualitative study
  • 2023
  • Ingår i: International Journal of Nursing Studies Advances. - : Elsevier. - 2666-142X. ; 5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The need for support in self-care at home will increase with the growing older population with chronic illness. Many people have one or more chronic illnesses and struggle with self-care activities, often supported by informal carers at home. The rapid development of telemonitoring applications in primary care calls for increased knowledge about how people with chronic illness and their informal carers experience the use of telemonitoring applications at home.Objective This study aims to describe experiences of self-care management at home when living with hypertension or heart failure, with support from primary care through telemonitoring.Design A descriptive qualitative approach was applied using semi-structured interviews with patients and informal carers in a pilot project on telemonitoring of chronic illness in primary care from October 2019 to June 2021.SettingParticipants were recruited from three primary care settings and one medical department at one hospital in a region in southern Sweden.ParticipantsA purposive sample of patients (n = 20) with chronic illness living at home and their informal carers (n = 4) were recruited.Methods Semi-structured telephone interviews were conducted, guided by open-ended questions targeting patients’ and informal carers’ experiences of self-care management at home and using telemonitoring applications as support. Transcribed interviews were analyzed through qualitative content analysis.Results ’Developing the capability to perform self-care with technology as both an intruder and an invited guest’ was the unifying theme that tied together the experiences of patients with chronic illness and their informal carers. Experiences of self-care management included acquiring necessary self-care skills, expertise in managing their chronic illness, and reciprocal relationships with healthcare professionals when using telemonitoring application as support in self-care monitoring of vital parameters. However, uncertainty regarding the interpretation of symptoms and a feeling of exclusion were seen.Conclusions Telemonitoring applications offer potential support for patients with chronic illnesses and their informal carers, enabling them to establish new routines and enhance motivation for self-care activities at home. This study emphasizes the adaptability of telemonitoring applications in meeting the unique support requirements of patients and informal carers when managing self-care at home.
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13.
  • Svensson, Ingrid, et al. (författare)
  • Unfolding alignment - How top management work to align demand and capacity : an ethnographic study of resilience in a Swedish healthcare region.
  • 2023
  • Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Resilient healthcare organizations maintain critical functions and high-quality care under varying conditions. While previous research has focused on the activities of frontline healthcare professionals working at the "sharp end" of care, less attention has been paid to managers at the top management level. More knowledge is needed to fully understand how the managers align demand and capacity at the "blunt end" of care. Therefore, this study aimed to explore how top managers work to align demand and capacity in a healthcare region in Sweden.METHODS: Observations of management team meetings, interviews, and conversations were conducted with top managers responsible for healthcare in one of Sweden's 21 regions. Data collection used an ethnographic approach. Data were analyzed using qualitative reflexive thematic analysis.RESULTS: The data showed how alignment work was done through active reflection that built on past experiences and on structures built into the organization at the same time as taking future potential outcomes and consequences into account. In addition to collaborative, preventive, supportive, and contextualizing work, which was conducted in the present, a general approach permeated the organization, which enabled connecting actions, i.e., different forms of alignment work, occurring at different points in time, and connecting different types of knowledge across organizational borders and stakeholders.CONCLUSION: This study explored how top managers work to align demand and capacity in a healthcare region in Sweden. It was shown how four categories of work; collaborative, preventive, supportive and contextualization work, together with a general approach; focusing on opportunities, building on a stable past and taking a reflective stance, constitute alignment in practice. More; the alignment work was done in the here and now, with both the past and future in mind. The ability to take action to benefit the whole is a possibility and a responsibility for top management. In the region studied, this was done by aligning demands with capacity based on past experiences and focusing on the available opportunities to connect knowledge needed within and across organizational borders.
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14.
  • Adelsjö, Igor, et al. (författare)
  • Communication about medication management during patient–physician consultations in primary care : a participant observation study
  • 2022
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:11
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.Setting Two primary care centres in southern Sweden.Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.
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15.
  • Adelsjö, Igor (författare)
  • Medication communication with older adults experiencing chronic illness and polypharmacy
  • 2023
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Populations in many high-income countries are ageing, with an ever-increasing proportion of the population aged 65 years or older. Despite increasingly better health in older people, susceptibility to chronic illness increase with age. As life expectancy increases, the length of time people can live with chronic illness increases correspondingly, mainly due to improved medication treatments. Decreased number of hospital beds per capita and length of stay in hospital has gained primary care an increasing role in the healthcare system, with higher demands on patients and their knowledge and abilities to manage medications and self-management.Aim: The overarching aim of this thesis was to explore how medication regimens are communicated in primary care consultations and in written discharge letters.Methods: In Study I, passive participant observations of primary care consultations were audio-recorded, transcribed and analysed using content analysis. Study II had a convergent mixed methods design. An assessment matrix, constructed based on previous research, was used to assess and quantify discharge letter content. The quantified discharge letter content, questionnaires and register data were used to calculate correlations between discharge letter content and readmission rate as well as self-rated quality of care transition. Finally, associations between discharge letter content and time to readmission were calculated both univariable and multivariable. In addition to discharge letter content, several other potential independent variables were included in the multivariable analysis.Results: Both studies show that physicians were prone to give information about medications and blood-samples or other examinations performed in advance to the consultation (Study I) or during the hospital admission (Study II). The physicians were, however, less prone to inform patients about self-management and lifestyle changes, symptoms to be aware of, and what to do in case they would appear. Communication was occasionally hindered by misunderstandings, e.g., when vague expressions or words with ambiguous meaning was used. Ambiguities e.g., arose due to dialectal disparity. Although physicians mainly communicated in plain language with patients, medication names imposed a significant problem for patients and in communication about medications. Discharge letter content was not associated to readmissions, the only significant predictor variables for time to readmission were previous admission the past 180 days and birth outside the Nordic countries. Discharge letters with more content were, on the other hand, correlated to worse self-estimated quality of care transition from hospital to home (Study II).Conclusions: Physicians informed patients about tests and examinations performed in the past time, and comprehensive information was provided about medications, both during consultations and in discharge letters. However, information about symptoms to be aware of and measures to take in case they would appear was scarce in consultations and discharge letters. In conversations where lifestyle changes were raised, the topic was quickly dropped without recommendations or offering support if the patient showed unconcern. Lifestyle changes in relation to chronic illness and medications were rarely discussed. Improved lifestyle as a means of reducing the need for medications was not discussed or informed about in discharge letters. Discharge letter content did not have any impact on readmissions.
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16.
  • Adelsjö, Igor, et al. (författare)
  • The impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days in patients with chronic illness
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Aim: To determine the impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days, and to identify correlations between discharge letter content and quality of care transitions among patients with chronic illness.Design: A convergent mixed methods design.Methods: Discharge letters from 154 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of 'discharge letter score'. Bivariate correlations between discharge letter score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between discharge letter score and time to readmission.Results: All discharge letters contained at least five of eleven key elements. In less than four percent, all eleven key elements were present. Neither discharge letter score nor single key elements correlated with 30-day or 90-day readmission rate. Discharge letter score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.Conclusion: Discharge letter score is not correlated with either 30-day or 90-day readmission rate or with time to readmission at 90 days, when patient characteristics are adjusted for.Implications for the profession and patient care: Written discharge summaries are not enough to facilitate safe care transitions and self-management after discharge. A person-centred approach, providing written and verbal information to patients, encouraging patient involvement soon after discharge, may be needed to avoid readmission.
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17.
  • Backåberg, Sofia, 1979-, et al. (författare)
  • Tidöavtalet hotar den sömlösa vården av äldre
  • 2022
  • Ingår i: Sydsvenskan. - : Sydsvenska dagbladets aktiebolag. - 1652-814X. ; :2022-11-09
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • Rätt till fast läkarkontakt kan absolut vara bra, speciellt för diagnostik, bedömning och medicinsk behandling. Men det räcker inte, skriver forskare och lärare vid Linnéuniversitetet.
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18.
  • Berggren, Karin, et al. (författare)
  • Healthcare workers' experiences of patient safety in the intensive care unit during the COVID-19 pandemic : A multicentre qualitative study
  • 2023
  • Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 32:19-20, s. 7372-7381
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo describe healthcare workers' experiences of preconditions and patient safety risks in intensive care units during the COVID-19 pandemic. BackgroundHealthcare workers' ability to adapt to changing conditions is crucial to promote patient safety. During the COVID-19 pandemic, healthcare workers' capacity to maintain safe care was challenged and a more in-depth understanding on frontline experiences of patient safety is needed. DesignA qualitative descriptive design. MethodsIndividual interviews were conducted with 29 healthcare workers (nurses, physicians, nurse assistants and physiotherapists) from three Swedish hospitals directly involved in intensive care of COVID-19 patients. Data were analysed with inductive content analysis. Reporting followed the COREQ checklist. ResultsThree categories were identified. Hazardous changes in working conditions describes patient safety challenges associated with the extreme workload with high stress level. Imperative adaptations induced by changed preconditions for patient safety which include descriptions of safety risks following adaptations related to temporary intensive care facilities, handling shortage of medical equipment and deviations from routines. Safety risks triggered by reorganisation of care describe how the diluted skill-mix and team disruptions exposed patients to safety risks, and that safety performance mostly relied on individual healthcare worker's responsibility. ConclusionsThe study suggests that healthcare workers experienced an increase in patient safety risks during the COVID-19 pandemic mainly because the extremely high workload, imperative adaptations, and reorganisation of care regarding skill-mix and teamwork. Patient safety performance relied on the individuals' adaptability and responsibility rather than on system-based safety. Relevance to Clinical PracticeThis study provides insights on how healthcare workers' experiences can be used as a source of information for recognition of patient safety risks. To improve detection of safety risks during future crises, guidelines on how to approach safety from a system perspective must include healthcare workers' perceptions on safety risks. Patient and Public ContributionNone in the conceptualisation or design of the study.
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19.
  • Bjurling-Sjöberg, Petronella, 1968-, et al. (författare)
  • Resilient performance in healthcare during the COVID-19 pandemic (ResCOV) : study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety.
  • 2021
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:12
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Since early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic's rampage, the processes involved and the consequences on working conditions, ethics and patient safety.METHODS: An emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants' first-person stories are complemented with data from the healthcare organisations' internal documents and national and international official documents.ANALYSIS: Experiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic.ETHICS AND DISSEMINATION: This project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.
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20.
  • Brandberg, Carina, et al. (författare)
  • Self-management challenges following hospital discharge for patients with multimorbidity : a longitudinal qualitative study of a motivational interviewing intervention
  • 2021
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:7
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThe aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period.DesignThis is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions.SettingThe RCT was conducted at six wards in two hospitals—one university hospital and one general hospital in Stockholm, Sweden, during 2016–2018.ParticipantsSixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study.InterventionsEach participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed.ResultsSelf-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: ‘Managing a system-centred care’ and ‘Handling the burden of living with multiple illnesses at home post-discharge’.ConclusionsSelf-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs.
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21.
  • Carlqvist, Catharina, et al. (författare)
  • Health care professionals' experiences of how an eHealth application can function as a value-creating resource-a qualitative interview study
  • 2021
  • Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients' engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.
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22.
  • Ekstedt, Mirjam, Professor, et al. (författare)
  • Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases : A Theory-Driven User-Centered Approach
  • 2022
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:1
  • Tidskriftsartikel (refereegranskat)abstract
    • The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.
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23.
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24.
  • Ekstedt, Mirjam, Professor, et al. (författare)
  • Nursing students' perception of the clinical learning environment and supervision in relation to two different supervision models : a comparative cross-sectional study
  • 2019
  • Ingår i: BMC Nursing. - : BioMed Central. - 1472-6955. ; 18:1, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Knowledge concerning nursing students' experiences of the clinical learning environment and how supervision is carried out is largely lacking. This study compares nursing students' perceptions of the clinical learning environment and supervision in two different supervision models: peer learning in student-dedicated units, with students working together in pairs and supervised by a "preceptor of the day" (model A), and traditional supervision, in which each student is assigned to a personal preceptor (model B). Methods: The study was performed within the nursing programme at a university college in Sweden during students' clinical placements (semesters 3 and 4) in medical and surgical departments at three different hospitals. Data was collected using the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, CLES+T, an instrument tested for reliability and validity, and a second instrument developed for this study to obtain deeper information regarding how students experienced the organisation and content of the supervision. Independent t-tests were used for continuous variables, Mann-Whitney U-tests for ordinal variables, and the chi-square or Fischer's exact tests for categorical variables. Results: Overall, the students had positive experiences of the clinical learning environment and supervision in both supervision models. Students supervised in model A had more positive experiences of the cooperation and relationship between student, preceptor, and nurse teacher, and more often than students in model B felt that the ward had an explicit model for supervising students. Students in model A were more positive to having more than one preceptor and felt that this contributed to the assessment of their learning outcomes. Conclusions: A good learning environment for students in clinical placements is dependent on an explicit structure for receiving students, a pedagogical atmosphere where staff take an interest in supervision of students and are easy to approach, and engagement among and collaboration between preceptors and nurse teachers. This study also indicates that supervision based on peer learning in student-dedicated rooms with many preceptors can be more satisfying for students than a model where each student is assigned to a single preceptor.
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25.
  • Ekstedt, Mirjam, Professor, et al. (författare)
  • Patient safety and sense of security when telemonitoring chronic conditions at home: the views of patients and healthcare professionals : a qualitative study
  • 2023
  • Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Chronic diseases are increasing worldwide, and the complexity of disease management is putting new demands on safe healthcare. Telemonitoring technology has the potential to improve self-care management with the support of healthcare professionals for people with chronic diseases living at home. Patient safety threats related to telemonitoring and how they may affect patients’ and healthcare professionals’ sense of security need attention. This study aimed to explore patients’ and healthcare professionals’ experiences of safety and sense of security when using telemonitoring of chronic conditions at home.Methods: Semi-structured interviews were conducted with twenty patients and nine healthcare professionals (nurses and physicians), recruited from four primary healthcare centers and one medical department in a region in southern Sweden using telemonitoring service for chronic conditions in home healthcare.Results: The main theme was that experiences of safety and a sense of security were intertwined and relied on patients´ and healthcare professionals´ mutual engagement in telemonitoring and managing symptoms together. Telemonitoring was perceived to increase symptom awareness and promote early detection of deterioration promoting patient safety. A sense of security emerged through having someone keeping track of symptoms and comprised aspects of availability, shared responsibility, technical confidence, and empowering patients in self-management. The meeting with technology changed healthcare professionals’ work processes, and patients’ daily routines, creating patient safety risks if combined with low health- and digital literacy and a naïve reliance on technology. Empowering patients’ self-management ability and improving shared understanding of the patient’s health status and symptom management were prerequisites for safe care and the patient´s sense of security.Conclusions: Telemonitoring chronic conditions in the homecare context can promote a sense of security when care is co-created in a mutual understanding and responsibility. Attentiveness to the patient’s health literacy, symptom management, and health-related safety behavior when using eHealth technology may enlighten and mitigate latent patient safety risks. A systems approach indicates that patient safety risks related to telemonitoring are not only associated with the patient’s and healthcare professionals functioning and behavior or the human-technology interaction. Mitigating patient safety risks are likely also dependent on the complex management of home health and social care service.
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26.
  • Ekstedt, Mirjam, Professor, et al. (författare)
  • Planerad vila förebygger överträning
  • 2010
  • Ingår i: Svensk idrottsmedicin. - : Svensk Idrottsmedicinsk Förening, SIMF. - 1103-7652. ; :1, s. 14-17
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • Utvecklingen från naturlig trötthet till utmattning följer ungefär samma förlopp vid mentalöveransträngning som vid sjukdom eller fysisk överbelastning. Genom att aktivt prioritera ochplanera in tid för vila och återhämtning förebygger man överträning och utmattning.
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27.
  • Ekstedt, Mirjam, Professor (författare)
  • Teoretiska perspektiv på patientsäkerhet
  • 2019. - 1
  • Ingår i: Hemsjukvård. - Stockholm : Liber. - 9789147112777 ; , s. 23-50
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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28.
  • Engström, Ingemar, 1952-, et al. (författare)
  • Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review
  • 2023
  • Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
  • Forskningsöversikt (refereegranskat)abstract
    • BackgroundContinuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI.MethodsEleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518.ResultsWe identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas.ConclusionsThe results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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29.
  • Flink, Maria, et al. (författare)
  • Kontinuitet och integrerad vård
  • 2019. - 1
  • Ingår i: Hemsjukvård. - Stockholm : Liber. - 9789147112777 ; , s. 267-280
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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30.
  • Flink, Maria, et al. (författare)
  • Patienters delaktighet för säker vård
  • 2019. - 1
  • Ingår i: Hemsjukvård. - Stockholm : Liber. - 9789147112777 ; , s. 191-207
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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31.
  • Freilich, Joel, et al. (författare)
  • "Standing on common ground"-a qualitative study of self-management support for patients with multimorbidity in primary health care
  • 2020
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 21:1, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Multimorbidity, the co-existence of two or more chronic conditions in an individual, is present in most patients over 65 years. Primary health care (PHC) is uniquely positioned to provide the holistic and continual care recommended for this group of patients, including support for self-management. The aim of this study was to explore professionals', patients', and family caregivers' perspectives on how PHC professionals should support self-management in patients with multimorbidity. This study also includes experiences of using telemedicine to support self-management. Methods A mixed qualitative method was used to explore regular self-management support and telemedicine as a tool to support self-management. A total of 42 participants (20 physicians, 3 registered nurses, 12 patients, and 7 family caregivers) were interviewed using focus group interviews (PHC professionals), pair interviews (patients and family caregivers), and individual interviews (registered nurses, patients, and family caregivers). The study was performed in urban areas in central Sweden and rural areas in southern Sweden between April 2018 and October 2019. Data were analyzed using content analysis. Results The main theme that emerged was "Standing on common ground enables individualized support." To achieve such support, professionals needed to understand their own views on who bears the primary responsibility for patients' self-management, as well as patients' self-management abilities, needs, and perspectives. Personal continuity and trustful relationships facilitated this understanding. The findings also indicated that professionals should be accessible for patients with multimorbidity, function as knowledge translators (help patients understand their symptoms and how the symptoms correlated with diseases), and coordinate between levels of care. Telemedicine supported continual monitoring and facilitated patient access to PHC professionals. Conclusion Through personal continuity and patient-centered consultations, professionals could collaborate with patients to individualize self-management support. For some patients, this means that PHC professionals are in control and monitor symptoms. For others, PHC professionals play a less controlling role, empowering patients' self-management. Development and improvement of eHealth tools for patients with multimorbidity should focus on improving the ability to set mutual goals, strengthening patients' inner motivation, and including multiple caregivers to enhance information-sharing and care coordination.
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32.
  • Göras, Camilla, 1969-, et al. (författare)
  • From Threatening Chaos to Temporary Order through a Complex Process of Adaptation : A Grounded Theory Study of the Escalation of Intensive Care during the COVID-19 Pandemic.
  • 2023
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:21
  • Tidskriftsartikel (refereegranskat)abstract
    • To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. The main aim of this research was to explain the escalation process of intensive care during the first wave of the pandemic from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. This resulted in a novel conceptual model (including 6 main categories and 24 subcategories), and 41 recommendations. The conclusion of these findings is that the escalation of intensive care can be conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components of space, stuff, staff, system and science, with associated continuity plans, must be implemented, anchored and communicated to actors at all levels of the system.
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33.
  • Göras, Camilla, 1969-, et al. (författare)
  • Managing complexity in the operating room : a group interview study
  • 2020
  • Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20:1, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Clinical work in the operating room (OR) is considered challenging as it is complex, dynamic, and often time- and resource-constrained. Important characteristics for successful management of complexity include adaptations and adaptive coordination when managing expected and unexpected events. However, there is a lack of explorative research addressing what makes things go well and how OR staff describe they do when responding to challenges and compensating for constraints. The aim of this study was therefore to explore how complexity is managed as expressed by operating room nurses, registered nurse anesthetists, and surgeons, and how these professionals adapt to create safe care in the OR. Method Data for this qualitative explorative study were collected via group interviews with three professional groups of the OR-team, including operating room nurses, registered nurse anesthetists and operating and assisting surgeons in four group interview sessions, one for each profession except for ORNs for which two separate interviews were performed. The audio-taped transcripts were transcribed verbatim and analyzed by inductive qualitative content analysis. Results The findings revealed three generic categories covering ways of creating safe care in the OR: preconditions and resources, planning and preparing for the expected and unexpected, and adapting to the unexpected. In each generic category, one sub-category emerged that was common to all three professions: coordinating and reaffirming information, creating a plan for the patient and undergoing mental preparation, and prioritizing and solving upcoming problems, respectively. Conclusion Creating safe care in the OR should be understood as a process of planning and preparing in order to manage challenging and complex work processes. OR staff need preconditions and resources such as having experience and coordinating and reaffirming information, to make sense of different situations. This requires a mental model, which is created through planning and preparing in different ways. Some situations are repetitive and easier to plan for but planning for the unexpected requires anticipation from experience. The main results strengthen that abilities described in the theory of resilience are used by OR staff as a strategy to manage complexity in the OR.
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34.
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35.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Bridging Boundaries for Integrated Care : Constructing Interprofessional Collaboration Pathways for Complex Care Needs
  • 2024
  • Ingår i: The First Global Conference on Person-Centred Care: Knowledge(s) and Innovations for Health in Changing Societies. - Göteborg : University of Gothenburg. - 9789153106708 ; , s. 255-256
  • Konferensbidrag (refereegranskat)abstract
    • Background: Amid the increasing prevalence of chronic diseases and multimorbidity globally, the quest for integrated care models has intensified. However, empirical evidence on their implementation remains limited. Understanding the intricacies of effective interprofessional collaboration is crucial for achieving seamless integration of care.Aim: This study seeks to construct a grounded theory elucidating the dynamics of interprofessional collaboration across care providers to support integrated care for persons with complex needs.Design: A constructivist grounded theory approach guided the research.Methods: Observational and interview data were collected and analyzed using constant comparative methods to reach theoretical saturation. The sample consisted of 86 participants from diverse professional backgrounds within health and social care sectors, including hospital, ambulance services, primary care, and community care settings.Results: The theory titled “Negotiating Care in Organizational Borderlands” conceptualizes interprofessional collaboration as a complex and layered process. The process encompasses three distinct levels, influenced by how effectively organizational and professional boundaries are navigated. At the fragmentation level, care is disjointed, leading to a lack of cohesion among providers. The dependence level sees professionals relying on each other yet struggling with boundary issues. Ultimately, integration is possible when care providers collaboratively transcend organizational divides, leveraging their collective expertise while maintaining clearly defined accountability lines.Conclusion: Establishing clear pathways for robust collaboration is pivotal for care integration. However, care integration from the patient's perspective does not prevent healthcare professionals from encountering fragmented roles. This underscores the importance of clearly defined accountability lines to support shared responsibility and to bridge gaps across professional and organizational boundaries.Relevance to Clinical Practice: This research emphasizes the need for adaptive collaboration to support integrated care for persons with complex needs. It underscores the importance of clear accountability and communication pathways in organizational borderlands to provide person-centered care and meet individual patient needs. 
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36.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Entangled in complexity : An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs
  • 2024
  • Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648.
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs.Design: An ethnographic design using multiple convergent data collection techniques.Methods: Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings.Results: Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed ‘safe care transition pathway’ addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions.Conclusion: To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions.Implications: The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology  integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes.
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37.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Exploring interdependencies, vulnerabilities, gaps and bridges in care transitions of patients with complex care needs using the Functional Resonance Analysis Method
  • 2023
  • Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundHospital discharge is a complex process encompassing multiple interactions and requiring coordination. To identify potential improvement measures in care transitions for people with complex care needs, intra- and inter-organisational everyday work needs to be properly understood, including its interdependencies, vulnerabilities and gaps. The aims of this study were to 1) map coordination and team collaboration across healthcare and social care organisations, 2) describe interdependencies and system variability in the discharge process for older people with complex care needs, and 3) evaluate the alignment between discharge planning and the needs in the home.MethodsData were collected through participant observations, interviews, and document review in a region of southern Sweden. The Functional Resonance Analysis Method (FRAM) was used to model the discharge process and visualise and analyse coordination of care across healthcare and social care organisations.ResultsHospital discharge is a time-sensitive process with numerous couplings and interdependencies where healthcare professionals’ performance is constrained by system design and organisational boundaries. The greatest vulnerability can be found when the patient arrives at home, as maladaptation earlier in the care chain can lead to an accumulation of issues for the municipal personnel in health and social care working closest to the patient. The possibilities for the personnel to adapt are limited, especially at certain times of day, pushing them to make trade-offs to ensure patient safety. Flexibility and appropriate resources enable for handling variability and responding to uncertainties in care after discharge.ConclusionsMapping hospital discharge using the FRAM reveals couplings and interdependencies between various individuals, teams, and organisations and the most vulnerable point, when the patient arrives at home. Resilient performance in responding to unexpected events and variations during the first days after the return home requires a system allowing flexibility and facilitating successful adaptation of discharge planning.
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38.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • In pursuit of integrated care : Interprofessional collaboration in transitional care for older people with complex care needs
  • 2023
  • Ingår i: Presented at the Nordic Conference in Nursing Research, Reykjavik, Iceland, October 2-4, 2023.
  • Konferensbidrag (refereegranskat)abstract
    • Background:Contemporary healthcare systems are based on a reductionist, biomedical paradigm maladapted to meet the needs of an aging population with multimorbidity. Integrated care and interprofessional collaboration are suggested to connect the different parts of healthcare. However, how this can be realised is less understood.The aim of the study was to develop a deeper understanding of how interprofessional collaboration across care providers in transitional care is conducted to achieve integrated care for older people with complex care needs.Method:Using constructivist grounded theory, observations and interviews were conducted with healthcare and social care professionals (n=86) from a multidisciplinary and cross-stakeholder perspective in a region in Sweden.Results:Interprofessional collaboration in transitional care emerges as a continuum of "Moving from fragmentation to coupling and integration through collaborative efforts". On the lowest level of integration, professionals are working in organisational “silos” that are difficult to cross, as each specialist's expert knowledge is necessary for the vulnerable patient´s wellbeing. Patients´ perception of seamless care is facilitated by the mutual sharing of patient data across organizations through integrated information systems. The highest level of integration is consolidated as the interprofessional team collaborates on a pronounced common ground with a shared mental map of the goals of care, constructing unity for the older person and their family.Conclusion:To achieve seamless transitional care for older people with complex care needs, clear boundaries and liability areas are necessary, and actors in interprofessional teams are required to assume responsibility across conceivable gaps across organizations.
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39.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Integrating the FRAM and ethnography in nursing research : Insights from a project on complex care transitions
  • 2024
  • Ingår i: Presented at the 16th FRAMily meeting/workshop, Lund, Sweden, June 3-6, 2024.
  • Konferensbidrag (refereegranskat)abstract
    • The challenge of ensuring patient safety and continuity of care during complex care transitions necessitates a deeper understanding beyond what traditional research methodologies typically offer. This study explores the integration of the Functional Resonance Analysis Method (FRAM) with ethnographically derived patient scenarios to thoroughly investigate the complexities, variabilities, and unforeseen dynamics within these transitions.Adopting an ethnographic methodology, we have developed patient scenarios through comprehensive document reviews, participant observations and interviews with 37 healthcare professionals across multiple healthcare environments. These scenarios set the stage for applying the FRAM analysis, enabling an in-depth analysis of the care transition process. This approach is pivotal for identifying critical moments and decisions that significantly affect patient safety and for revealing potential system vulnerabilities.Our research sheds light on the daily practices and challenges healthcare professionals face during complex care transitions. It highlights systemic vulnerabilities and areas prone to risks while emphasizing effective practices. It underscores the importance of patient and family participation in facilitating safe and seamless transitions. From our findings, we present a "safe care transition pathway," offering a structured approach that encapsulates strategies for patient and family participation, and recommendations for overcoming identified vulnerabilities.Our study demonstrates that combining the FRAM with ethnographic research and patient scenarios offers a comprehensive and nuanced methodology for analyzing complex healthcare processes. This approach is particularly valuable for uncovering the variabilities and emergent behaviors that can affect care transitions. It provides a scaffold for future nursing research and practice to improve understanding and management of complex care transitions in healthcare environments. 
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40.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Interlacing the threads of seamless care : Interprofessional collaboration in care transitions for older people with complex care needs
  • 2022
  • Ingår i: International Journal of Integrated Care. - : Ubiquity Press. ; , s. 360-360
  • Konferensbidrag (refereegranskat)abstract
    • Introduction: Current healthcare systems are not optimally designed to meet the needs of aging populations. With shorter hospital stays, fewer hospital beds, and fragmentation of the healthcare system, older people with complex care needs are recognised as particularly vulnerable. This development further increases the demands on older people and their family to assume responsibility of own health, and to navigate through the healthcare system, knowing of when and where to seek help. In care transitions, an interprofessional collaboration across care providers is considered as a path to deliver seamless care. Still, it seems hard to achieve.Aim and Method: The aim of the study is to explore interprofessional collaboration in care transitions from inpatient care to home healthcare for older people with complex care needs.Care transitions involve a variety of healthcare teams across stakeholder boundaries. Hence, to study this extensive process, an explorative qualitative methodology was chosen, using Constructivist Grounded Theory. The sampling approach was guided by the continuous analysis of the collected data, utilizing a theoretical sampling. Fifty-nine multidisciplinary healthcare and social care professionals (HSCP) from different stakeholders were recruited. Document analysis, participatory observations and semi-structured interviews were conducted and analysed according to Charmaz.Results: Collaborating for a comprehensive care of older people with complex care needs emerges as interlacing the different threads of care to construct seamless care. Organizational gaps and legislations divide the HSCP as they strive to perform safe care within system boundaries, limited by interdependencies and communication organized in silos. Care is integrated as HSCP assumes accountability by going above and beyond their responsibility, constructing unity for the older person and their family. Seamless care is facilitated when information systems are integrated and by mutual sharing of patient data across organizations. To achieve seamless care for older people with complex care needs, HSCP need to adapt the delivery of care to the older person’s needs and resources instead of performing care as per organizational boundaries and conditions. Further, the autonomy of older people and their families need to be strengthened, including them as partners in the collaboration and coordination of care.Conclusions: Care efforts for older people with complex care needs are visualized as threads that together create a comprehensive care. To weave the threads together, a collaborative effort is required, strengthening the autonomy of the older person and their family, supported by integrated information systems that coordinate the care seamlessly.Implications and limitations: This study contributes to the understanding of interprofessional collaboration in care transitions of older people with complex care needs. Key strengths include the rich data and multidisciplinary perspective on providing integrated care. Limitations concern the absence of patient, family and informal caregivers’ involvement which should be included in further studies.
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41.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Optimizing resilient care transitions: The synergy of interprofessional collaboration and organizational adaptability
  • 2024
  • Ingår i: Presented at the Resilient Health Care Society Summer Meeting 2024, Stavanger, Norway, June 9-12, 2024.
  • Konferensbidrag (refereegranskat)abstract
    • BackgroundNavigating care transitions for patients with complex care needs represent a formidable challenge, where resilience becomes a crucial benchmark for quality and safety. There is a need to develop a healthcare infrastructure that not only reacts to disruptions but also proactively strengthens its capacity for continuity and patient safety. By addressing vulnerabilities and enhancing systemic responsiveness, the study illustrates how a coordinated, patient-centered approach is pivotal in building a healthcare infrastructure that can effectively navigate and adapt to challenges, thereby embodying the essence of resilient healthcare.ObjectiveThe aim of the study was to visualize vulnerabilities inherent in care transitions and to demonstrate how resilience—manifested through interprofessional collaboration and organizational adaptability—can fortify these critical junctures for patients with complex care needs.MethodsEmploying an ethnographic methodology, we engaged in document review, participant observations, and interviews with an array of healthcare and social care professionals involved in the care trajectory of patients with complex care needs. Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings.ResultsOur findings reveal that timing and precision variability during care transitions not only exacerbate vulnerabilities but also jeopardize patient safety. The inherent systemic rigidity, particularly during non-standard hours, amplifies the strain on resources and escalates the demands placed on care providers. In the face of patient needs' inherent unpredictability, the capacity of an organization to adapt is not just advantageous but essential. The crux of resilience in this context is interprofessional collaboration, which empowers healthcare teams to manage care proactively and navigate transitions more securely. Through collaborative practices, professionals are equipped to pool knowledge, predict fluctuations in patient conditions, and proactively coordinate responses to unexpected situations.ConclusionsWe advocate for a resilient model of care transition that is anchored in the collaborative synergy of healthcare teams, strategic resource management, and robust communication infrastructures. This model advocates for the vital contributions of frontline workers, patients, and their families, suggesting that their involvement is key in overcoming systemic obstacles and championing integrated, person-centered care. Our proposed pathway seeks to foster a healthcare environment where resilience is ingrained in the culture and practices, thereby ensuring safe, continuous, and responsive care transitions for all patients, particularly those with complex care needs.
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42.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Resilience in Action: Frontline Decision-Making in Swedish Ambulance Services During COVID-19
  • 2024
  • Ingår i: Presented at the Resilient Health Care Society Summer Meeting 2024, Stavanger, Norway, June 9-12, 2024.
  • Konferensbidrag (refereegranskat)abstract
    • BackgroundThe COVID-19 pandemic has significantly tested the resilience of global healthcare systems, particularly in emergency medical services. This study delves into the Swedish ambulance services' response to the pandemic, focusing on the dynamics of resilient performance and decision-making processes under extreme pressure. Understanding these responses is crucial for strengthening system-wide preparedness for future healthcare crises. ObjectiveThe aim of the study was to explore frontline decision-making, adaptation, and learning over time in ambulance care during the COVID-19 pandemic.MethodsWe gathered data from twenty-eight registered nurses in the Swedish ambulance services, who reported on 56 critical incidents during the pandemic using free-text questionnaires. The Critical Incident Technique, supplemented by Interpretive Description, was employed to analyze these incidents, concentrating on aspects of resilience in the context of emergency healthcare practice.ResultsAnalysis of the data revealed four main themes: ‘Navigating uncharted waters under never-ending pressure’ which underscores the continuous adaptation to evolving care challenges; ‘Balancing on the brink of an abyss’ reflecting the critical nature of decision-making amidst limited resources; ‘Sacrificing the few to save the many’ addressing the ethical complexities in prioritization and resource allocation; and ‘Bracing for the next wave’ indicating the importance of proactive planning for future resilience. These themes highlight a healthcare system's capacity to not only endure disruptions but to also evolve through them. Key to resilient practices were effective information sharing and the ability to discern between beneficial and harmful adaptations.ConclusionsThe study emphasizes the crucial role of dynamic leadership in crisis scenarios. It highlights the need for a balance between autonomous decision-making by frontline workers and structured guidance from management. Building ethical competence through situational awareness, reflective practices, and participation in ethical discourse is vital. These practices empower frontline workers to confidently manage ethical decision-making in crisis situations, thereby enhancing the adaptive capacity of healthcare systems in the face of future challenges.
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43.
  • Hedqvist, Ann-Therese, Doktorand, et al. (författare)
  • Vulnerable patients in a complex system depend on interprofessional team adaptation at hospital discharge
  • 2022
  • Ingår i: International Society For Quality In Health Care (ISQua) 38th International Conference, Brisbane, Australia, October 17-20, 2022.
  • Konferensbidrag (refereegranskat)abstract
    • Objectives: The highly differentiated and specialized healthcare systems are not optimally designed to provide patients with chronic conditions in need of treatment from multi-professional teams with a smooth and seamless care trajectory. Care transitions, especially hospital discharge, tend to be critical for patients' safety and health outcomes. Interprofessional team collaboration across care providers is crucial for efficient and safe care transitions, depending on dynamic and adaptive teams in the unavoidable uncertainty characterizing today's healthcare systems. This study explores adaptation and maladaptations in horizontal team collaboration in care transitions of vulnerable patients with complex care needs at discharge from hospital to their private homes.Methods: The study was conducted in a southern region in Sweden using an ethnographic methodology with participatory observations, document review and interviews. A total of 77 professionals from hospital and primary care participated. A purposive sampling strategy was utilized to capture the interprofessional team collaboration across organizations in the patient's care transition from hospital to home. The comprehensive data was then applied to two patient cases and analysed with the Functional Resonance Analysis Method.Results: Successful team adaptations as well as maladaptations are revealed as homecare team and patients attempt to manage the uncontrolled conditions in the home after discharge. Maladaptations occur as the organizational capacity is insufficient to meet the needs of the patients in their home environment. The demands challenge the resources of the patient, his or her family, and the homecare team must anticipate and adapt to the unexpected to maintain patient safety. Whether the team adaptations of preparing discharge were successful or not will be revealed through adaptive outcomes or adverse events. Information sharing emerges as a central prerequisite for successful team collaboration in care transitions. Flawed or insufficient access to information affected the team performance by hindering anticipating and planning for the care at home. In exacerbations of the chronic illness, information access and communication are needed to obtain a holistic view and respond to the altered care needs. For the team to adapt to the new demands, each team member require a clear understanding of their own as well as other team member’s roles and responsibilities. Ambiguity or imprecision could lead to uncertainty of who does what and where lines are drawn between organizations. By interprofessional collaboration during the discharge planning, a shared understanding of treatment and care needed at home is distributed to the team as a collective cognitive mind. Through a shared mental model, the team may anticipate and prepare for the patient's arrival home. When the team collaboration failed or communication was insufficient, gaps appeared, which pressed the need for further adaptations. Successful adaptations could bridge the gaps, maintaining safe and secure care for the patient, while maladaptations posed a risk of patient harm or re-hospitalisation.Conclusion: To maintain patient safety in transitional care from hospital to home, adaptations to the variability of the system are not to be stifled. Instead, the system needs to allow for flexibility, promoting availability of all resources needed since these are hard to predict. Responding to unexpected events and variations requires allocated resources in the first few days of homecoming, allowing for flexibility and thus increasing patient safety.
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44.
  • Heijkenskjold, Katarina Bredenhof, et al. (författare)
  • The patient's dignity from the nurse's perspective
  • 2010
  • Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 17:3, s. 313-324
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to understand how nurses experience patients' dignity in Swedish medical wards. A hermeneutic approach and Flanagan's critical incident technique were used for data collection. Twelve nurses took part in the study. The data were analysed using hermeneutic text interpretation. The findings show that the nurses who wanted to preserve patients' dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, friends, and unique persons with their own history, and have the courage to see when patients' dignity is violated, although this is something they do not wish to see because it makes them feel bad. Nurses do not have the right to deny patients their dignity or value as human beings. The new understanding arrived at by the hermeneutic interpretation is that care in professional nursing must be focused on taking responsibility for and protecting patients' dignity.
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45.
  • Hellström, Amanda, et al. (författare)
  • Monitorering i hemmet : Framtidens sjukvård
  • 2021
  • Rapport (populärvet., debatt m.m.)abstract
    • Digitalisering av hälso- och sjukvårdstjänster ökar, och som ett led i detta har hemmonitorering testats i en förstudie, för att senare om möjligt kunna implementeras i större skala. Hemmonitoreringen har i detta fall inneburit att patienter rapporterat in vitalparametrar samt utförd egenvård till en sjuksköterska, som mottagit och registrerat värdena. Sjuksköterskan och patienten har haft en kontinuerlig kontakt så att värden och justeringar i behandling har kunnat kommuniceras, diskuterats och följas upp. Totalt erbjöds 65 patienter med diabetes, hypertoni eller hjärtsvikt, kopplade till fem olika vårdenheter, att delta i studien. Patienterna genomförde hemmonitoreringen under 6 månader. Syftet med denna rapport var att undersöka hur hemmonitorering genom telemedicin påverkar patienternas situation i hemmet, sjukdomskontroll och vårdkonsumtion samt funktionalitet och användbarhet av hemmonitorering ur patient- och personalperspektiv.Resultatet visar de flesta av patienterna och vårdgivarna ansåg hemmonitoreringen som något positivt. Men för att dra bästa nytta av monitoreringen behövs avsatta personalresurser för att handha inkommande data och kommunikation med patienter kopplade till systemet, samt att patienterna har en god grundförståelse för sin sjuklighet. Tekniska aspekter som förmåga att kunna hantera rapporteringsterminal och medicinsk utrustning medförde inga större problem för patienterna i studien, och många ansåg systemet lätt att lära sig, lätt att integrera i dagliga rutiner samt att det inte tog så mycket tid i anspråk. Hemmonitorering tycks lämpa sig för många olika patientgrupper, men vid utbyggnad av användandet kan det vara hjälpfullt att göra detta genom samskapande processer med patienter, anhöriga och involverad vårdpersonal, så att innehåll och utformning matchar de behov som finns för patientgruppen.I föreliggande rapport har inga aspekter gällande cybersäkerhet undersökts, men detta kan vara en aspekt att ta hänsyn till då känslig information delas trådlöst mellan patient och vårdgivare.
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46.
  • Hellström, Amanda, et al. (författare)
  • Validation of the patient activation measure in patients at discharge from hospitals and at distance from hospital care in Sweden
  • 2019
  • Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 19:1, s. 1-11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The Patient Activation Measure (PAM) is a recognized measure of how active patients are in their care, and has been translated into several languages and cultural contexts. Patient activity, self-care, and health literacy have become increasingly important aspects of health care, and thus reliable measures of these are needed. However, a Swedish translation of PAM is currently lacking. The aim of the study was to translate and assess the validity and reliability of the Swedish PAM-13. Methods: A self-report questionnaire was handed out to 521 patients at ten medical, geriatric, and surgical wards, and one Virtual Health Room. The Rasch model was employed, using the partial credit model, to assess the functioning of the PAM scale, item fit, targeting, unidimensionality, local independence, differential item functioning (DIF), and person-separation index. Evidence of substantive, content, structural, and external validity was examined. Results: Of the 521 patients who were consecutively handed a questionnaire, 248 consented to participate, yielding a response rate of 47.6%. The average measure for each category advanced monotonically. The difficulty of the PAM items ranged from - 1.55 to 1.26. The infit and outfit values for the individual items were acceptable. Items 1, 2, and 4 showed disordered thresholds. The mean person location was 1.48 (SD = 1.66). The person-item map revealed that there were no item representations at the top of the scale. The evidence for unidimensionality was ambiguous and response dependency was seen in some items. DIF was found for age. The person separation index was 0.85. Conclusion: The Swedish PAM-13 was reliable, but was not conclusively found to represent one underlying construct. It seems that the Swedish PAM-13 lacks strong evidence for substantive, content, and structural validity. Although valid and reliable measures of ability for activation in self-care among patients are highly warranted, we recommend further development of PAM-13 before application in everyday clinical care.
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47.
  •  
48.
  • Hybinette, Karl, et al. (författare)
  • A First-line management team’s strategies for sustaining resilience in a specialised intensive care unit—a qualitative observational study
  • 2021
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:3
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesAcute care units manage high risk patients at the edge of scientifically established treatments and organisational constraints while aiming to balance reliability to standards with the needs of situational adaptation (resilience). First-line managers are central in coordinating clinical care. Any systemic brittleness will be evident only in retrospect through, for example, care quality measures and accident statistics. This challenges us to understand what successful managerial strategies for adaptation are and how they could be improved. The managerial work of balancing reliability and adaptation is only partially understood. This study aims to explore and describe how system resilience is enhanced by naturally occurring coordination performed in situ by a management team under variable circumstances.DesignAn explorative observational study of a tertiary neonatal intensive care unit (NICU) in Sweden. One year of broad preparatory work followed by focused shadowing observations of coordination analysed through inductive–deductive content analysis from a perspective of resilience engineering.ParticipantsA team of managers (ie, clinical coordinators, head nurses, senior medical doctors).ResultsThe results describe a functional relationship between operational stress and a progression of adjustments in the actual situation, expressed through recurring patterns of adaptation. Managers focused on maintaining coherence in escalating problematic situations by facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations.ConclusionsCoordination supports a coherent goal setting by increased team collaboration and is supported by team members’ abilities to predict the behaviour of each other. Our findings suggest that in design of future research or training for coordination, the focus of assessment and reflection on adaptive managerial responses may lie on situations where the system was ‘stretched’ or ‘needed reorganisation’ and that learning should be about whether the actions were able to achieve short-term goals while preserving the long-term goals.
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49.
  • Hybinette, Karl, et al. (författare)
  • Exploring patient flow management through a lens of cognitive systems engineering
  • 2023
  • Ingår i: Ergonomics. - : Taylor & Francis. - 0014-0139 .- 1366-5847. ; 66:12, s. 2106-2120
  • Tidskriftsartikel (refereegranskat)abstract
    • Hospitals work to provide quality, safety, and availability to patients with a wide variety of care needs, which makes efficient prioritisation and resource utilisation essential. Anticipation of each patients' trajectory, while monitoring available resources across the hospital, are major challenges for patient flow management. This study focuses on how hospital patient flow management is realised in situ with the help of concepts from cognitive systems engineering. Five semi-structured interviews with high level managers and shadowing observations of seven full work-shifts with management teams were conducted, to explore how patient flow is coordinated and communicated across the hospital. The data has been analysed using qualitative content analysis. The results describe patient flow management using an adapted Extended Control Model (ECOM) and reveal how authority and information might be better placed closer to clinical work for increased efficiency of patient flow.Practitioner summary: This study describes how a large tertiary paediatric hospital's patient flow management functions. The results offer a new understanding of how patient flow management is communicated and coordinated across organisational levels of the hospital and how authority and information might be better placed closer to clinical work for increased efficiency.
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50.
  • Kaltenbrunner, Monica, et al. (författare)
  • Utvärdering av boendeprocessen inom Kalmar kommun
  • 2022
  • Rapport (populärvet., debatt m.m.)abstract
    • Genom bland annat omställningen till Nära vård men även utifrån en strävan att höja kvalitén inom vård- och omsorgsverksamheten har ett behov av att omstrukturera arbetsprocesser vid vård- och omsorgsboenden i Kalmar kommun uppstått. Utifrån det behovet skapades boendeprocessen som introducerades till medarbetare i verksamheterna hösten 2021 och därefter infördes praktiskt i verksamheterna i början av 2022.Vid organisationsförändringar är det viktigt att få kännedom om hur medarbetare och chefer uppfattat och tar till sig förändringen. Vissa individer är snabba att ta till sig av nya förändringar medan andra behöver mer tid. Genom att utvärdera införandet av boendeprocessen kan insatser kring införandet anpassas till medarbetarnas och verksamheternas behov. Deltagare i utvärderingen var chefer och medarbetare (sjuksköterskor, undersköterskor, vårdbiträden, arbetsterapeuter och biståndsbedömare) vid 13 vård- och omsorgsboenden samt 8 nattenheter som arbetar med boendeprocessen i Kalmar kommun. Vid utvärderingen av införandet av boendeprocessen användes enkäten ”Implementation process assessment tool” (IPAT). Chefer och medarbetare fick besvara enkäten under första delen av 2022. Svarsfrekvens uppgick till 49% (234 deltagare). Resultaten visar att verksamheterna befinner sig i början av införandet av boendeprocessen. De allra flesta chefer och medarbetare är motiverade till, och engagerade i, att föra in boendeprocessen i sin verksamhet. Många deltagarna skattade att de tror att de kan bidra till att införa boendeprocessen samt uppger att de har stöd i processen. Det framkom också att många tror att boendeprocessen kan gynna både sin egen arbetsmiljö och att den kan vara gynnsam för omsorgstagarna.  
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