| 1. |
- Ahlstedt, Carina, et al.
(författare)
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Flourishing at work : Nurses' motivation through daily communication - An ethnographic approach
- 2020
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Ingår i: Nursing and Health Sciences. - Australia : John Wiley & Sons. - 1441-0745 .- 1442-2018. ; 22:4, s. 1169-1176
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Tidskriftsartikel (refereegranskat)abstract
- Shortage and turnover of registered nurses are worldwide challenges, and work motiva-tion is one factor in retaining staff in the healthcare sector. The aim of this study was toexplore registered nurses' motivation expressed in daily communication, using the basicneeds in self-determination theory as a framework. A secondary analysis of ethno-graphic data, collected through participant observations, informal interviews duringobservations, and individual interviews, was used. A total sample of all registered nursesemployed at a hospital unit in Sweden (n = 10) participated. The data were analyzed the-matically through the lens of the basic needs in self-determination theory: autonomy,competence, and relatedness. Self-regulation of learning, the possibilities to discuss work-related challenges with colleagues, and having registered nurses lead dialogues with phy-sicians were factors connected to autonomy. Having a registered nurse and physiciansolve problems together was a factor connected to competence.Asenseofbelongingand security in a permissive climate between registered nurses was co nnected to relat-edness. This paper has implications for increased awareness of the three basic motiva-tional needs, which could be used in the development of attractive workplaces
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| 2. |
- Ahlstedt, Carina, 1969-, et al.
(författare)
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What makes registered nurses remain in work? : An ethnographic study
- 2019
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Ingår i: International Journal of Nursing Studies. - : Elsevier Ltd. - 0020-7489 .- 1873-491X. ; 89, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- Background: Registered nurses’ work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses’ workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses’ work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses’ development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.
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| 3. |
- Arving, Cecilia, et al.
(författare)
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Creating a new profession in cancer nursing? : Experiences of working as a psychosocial nurse in cancer care
- 2011
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 20:19-20, s. 2939-2947
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Tidskriftsartikel (refereegranskat)abstract
- Aims. To describe the nature of being a psychosocial nurse in cancer care. Background. Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored. Design. A qualitative inductive interview approach was used. Methods. A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed. Results. The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were. Conclusions. This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. Relevance to clinical practices. The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls.
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| 4. |
- Bastholm Rahmner, Pia, et al.
(författare)
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"Limit work to here and now" : A focus group study on how emergency physicians view their work in relation to patients' drug treatment
- 2008
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Ingår i: International Journal of Qualitative Studies on Helath and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 3:3, s. 155-164
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Tidskriftsartikel (refereegranskat)abstract
- Patients come to the emergency department (ED) with complex medication and some patients present symptoms of adverse drug effects. Drug treatment is a complex process for physicians to handle. The aim of this study was to explore how a group of ED physicians view their work in relation to patients’ drug treatment. Three semi-structured focus group discussions with 12 physicians in an ED in Sweden were conducted and analysed thematically. The core theme was ‘‘limit work to here and now’’. Three descriptive themes were identified in relation to the main theme; (1) focussing to cope with work; (2) decision making on limited patient-specific information; and (3) actively seeking learning moments. The findings show that the physicians actively seek learning moments in work. Signing their own notes in the computerized medical record is a way of getting feedback on the treatment they have initiated and it was seen as a large part of their clinical education. If we want to support the physicians with new technology for safer drug treatment, such as a computerized drug prescribing support system, the support system should be adapted to the different learning styles and needs.
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| 5. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system
- 2004
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Ingår i: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 17:4, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.
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| 6. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Variations in understanding the drug-prescribing process : a qualitative study among Swedish GPs
- 2009
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 26:2, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.
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| 7. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Whose job is it anyway? : Swedish general practitioners' perception of their responsibility for the patient's drug list.
- 2010
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Ingår i: Annals of Family Medicine. - : Annals of Family Medicine. - 1544-1709 .- 1544-1717. ; 8:1, s. 40-46
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
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| 8. |
- Bjuresäter, Kaisa, 1970-
(författare)
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Home enteral tube feeding - from patients’, relatives’ and nurses’ perspectives
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.
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| 9. |
- Björkman, Annica, et al.
(författare)
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Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study
- 2021
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Ingår i: BMC Nursing. - : Springer. - 1472-6955. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMedical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010.MethodsThe study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33).ResultsTelephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010.ConclusionThe proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.
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| 10. |
- Björkman, Ingeborg, et al.
(författare)
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Developing the role of the drug and therapeutics committees : Perceptions of chairs
- 2007
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 20:2, s. 161-178
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. Design/methodology/approach – Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. Findings – Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. Originality/value – This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.
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| 11. |
- Björkman, Ingeborg, et al.
(författare)
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The role of drug and therapeutics committees : Perceptions of chairs and information officers
- 2005
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 18:4, s. 235-48
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach – Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. “Patient awareness” was studied by content analysis. Findings – In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value – The importance of “patient awareness” within DTCs must be further explored.
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| 12. |
- Carlsson, Lars, et al.
(författare)
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General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system : A qualitative focus-group study
- 2015
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes. Methods: A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used. Results: Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process. Conclusions: Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.
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| 13. |
- Coyne, I., et al.
(författare)
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Centeredness in Healthcare : A Concept Synthesis of Family-centered Care, Person-centered Care and Child-centered Care
- 2018
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Ingår i: Journal of Pediatric Nursing. - : W.B. Saunders. - 0882-5963 .- 1532-8449. ; 42, s. 45-56
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increasingly within healthcare, different kind of ‘centeredness’ are used to denote the focus of care which can create confusion for practitioners. Methods: A concept analysis was undertaken to identify the antecedents, attributes and relationship between family-, person-, and child-centered care. PubMed and CINAHL were searched from 2012 to 2017 and thirty-five papers were reviewed. Results: Both person- and child-centered care are focused on individuals, a symmetric relationship and the tailoring of care to individual needs while family- centered care is focused on the family as a unit of which the child is included. Person-centered care focuses on an adult person with autonomy, while the focus in child-centered care is the individual child as an own actor with rights but still close to a family. Conclusion: It appears at a conceptual level that the concepts of centeredness contain both similarities and differences. Finding ways to structure nursing and focus the care that respects a person's dignity and humanity is essential in healthcare and should be a major goal of health policy and health systems worldwide. Implications: The identification of the antecedents and attributes embedded in the concepts may help raise professionals’ awareness of the different foci and how this will influence one's practice. There is a need to recognize strengths and weaknesses of the centeredness in different settings and environments. Furthermore, it is important to know which approach to apply within different situations so that quality care is enabled for every person, child and family.
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| 14. |
- Danielsson, Lena, et al.
(författare)
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Anaesthetizing children-From a nurse anaesthetist's perspective-A qualitative study
- 2018
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 5:3, s. 393-399
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to describe nurse anaesthetists' experiences of encountering and caring for children in connection to anaesthesia.Design: Qualitative design.Methods: Sixteen written narratives based on eight nurse anaesthetists' experiences of meeting children was analysed using qualitative content analysis.Results: The overarching theme was: "anaesthetizing children is a complex caring situation, including interactions with the child and parents as well as ensuring patient safety, affected by the perioperative team and organizational prerequisites". The nurses stated that in their interaction with the family, their goal was to ensure that children and parents felt secure and calm. "Striving to work in confidence" underlined the team and organizational influences. Encountering children involves more than knowledge about technical equipment, procedures and drugs. Knowledge about children's development and fears and parents' needs are essential for an optimal caring situation. Organizations need to realize that extra time, skills and resources are needed to safely anaesthetize children.
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| 15. |
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| 16. |
- Edelbring, Samuel, PhD, Docent, 1969-, et al.
(författare)
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Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams
- 2023
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 109:Suppl., s. 70-70
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunityt o improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin.Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings.Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus.Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person-centeredness in clinical reasoning, the team need to further put the patient’s personal goals and perception of goal-achievement in the forefront as well as improve communication skills to catch patient needs and facilitate shared decisions.
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| 17. |
- Elvén, Maria, 1973-, et al.
(författare)
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A tension between surrendering and being involved : An interview study on person-centeredness in clinical reasoning in the acute stroke setting
- 2023
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 112
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore how stroke survivors experience and prefer to participate in clinical reasoning processes in the acute phase of stroke care.METHODS: An explorative qualitative design was used. Individual interviews were conducted with 11 stroke survivors in the acute phase of care and analyzed using reflexive thematic analysis.RESULTS: The analysis identified five themes: What's going on with me?; Being a recipient of care and treatment; The need to be supported to participate; To be seen and strengthened; and Collaboration and joint understanding.CONCLUSION: Stroke survivors experience many attributes of person-centeredness in the acute phase of care but, according to their stories, their participation in clinical reasoning can be further supported. The tension between surrendering and the desire to be more actively involved in the care needs to be considered to facilitate participation in clinical reasoning.PRACTICE IMPLICATIONS: Stroke survivors' participation in clinical reasoning in the acute phase can be facilitated by health professionals noticing signs prompting a shift towards increased willingness to participate. Furthermore, health professionals need to take an active role, sharing their expertise and inviting the stroke survivors to share their perspective. The findings can contribute to further develop person-centered care in acute settings.
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| 18. |
- Elvén, Maria, 1973-, et al.
(författare)
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Person-Centeredness in Clinical Reasoning of Interprofessional Stroke Teams
- 2022
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Ingår i: ICCH2022. International Conference on communication in Healthcare 2022. Abtract book.. ; , s. 125-126
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Konferensbidrag (refereegranskat)abstract
- Background: Although person-centered care is prioritized in healthcare, challenges remain before such care is integrated in everyday communication and practice. One way to strengthen person-centered care is that health professionals’ clinical reasoning (i.e., assessment and management) is pervaded by patient participation and individualized to patient needs. Interprofessional team meetings, focusing on goals and management planning, is an opportunity to improve person-centeredness. However, there is a lack of understanding of how person-centeredness is created in the clinical reasoning of teams. This study aims to explore how clinical reasoning is performed from a person-centered perspective in team meetings with patients with stroke and next of kin.Methods: Explorative qualitative design employing a thematic analysis of audio recorded communication at three team meetings. In total, three patients, two next of kin, and 15 professionals representing eight health professions, participated in the meetings.Findings: Four themes and eight subthemes were established: a) Emphasizing the patient’s resources; b) Struggling to find a common understanding, including subthemes: Unite the person’s narrative, the relative’s view, and the expertise of the interprofessional team, missed opportunities to clarify patient needs and wishes, and active listening and receptiveness; c) Balancing the patient’s goals and professionals’ goals, including subthemes: Shared goals, the professionals’ view of appropriate goals, and the professionals’ assessment governs achievement of goals; d) Ambiguity in decisions about the management plan, including subthemes: Initiating shared decision making and lack of clarity and consensus.Discussion: This study reveals how the patient, next of kin and team contribute to shared understanding of the patient’s problem. Goals were guided by the patient’s and professionals’ expertise. To improve person- centeredness in clinical reasoning, the team need to further put the patient’s personal goals and perception of goal-achievement in the forefront as well as improve communication skills to catch patient needs and facilitate shared decisions.
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| 19. |
- Elvén, Maria, 1973-, et al.
(författare)
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Reasoning about reasoning : using recall to unveil clinical reasoning in stroke rehabilitation teams
- 2024
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin.Materials and methods: An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed.Results: A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions.Conclusions: Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
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| 20. |
- Ernesäter, Annica, 1970-, et al.
(författare)
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A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct : a case–control study
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:10, s. e005961-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
- Ernesäter, Annica, 1970-, et al.
(författare)
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Computerized decision support systems in telenursing : how it is perceived by telenurses
- 2009
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Ingår i: Med-e-Tel 2009. ; , s. 409-410
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Konferensbidrag (refereegranskat)abstract
- Telephone advice nursing (telenursing) is an expanding service in many Western countries and in recent year’s centralization of telenursing services has occurred in some countries. Telenursing is a complex and knowledge intensive health service were registered nurses (RN’s) individually triage callers need for further care, give self care advice or refer the caller to appropriate care giver. These telenurses have numerous patient encounters every day, regarding all ages of callers and questions presented to the telenurses addresses a broad variation of medical conditions. Telenursing has shown to be appreciated by the population as well as cost efficient. In an attempt to ensure quality and safety within telenursing the use of computerized decision support systems (CDSS) increased since CDSS enables uniformity and consistency of advices given to callers. Traditionally, telenurses have relied on clinical knowledge, collegial support and books when triaging callers and few studies describe how telenurses perceive CDSS in their daily work.Eight telenurses from three different telephone advice call centres, all using CDSS took part in semi-structured interviews in 2006. Data were analysed using qualitative content analysis.The aim of the study was to describe telenurses experiences of working with CDSS. Telenurses described that the CDSS had both positive and negative influences of their work. They described that the CDSS simplified their work, complemented their knowledge and gave them a sense of security. They also described how the CDSS contributed to quality improvement of telenursing. The negative aspects of the CDSS were described as being inhibited by the system. Telenurses described how they perceived the system as partly incomplete and controlling and that they sometimes disagreed with the measures presented by the system.These advantages and disadvantages perceived within the system can be connected to the concepts of usability: user-worthiness and user-friendliness. Software should be easy to learn, contain few errors and be easy to orient in, to enhance usability. Hence usability could be further improved in the present system.There might be a risk that the CDSS will mechanize and undermine the communication between callers and telenurses. It is important, in order to increase the telenurses’ professional competence and the feeling of tele-presence that callers not only are given a correct estimation of their conditions but also a sense of security and confirmation. Otherwise callers may seek emergency care solely because of insecurity and anxiety.
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| 25. |
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| 26. |
- Ernesäter, Annica, et al.
(författare)
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Incident reporting in nurse-led national telephone triage in Sweden : The reported errors reveal a pattern that needs to be broken
- 2010
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Ingår i: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 16:5, s. 243-247
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Tidskriftsartikel (refereegranskat)abstract
- We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.
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| 27. |
- Ernesäter, Annica, 1970-, et al.
(författare)
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Malpractice claims regarding calls to Swedish telephone advice nursing : what went wrong and why?
- 2012
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Ingår i: Journal of Telemedicine and Telecare. - London, United Kingdoms : Sage Publications. - 1357-633X .- 1758-1109. ; 18:7, s. 379-383
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Tidskriftsartikel (refereegranskat)abstract
- We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.
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| 28. |
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| 29. |
- Ernesäter, Annica, 1970-
(författare)
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National Telephone Advice Nursing in Sweden : Patient Safety and Communication
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate patient safety and communication within national telephone advice nursing (SHD) in Sweden. Four empirical studies with different perspectives were conducted. The aim of Study I was to describe telenurses’ experiences of working with computerized decision support systems and how such systems could influence their work. The telenurses described a duality of perceptions: the CDSS both supported and inhibited their work. Study II aimed at describing medical errors that had led to an incident report within the context of SHD. Incident reports sent to and from the SHD during 2007 were collected. The results showed that telenurses have limited possibilities to refer callers to the appropriate level of care, and that other healthcare providers reported that telenurses had made an incorrect assessment regarding callers’ need for care. Study III aimed at describing the actual communication between telenurses and callers expecting a higher level of care than recommended by telenurses, and at investigating relationships within the communication between telenurses and callers. The results showed that telenurses were more prone to use closed-ended questions and did not follow up on callers’ understanding of the advice given. There was also a statistically significant positive relationship between callers’ expressions of Concern and telenurses’ expressions of Criticism, and also between utterances of Criticism between the parties. The aim of Study IV was to describe the characteristics of all malpractice claims following telephone calls to SHD, including the identified causes, the healthcare providers’ measures, and the actual communication between the telenurses and callers. The results showed that among the cases, 13 of 33 patients died and 12 were admitted to intensive care. The National Board of Health and Welfare’s (NBHW) investigations most commonly reported communication failure as the cause of the malpractice claims. The measures reported by SHD most commonly involved discussion in work groups and education of staff. Communication analysis showed a positive correlation between the callers’ expressions of Concern and the telenurses’ expressions of Reassurance. The results also showed communication patterns similar to those found in Study III. Hence, telenurses’ communicative strategies are not in line with the “dialogue process” they are educated in and could be regarded as a threat to patient safety.In conclusion, the importance of high quality communication is undoubted within telephone advice nursing, and specific training and supervision in communication for telenurses might contribute to improving their communicative competence as well as patient safety. Adapting the CDSS into encourage telenurses to explore callers’ reasons for calling and to follow up on understanding might facilitate patient safety. Organizations also need to take a system-wide approach when addressing patient safety issues and ensure that telenurses are given the resources they need to fulfill their work.
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| 30. |
- Ernesäter, Annica, et al.
(författare)
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Telenurses' experiences of working with computerized decision support : supporting, inhibiting and quality improving
- 2009
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 65:5, s. 1074-1083
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper is a report of a study conducted to describe telenurses' experiences of working with computerized decision support systems and how such systems could influence their work. BACKGROUND: Telenursing is an expanding service in many Western countries, and in recent years centralization of telenursing services has occurred in Sweden. In connection with this, the use of computerized decision support has increased. METHOD: Eight Registered Nurses from three telephone advice call centres in Sweden who were using computerized decision support took part in semi-structured interviews in 2006. The data were analysed using qualitative content analysis. FINDINGS: The findings are presented as one theme and three categories. Telenurses experienced their work with a decision support system as supporting, inhibiting and quality improving. Based on two of the categories - 'supporting' and 'inhibiting' - a theme was revealed: being strengthened, but simultaneously controlled and inhibited. This theme represents the individual level. The telenurses found that the decision support system simplified their work, complemented their knowledge, gave them security and enhanced their credibility. They also described experiencing the system as incomplete, sometimes in conflict with their own opinions and controlling. The third category referred to the organizational level: the decision support system ensured the quality of telenursing. CONCLUSIONS: Although the telenurses experienced computerized decision support as both supporting and inhibiting, they preferred working with it. They also described how a computerized decision support system cannot replace telenurses' knowledge and competence, and that it should be considered as complementary.
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| 31. |
- Ernesäter, Annica, et al.
(författare)
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Telephone nurses' communication and response to callers' concern : a mixed methods study
- 2016
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Ingår i: Applied Nursing Research. - : Elsevier BV. - 0897-1897 .- 1532-8201. ; 29, s. 116-121
-
Tidskriftsartikel (refereegranskat)abstract
- AimsTo describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concernBackgroundTelephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.MethodRIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.ResultsTelephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapprovalwere found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.ConclusionTelephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.
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| 32. |
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| 33. |
- Ewertsson, Mona, 1958-, et al.
(författare)
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Use of technical skills and medical devices among new registered nurses : A questionnaire study
- 2015
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Ingår i: Nurse Education Today. - : Churchill Livingstone. - 0260-6917 .- 1532-2793. ; 35:12, s. 1169-1174
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Tidskriftsartikel (refereegranskat)abstract
- Background: One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way.Objectives: The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices.Design: A cross-sectional study with descriptive and comparative design.Participants: RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1year were included in the study (n=113, response rate 57%).Method: Data were collected by means of a postal questionnaire.Results: Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon.Conclusions: This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed.
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| 34. |
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| 35. |
- Ewertsson, Mona, 1958-, et al.
(författare)
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Walking the bridge : Nursing students' learning in clinical skill laboratories
- 2015
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Ingår i: Nurse Education in Practice. - : Elsevier BV. - 1471-5953 .- 1873-5223. ; 15:4, s. 277-283
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Tidskriftsartikel (refereegranskat)abstract
- Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified walking the bridge in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.
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| 36. |
- Fredriksson, Mio, et al.
(författare)
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Caesarean section on maternal request : a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden
- 2024
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Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process).ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.
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| 37. |
- Gustafsson, Silje
(författare)
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Self-care for Minor Illness: People's Experiences and Needs
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During later years, the primary care services are experiencing a heavier strain in terms of increasing expenses and higher demand for medical services. An increased awareness about pharmaceutical adverse effects and the global concern of antibiotic resistance has given self-care and active surveillance a stronger position within the primary care services. The management strategy for minor illnesses is important because care-seekers tend to repeat successful strategies from past events, and past experience with self-care drives future self-care practices. The overall aim of this thesis was to explore people’s experiences and needs when practicing self-care and receiving self-care advice for minor illnesses. This was achieved by studying people’s experiences with and knowledge of minor illnesses, self-care interventions and channels of information used when providing self-care for minor illness. Needs for confidence in self-care were studied, as well as supporting and obstructing factors in the practice of self-care. Satisfaction with telephone nursing and people’s experiences of reassurance in relation to the decision-making process in self-care for minor illness was explored. The results showed that experience correlated with self-rated knowledge of the condition, and the least common conditions most often generated a health care services consultation. To confidently practice self-care people needed good knowledge and understanding about obtaining symptom relief. Younger persons more often reported the need of having family or friends to talk to. Easy access to care was most often reported as a support in self-care, and a lack of knowledge about illnesses was most often reported as obstructing self-care. Care-seekers receiving self-care advice were less satisfied with the telephone nursing than care-seekers referred to medical care, and feeling reassured after the call was the most important factor influencing satisfaction. Self-care advice had a constricting influence on healthcare utilization, with 66.1% of the cases resulting in a lower level of care than first intended. The course of action that persons in self-care decided on was found to relate to uncertainty and perception of risk. Reassurance had the potential to allay doubts and fears to confidence, thereby influencing self-care and consultation behavior. In conclusion, symptoms of minor illness can cause uncertainty and concern, and reassurance is an important factor influencing people’s course of action when afflicted with minor illness. The nurse constitutes a calming force, and the encounter between the nurse and the care-seeker holds a unique possibility of reassurance and confidence that minor illness is self-limiting to its nature and that effective interventions can provide relief and comfort. Just as health is more than the absence of disease, self-care is more than the absence of medical care.
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| 38. |
- Hafskjold, Linda, et al.
(författare)
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A cross-sectional study on person-centred communication in the care of older people : the COMHOME study protocol.
- 2015
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 5:4
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice.METHODS AND ANALYSIS: This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments.ETHICS AND DISSEMINATION: Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.
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| 39. |
- Hafskjold, Linda, et al.
(författare)
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Older persons' worries expressed during home care visits : Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences
- 2016
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 99:12, s. 1955-1963
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons' worries and (2) the content of these expressions. Methods: An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. Results: Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. Conclusion: The two-step approach provides an in-depth knowledge of older persons' worries, causes of worries, and their related emotions. Practice implications: The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers.
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| 40. |
- Hakimnia, Roya, et al.
(författare)
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Doing gender in the context of telenursing : Analyses of authentic calls to a telenursing site in Sweden
- 2015
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7940 .- 2324-7959. ; 3:2, s. 24-30
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Aim: The aim of the present study was to analyze authentic health calls to a telenursing site in Sweden regardingreasons for calling and outcome of the calls with focus on a gender perspective. Background: Telephone advice nursing isan expanding service in many Western countries. In Sweden, all regions are now connected to a national telenursing service.Healthcare in Sweden is stipulated by law to be equitable. This includes the teleursing service, which is a new actor in Swedishhealthcare system, and which often is a citizen’s first contact with healthcare.Methods: The study had a descriptive and comparative design. 800 authentic calls to SHD were analysed regarding reasons forcalling, and outcome of the calls.Results: The results showed that men, and especially fathers, received more referrals to general practitioners than women. Themost common caller was a woman fluent in Swedish (64%), and the least likely caller was a man non-fluent in Swedish (3%).All in all, 70% of the callers were women. When the calls concerned children, 78% of the callers were female. In total, 9% ofthe calls were made by a man calling for another person. Callers were predominately young (mean age 29 years for women and33 for men).Conclusions: It is important that telenursing does not become a “feminine” activity, only suitable for young callers fluent inSwedish. Given the telenurses’ gatekeeping role, there is a risk that differences on this first level of health care can be reproducedthroughout the whole healthcare system. In striving for more equitable telenursing services, future research might investigate ifcampaigns encouraging men to call, and more frequent use of translators could enhance access to telenursing services.
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| 41. |
- Hakimnia, Roya, et al.
(författare)
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Exploring the communication between telenurse and caller – A critical discourse analysis.
- 2014
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 24:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Telenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given.Aim: The aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177.Methodology: A qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study.Results: The CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency.Conclusion: Telenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers’ different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.
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| 42. |
- Harder, Maria, 1970-, et al.
(författare)
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An integrative review of communication in a professional-parental relationship provided in child health services : An authoritarian or guiding approach
- 2024
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Ingår i: Patient Education and Counseling. - 0738-3991 .- 1873-5134. ; 118
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesEarly parental support, provided by nurses within child health services, aims to strengthen parents in their parenthood. The aim of this integrative review is to describe communication in parental support in encounters between child health nurses and parents in child health services.MethodsAn integrative review was conducted. The databases Cinahl+ , MedLine, Psych Info, and Scopus were searched, 312 articles were screened, and 16 articles were found to be eligible.ResultsThe studies included qualitative and quantitative methods, using interviews, focus group interviews, and observations. The findings show an overarching theme: The significance of mutuality in communication in a professional-parental relationship, further described in the following categories, 1) Authoritarian approach: a controlling manner, a neglecting manner, and a teaching manner; 2. Guiding approach: a counselling manner and a compliant manner.ConclusionsThe communication between nurses and parents can be understood as having several layers; the organisational context, the professional skills, knowledge, and experiences, and parents’ knowledge, expectations, and needs. There is a lack of studies of authentic communication between nurses and parents; thus, future research is warranted.Practice implications:The authoritarian and guiding approaches in parental support show the required skills a nurse is expected to have, but sufficient organizational prerequisites are also crucial.
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| 43. |
- Hellerstedt-Börjesson, Susanne, et al.
(författare)
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Women Treated for Breast Cancer Experiences of Chemotherapy-Induced Pain Memories, Any Present Pain, and Future Reflections
- 2016
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Ingår i: Cancer Nursing. - 0162-220X .- 1538-9804. ; 39:6, s. 464-472
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Tidskriftsartikel (refereegranskat)abstract
- Background: Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP). Objective: The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors. Methods: Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection. Results: A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence. Conclusions: Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy. Implications for Practice: Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.
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| 44. |
- Hellerstedt-Börjesson, Susanne, et al.
(författare)
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Women With Breast Cancer : Experience of Chemotherapy-Induced Pain: Triangulation of Methods
- 2015
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Ingår i: Cancer Nursing. - 0162-220X .- 1538-9804. ; 38:1, s. 31-39
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDChemotherapy treatment for cancer diseases can cause body pain during adjuvant therapy.OBJECTIVEThe aim was to describe the perceived impact of adjuvant chemotherapy-induced pain (CHIP) on the daily lives of women with newly diagnosed breast cancer, using triangulation.METHODFifty-seven women scheduled for chemotherapy in doses of 75 mg/m2 or greater of epirubicin and/or docetaxel participated. Twenty-two of these women registered pain with values of 4 or more on the visual analog scale on day 10 following chemotherapy. Of these 22, 16 participated in an interview and colored a printed body image. A qualitative thematic stepwise analysis of the interviews was performed.RESULTSChemotherapy-induced pain had a profound impact on daily life. Ten women reported the worst possible pain, with visual analog scale scores of 8 to 10. Three different categories crystallized: perception (A) of manageable pain, which allowed the women to maintain their daily lives; perception (B) of pain beyond imagination, whereby the impact of pain had become more complex; and perception (C) of crippling pain, challenging the women's confidence in survival.CONCLUSIONSThe findings highlight the inability to capture CHIP with 1 method only; it is thus necessary to use complimentary methods to capture pain. We found that pain had a considerable impact on daily life, with surprisingly high scores of perceived pain, findings that to date have been poorly investigated qualitatively.IMPLICATIONS FOR PRACTICENurses need to (1) better identify, understand and treat CHIP, using instruments and protocols; and (2) provide improved communication about pain and pain management.
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| 45. |
- Hjelmblink, Finn, et al.
(författare)
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Stroke patients' delay of emergency treatment
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:2, s. 307-311
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Tidskriftsartikel (refereegranskat)abstract
- Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.
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| 46. |
- Hjelmblink, Finn, et al.
(författare)
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The meaning of rehabilitation for older people who have survived stroke
- 2009
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Ingår i: Journal of Nursing and Healthcare of Chronic Illness. - : Wiley. - 1752-9816 .- 1752-9824. ; 1:2, s. 186-195
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To explore the meaning of rehabilitation to older, Swedish stroke survivors, from the time of the acute stroke to the end of the rehabilitation. Background. Many people who are stroke survivors do not resume social activities even though they have regained physical functions. However, the contents of stroke rehabilitation seems to depend on whether rehabilitation is understood from the disease perspective or the illness perspective contained in the International Classification of Functioning, Disability and Health. This in turn may determine the kind of rehabilitation offered to survivors. Design. Inductive, qualitative interview study undertaken during 2003. Method. Nineteen Swedish stroke survivors were interviewed twice, and the interviews were analysed using a Grounded Theory approach. Findings. To the older survivors, the meaning of rehabilitation was social reintegration. To achieve this they tried to regain lost physical and cognitive functions, relations (including play activities, everyday narratives and self-esteem) and lost certainty. The survivors needed to regain their ability to be not only to perform social activities. However, their rehabilitation ended when its focus turned to impairments found in the illness experiences of the survivors. The survivors developed their own cognitive and behavioural strategies for overcoming these kinds of obstacles to their social reintegration. Conclusion. Older, Swedish stroke survivors strive for a socially integrated life. Unacknowledged impairments experienced from the illness perspective of the survivors and the survivors’ own rehabilitation strategies should therefore be considered in their rehabilitation. Relevance to clinical practice. Stroke survivors need support from professionals who can understand and acknowledge the illness perspective of rehabilitation. Professionals should be able to understand how to facilitate the cognitive and behavioural strategies found in survivors’ illness narratives. In order to socially reintegrate, survivors’ rehabilitation should be transferred to the places where they have previously performed play activities together with family and friends.
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| 47. |
- Hjelmblink, Finn, et al.
(författare)
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To cope with uncertainty : stroke patients' use of temporal models in narratives
- 2006
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 20:4, s. 367-374
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Tidskriftsartikel (refereegranskat)abstract
- Stroke victims have to cope with a disrupted autobiography and anxiety because of an uncertain future. Professionals share this uncertainty. The patients reveal their experiences in narratives, and when they try to regain coherence and confidence in life, they use narratives in the reconstructions. Because they have a temporal problem, time might be an important issue in these narratives. The aim of this study was to elucidate the use of time models in stroke patients' narratives. Nineteen stroke patients, who had recently been discharged to their homes after the stroke, accepted to participate in the study. Their age span was between 56 and 89 years. They had lived active urban lives before the stroke, and poststroke only three had more serious physical impairment, and none was demented. They were asked to talk about their present life and their conceptions of future life. The interviews were audio-taped and transcribed verbatim and narratives that referred to temporal aspects were thematically analysed with reference to narrative time models. The stroke accident had caused an autobiographical disruption and a temporal split because of a new awareness of human temporality and an uncertainty of the future. Confronted with these problems of time, the stroke victims constructed narratives based on the time models: time cycles and dissolution of time limits, exchange of time and exclusion from time. Hence, the time models worked as tools when the stroke victims re-established coherence in their present and future life. Stroke patients handled an uncertain future by using temporal models in their narratives. Professionals can support stroke patients by reinforcing these models.
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| 48. |
- Hjelmblink, Finn, 1939-
(författare)
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Understanding Life After Stroke
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered.This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews were analysed through qualitative methods.Study I was about four survivors who delayed hospital arrival far beyond time limits for trombolytic treatment. The survivors had a strong need for control of body, autonomy and integrity and they demanded to be encountered in consultations as a person by a person. To make them search for emergency evaluation in time might demand an emergency care treating them according to these needs.In Study II the voice of an aphasic survivor was heard. Because of the damaged language his rehabilitation unilaterally focussed on language training and his need for comprehensive support and planning for the future was not observed. Implementation of a qualitative research method for text analysis adapted to practical use in dialogues with aphasic persons might ensure these survivors an adequate rehabilitation.Study III showed how time models in narratives helped stroke survivors to overcome uncertainty and recreate narrative coherence in their lives. Professionals can support survivors through revealing and reinforcing the meaning of these models.Study IV found that the meaning of rehabilitation to stroke survivors was social reintegration. Many probably did not socially reintegrate because their own strategies and subjectively experienced disabilities were unacknowledged in their rehabilitation. Through integrating illness-as-lived perspectives with biomedical perspectives, subjective dysfunctions and rehabilitation strategies of survivors could be acknowledged in stroke rehabilitation.
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| 49. |
- Hjelmblink, Finn, et al.
(författare)
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Understanding the meaning of rehabilitation to an aphasic patient through phenomenological analysis - a case study
- 2007
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 2:2, s. 93-100
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Tidskriftsartikel (refereegranskat)abstract
- Stroke patients with aphasia commonly suffer from distress related to their language deficit. They are often unable to express what they experience during their rehabilitation. Hence, the aim of this study was to reveal the meaning of rehabilitation to an aphasic person. With an approach based on the philosophy of Husserl and Merleau-Ponty, two open-ended interviews were analysed through the Empirical Phenomenological Psychological (EPP) method. The essential structure of the meaning of rehabilitation to the informant was that he lived as being responsible in a dichotomised situation. The informant had to adapt his behaviour, thereby destroying his chances of normal interactions; he was supposed to train in a goal-oriented way and believe in recuperation, but at the same time, he had to prepare himself and his next of kin for a failure. The defined impairment of aphasia misled both the informant and health care professionals to focus only language therapy, hence leaving the informant unsupported in other important aspects of the rehabilitation.
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| 50. |
- Hoffstedt, Caroline, et al.
(författare)
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Choosing not to choose-Patients' justification of a disengaged choice of primary care provider
- 2023
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Ingår i: Social Policy & Administration. - : John Wiley and Sons Inc. - 0144-5596 .- 1467-9515. ; 57:7, s. 1014-1031
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Tidskriftsartikel (refereegranskat)abstract
- A key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi-structured interviews with 18 respondents in a municipality in mid-Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient-doctor relationship than 'shopping around' for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the 'patient-consumer' role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made.
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