| 1. |
- Lindberg, Eva, et al.
(författare)
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Clashes between understanding and doing – leaders’ understanding of management in intensive care during a period of reorganisation
- 2003
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Ingår i: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 16:7, s. 354-60
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: The objective was to elucidate hospital leaders’ understanding of the organisational structures and processes and their understanding of their leading role during an intensive period of reorganisation. From a qualitative exploratory study using semi-structured interviews and thematic analysis four themes were identified: understanding the function of leadership and management, understanding organisational structures and processes, their own role as leader, and the outside world. The results indicate that the organisation is characterised by disintegration and erratic structures. The leaders perceive that they lead a learning organisation but in practical care work the organisation functions more like an organisation streamlined for mass production. This discrepancy between their understanding and practical daily care work led to dissatisfaction and existential chaos among the leaders. Our findings show an example of “clashes with the individual attractor pattern”, an urgent, but not yet very clear problem in health-care organisations of today.
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| 2. |
- Nilsson Kajermo, Kerstin, et al.
(författare)
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Swedish Translation, Adaptation and Psychometric Evaluation of the Context Assessment Index (CAI)
- 2013
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Ingår i: Worldviews on Evidence-Based Nursing. - : Wiley-Blackwell. - 1545-102X .- 1741-6787. ; 10:1, s. 41-50
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The strength of and relationship between the fundamental elements context, evidence and facilitation of the PARIHS framework are proposed to be key for successful implementation of evidence into healthcare practice. A better understanding of the presence and strength of contextual factors is assumed to enhance the opportunities of adequately developing an implementation strategy for a specific setting. A tool for assessing context-The Context Assessment Index (CAI)-was developed and published 2009. A Swedish version of the instrument was developed and evaluated among registered nurses. This work forms the focus of this paper. PURPOSE: The purpose of this study was to translate the CAI into Swedish, adapt the instrument for use in Swedish healthcare practice and assess its psychometric properties. METHODS: The instrument was translated and back-translated to English. The feasibility of items and response scales were evaluated through think aloud interviews with clinically active nurses. Psychometric properties were evaluated in a sample of registered nurses (n = 373) working in a variety of healthcare organisations in the Stockholm area. Item and factor analyses and Cronbach's alpha were computed to evaluate internal structure and internal consistency. RESULT: Sixteen items were modified based on the think aloud interviews and to adapt the instrument for use in acute care. A ceiling effect was observed for many items and the originally identified 37 item five-factor model was not confirmed. Item analyses showed an overlap between factors and indicated a one-dimensional scale. DISCUSSION: The Swedish version of the CAI has a wider application than the original instrument. This might have contributed to the differences in factor structure. Different opportunities for further development of the scale are discussed. CONCLUSIONS: Further evaluation of the psychometric properties of the CAI is required.
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| 3. |
- Aevarsson, Arnthór, et al.
(författare)
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Going to extremes - a metagenomic journey into the dark matter of life
- 2021
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Ingår i: FEMS Microbiology Letters. - : Oxford University Press (OUP). - 1574-6968. ; 368:12
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Forskningsöversikt (refereegranskat)abstract
- The Virus-X-Viral Metagenomics for Innovation Value-project was a scientific expedition to explore and exploit uncharted territory of genetic diversity in extreme natural environments such as geothermal hot springs and deep-sea ocean ecosystems. Specifically, the project was set to analyse and exploit viral metagenomes with the ultimate goal of developing new gene products with high innovation value for applications in biotechnology, pharmaceutical, medical, and the life science sectors. Viral gene pool analysis is also essential to obtain fundamental insight into ecosystem dynamics and to investigate how viruses influence the evolution of microbes and multicellular organisms. The Virus-X Consortium, established in 2016, included experts from eight European countries. The unique approach based on high throughput bioinformatics technologies combined with structural and functional studies resulted in the development of a biodiscovery pipeline of significant capacity and scale. The activities within the Virus-X consortium cover the entire range from bioprospecting and methods development in bioinformatics to protein production and characterisation, with the final goal of translating our results into new products for the bioeconomy. The significant impact the consortium made in all of these areas was possible due to the successful cooperation between expert teams that worked together to solve a complex scientific problem using state-of-the-art technologies as well as developing novel tools to explore the virosphere, widely considered as the last great frontier of life.
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| 4. |
- Andersson, Jonas E, 1964-
(författare)
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Architecture and Ageing : On the Interaction between Frail Older People and the Built Environment
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis deals with the type of architecture that materializes when age-related problems become a long-term condition (LTC) and gradually restrain the individual’s ability to perform activities in daily life (ADL). Their life situation necessitates a support from relatives or municipal eldercare staff in order for them to continue to participate in everyday living. In addition, the architectural space requires a close adjustment to the personal panorama of cognitive or functional impairments. The habitat can be a flat appropriated many years previously or in a residential care home for dependent and frail seniors. Architecture for ageing with dependency demonstrates how space can be used either to affirm or oppress the older person’s attempts to maintain an independent life style. By use of design theory, case study methodology and a heterogeneous research strategy, this study uses a threefold approach—a retrospective, a contemporaneous, and a future-oriented approach—to explore frail older people’s interaction with the architectural space of residential care homes. This has resulted in seven papers that focus on aspects of these human interactions with the built environment. Based on twelve exemplary models, the research paper I concludes that national guidelines result in a homelike, a hotel-like or a hospital-like environment. Research paper II is a retrospective study that examines the use of architecture competitions as a socio-political instrument to define architectural guidelines. Research paper III focuses on dependent seniors’ spatial appropriation of the communally shared space of a ward in a residential care home. Research paper IV employs two environmental assessment methods from the architecture profession and gerontological research (TESS-NH) in order to evaluate the use of interior colouring when refurbishing two residential care homes while the residents remained in place. Research paper V displays a municipal organizer’s considerations to opt for an architecture competition as a means of renewing architecture for the ageing population. Research paper VI examines competition documentation of three municipal architecture competitions organized during the period of 2006 to 2009. Research paper VII, the final study, explores notions concerning the appropriate space for ageing found among a group of municipal representatives, and people from organizations defending older people’s right. It supplies a model for understanding the appropriate space for ageing. This study illustrates the absence of older people with frailties in the public discussion about appropriate architecture for ageing. During the 20th century, the multi-dimensional idea of an architectural space with a homelike appearance has been used to contrast the negatively charged opposite—the complete and austere institution. The overarching conclusion of this study is that architecture for dependent and frail seniors constitutes a particular type of built space that requires an extended dialogue involving dependent seniors, architects, building contractors and care planners in order to conceive appropriate architecture for the ageing society.
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| 5. |
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| 6. |
- Henriksen, Eva, et al.
(författare)
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Can we bridge the gap between goals and practice through a common vision? : a study of politicians and managers’ understanding of the provisions of elderly care services
- 2003
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 65:2, s. 129-137
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were healthcare politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the healthcare of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.
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| 7. |
- Henriksen, Eva, et al.
(författare)
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Contradictions in elderly care : a descriptive study of politicians' and managers' understanding of elderly care
- 2003
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Ingår i: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 11:1, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- The care of older people in Sweden has undergone several major reorganisations during the past decade. The healthcare organisation, governed by the county councils, previously had the responsibility of providing care services for elderly people. However, the local municipalities have taken over that duty since 1992. The obligation of the health services is now restricted solely to medical issues. The present study focused on the understanding that politicians and managers have about caring for older people. A section of Stockholm with a population of 320 000 inhabitants was studied. The authors hypothesised that differences in understanding might have an impact on the services of care which older people receive. Interviews were conducted with eight leading politicians and 12 managers responsible for elderly care services. The main focus of inquiry concerned the participants' understanding of caring for older people. The results indicate that politicians and managers in elderly care sometimes have divergent views on how the care should be developed and produced to best serve older people. Five themes of understanding elderly care services and eight contradictory statements among the respondents were identified. A follow-up group session with the respondents was conducted to discuss the results of the interviews. The different ways of understanding elderly care services showed a complex and fragmented organisation lacking clear goals, structures and leadership. However, the authors found a willingness among respondents to collaborate with one another, as well as indications of positive attitudes toward improving healthcare, domiciliary and nursing care of older people.
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| 8. |
- Henriksen, Eva, et al.
(författare)
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Understanding and practice : a 7-year follow-up study on implementation of a cardiac rehabilitation program
- 2002
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 12:5, s. 671-684
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Tidskriftsartikel (refereegranskat)abstract
- The authors explore the perspectives of managers, health care professionals, and patients on a comprehensive cardiac rehabilitation program. Using qualitative methodology, they compare and analyze results from individual interviews and two conceptual modeling seminars held 7 years apart. Professionals and managers understood their own tasks in a professional-centered way that did not include the client’s perspective. Patients believed they were not seen in their whole context. Initially, health care organization was fragmented, lacking clear leadership, coordination, and communication between levels of care. However, lack of common understandings of structure, process, and outcome in cardiac rehabilitation services hampered the implementation of program changes.
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| 9. |
- Henriksen, Eva, et al.
(författare)
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Understanding cardiac follow-up services—a qualitative study of patients, healthcare professionals, and managers
- 2003
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Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151 .- 1873-1953. ; 2:2, s. 95-104
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Tidskriftsartikel (refereegranskat)abstract
- The study explores the experience and understanding of stakeholders involved in follow-up services after a cardiovascular event. A multimethod approach was used consisting of questionnaires, telephone surveys, and in-depth, face-to-face interviews. Five themes were identified: patients wished to be seen in their total context, patients should do as told; healthcare professionals perform check-ups and control cardiac risk factors; healthcare professionals are in charge of the care processes; and the structure and processes of the healthcare organization. Results indicate that healthcare professionals have considerable difficulty in understanding the patient's situation and to collaborate between different levels of care. Furthermore, the total healthcare organization lacked comprehensive and practical structures in the follow-up process, rehabilitation, and secondary preventive services.
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| 10. |
- Henriksen, Eva, 1952-
(författare)
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Understanding in Healthcare Organisations- a prerequisite for development
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study proposes that poor understanding of the structures, processes and outcomes of organisations seriously hampers collaboration between professional groups in care organisations. Three care settings were investigated: follow-up of patients with heart disease, an intensive care unit and care services for older people. The overall aim was to investigate how people understand structures, processes and outcomes in care organisations. The participants were patients, patient representatives, healthcare professionals, managers and politicians. A qualitative approach was used. Thematic analysis and grounded theory were employed in analysing the data. Despite considerable efforts, no major changes took place over a 7-year period as to how cardiac follow-up services were understood. The system of cardiac follow-up services was found fragmented in its organisation and in the way individuals understood it. The results indicate that care professionals, patients and leaders have dissimilar understandings. The data suggest that care is organised from a professional-centred perspective rather than from a holistic worldview of the patients’ total context. Leaders in intensive care perceive their organisation as a learning organisation. However, in daily work healthcare tends to function to what can be described as a mass production approach to care. This state of conflict caused confusion and chaos among the leaders. The municipal elderly care services and the county council’s geriatric organisation had difficulties in co-ordination. Older people were perceived as passive recipients of healthcare, rather than as consumers whose well being and outcome were a reflection to the quality of the service. The study concludes that despite the major changes that have taken place in the Swedish health and elderly care organisations over the past years, healthcare professionals’ understanding of their work has gone largely unchanged. Their understanding of care structures and processes did not change despite outside pressures. Lack of understanding of what others understand hampers development with the result that care organisations risk stagnation.
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| 11. |
- Håkanson, Cecilia, 1968-, et al.
(författare)
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First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care
- 2014
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Ingår i: Open Nursing Journal. - : Bentham open. - 1874-4346. ; 8, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.
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| 12. |
- Håkansson, Cecilia, et al.
(författare)
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First-line managers’ views on leadership and palliative care in Swedish nursing homes
- 2014
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Ingår i: Open Nursing Journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 8, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.
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| 13. |
- Lassmann-Klee, Paul, et al.
(författare)
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Differences of FENO in adult general populations of Nordic regions
- 2019
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 54:Suppl. 63
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Eventual differences of expiratory nitric oxide (FENO) levels in general populations of Nordic countries may reflect differences in eosinophilic inflammation at population level.Aim: To study the differences in FENO of Nordic regions and their epidemiological associations.Methods: From 1997 to 2003 we measured FENO (ppb) and conducted skin prick-tests for a random sample of adults (n=1498), aged 20-60 years from Finland (Helsinki), Sweden (Stockholm and Örebro) and Estonia (Narva and Saaremaa). We compared differences between regions by estimating odds ratios (OR) and 95% confidence intervals (CIs) for high FENO (>25 ppb) using logistic regression adjusted for gender, smoking and allergy. Finally, we estimated crude ORs and 95% CIs for high FENO and for asthma, rhinitis, current asthma symptoms and asthma medication.Results: The mean and standard deviation (SD) for FENO was 19(14) in Finland, 18(12) in Sweden and 16(15) in Estonia (p<0.001). Estonia had a lower mean FENO than other countries, with no differences between Finland and Sweden. Compared to Helsinki, the adjusted OR (95%CI) for high FENO was 0.42(0.21-0.81) in Stockholm, 0.65(0.43-0.98) in Örebro, 0.53(0.32-0.84) in Narva and 0.45(0.28-0.71) in Saaremaa. In Estonia, high FENO was associated with asthma, allergy, rhinitis, current asthma, and asthma medication; in Finland with rhinitis and use of short acting β-agonist; in Sweden with asthma and asthma medication. Smoking was associated with low FENO. Mean FENO in asthmatics was 24(19) in Finland, 20(12) in Sweden, and 43(49) in Estonia (p=0.07).Conclusions: We observed a higher mean FENO in Finland and Sweden compared to Estonia, and found no overall differences of FENO levels in asthmatics.
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| 14. |
- Seiger-Cronfalk, Berit, et al.
(författare)
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Utilization of palliative care principles in nursing home care : educational interventions
- 2015
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Ingår i: Palliative & Supportive Care. - : Cambridge University Press. - 1478-9515 .- 1478-9523. ; 13:6, s. 1745-1753
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study is part of the overarching PVIS (Palliative Care in Nursing Homes) project aimed at building competence in palliative care for nursing home staff. Our objective was to describe nursing home staff's attitudes to competence-building programs in palliative care. Method: Three different programs were developed by specialist staff from three local palliative care teams. In all, 852 staff at 37 nursing homes in the greater Stockholm area participated. Staff from 7 nursing homes participated in 11 focus-group discussions. Variation in size between the seven nursing homes initiated purposeful selection of staff to take part in the discussions, and descriptive content analysis was used. Results: The results suggest that staff reported positive experiences as they gained new knowledge and insight into palliative care. The experiences seemed to be similar independent of the educational program design. Our results also show that staff experienced difficulties in talking about death. Enrolled nurses and care assistants felt that they carried out advanced care without the necessary theoretical and practical knowledge. Further, the results also suggest that lack of support from ward managers and insufficient collaboration and of a common language between different professions caused tension in situations involved in caring for dying people. Significance of results: Nursing home staff experienced competence-building programs in palliative care as useful. Even so, further competence is needed, as is long-term implementation strategies and development of broader communication skills among all professions working in nursing homes.
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| 15. |
- Sundstedt, Milena, 1969-
(författare)
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Left Ventricular Dynamics During Exercise in Endurance Athletes
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Large quantities of data have described left ventricular adaptation to endurance training, but basic concepts on left ventricular performance during exercise remain controversial. In this thesis, we present the results of studies of left ventricular dynamics during exercise in 89 endurance-trained athletes.Using radionuclide ventriculography, 35 female and 30 male endurance athletes were studied in supine position. During supine exercise at 70% of the age-expected maximal heart rate, the adjustments in left ventricular volumes were small, suggesting a high preload before exercise. Stroke volume increased by changes in the left ventricular end-diastolic volumes but no changes were observed in the end-systolic volumes. Moreover, no significant differences were noted between male and female athletes.Contrast echocardiography was utilized when 24 male endurance athletes were studied during upright exercise. An almost linear increase in stroke volume was seen from upright rest to upright exercise at a heart rate of 160 beats per minute. Stroke volume increased by an almost linear increase in end-diastolic volume and showed an initial small decrease in end-systolic volume. The left ventricular cavity became geometrically more spherical with the largest increase in the left ventricular end-diastolic short-axis cavity diameters in the mid and apical part of the left ventricle. Left ventricular long-axis length obtained from the epicardial apex to the middle of the mitral annulus at end-diastole showed no significant change from rest to exercise. The mitral annulus motion contributed to more than 50% of the stroke volume during exercise with no significant difference between septal and lateral annular motion at peak exercise. Major changes were observed in left ventricular filling indices during upright exercise. The mean transmitral pressure gradient showed a linear increase and increased several times as the mean diastolic time decreased, with large reductions in mean left ventricular filling time. Despite the shortened filling time, the heart was able to increase the filling rate (measured as volume per time) five times. This observation verifies that the heart has large reserves at rest and reveals the increase in capacity during exercise.
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