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1.
  • Holst-Hansson, Annette, et al. (författare)
  • The breath of life : womens' experiences of breathing adapted radiation therapy
  • 2013
  • Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 17:3, s. 354-359
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To describe and analyze how women with breast cancer experience breathing adapted radiation therapy (BART) and to explore how women manage daily radiation therapy.Method: Individual interviews were conducted with 20 women treated with BART for breast cancer concerning their perception of radiation therapy. The transcribed interviews were analyzed using qualitative content analysis.Results: 'The breath of life' was the overall theme, as the women experienced the breathing as a way in which to influence their treatment and thus their survival. 'Participating in one's treatment, for good or ill', was the main category with four subcategories, 'Knowing one has done something good', 'Getting an extra bonus - healthwise', The experience of being in control' and 'Being in a high-technology environment'. The breathing technique became the strategy by which they could manage their treatment and gave them a sense of participation which led to a feeling of being in control. The women also felt that breathing benefited their health both mentally and physically. The high-technology environment was experienced as both hopeful and frightening.Conclusion: Survival or increasing the chances of survival, are of ultimate importance for a woman with breast cancer. BART requires commitment from the women, which was perceived as offering them an opportunity to participate in their own treatment, for their survival. Increasing the women's possibilities to participate in their treatment benefits their health and welfare during an otherwise turbulent time and allow the rehabilitation process to start during treatment.
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2.
  • Allvin, Renée, 1956-, et al. (författare)
  • Development of a questionnaire to measure patient-reported postoperative recovery : content validity and intra-patient reliability
  • 2009
  • Ingår i: Journal of Evaluation In Clinical Practice. - Oxford : Blackwell Publishing Ltd. - 1356-1294 .- 1365-2753. ; 15:3, s. 411-419
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.
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4.
  • Allvin, Renée, 1956-, et al. (författare)
  • Experiences of the postoperative recovery process : an interview study
  • 2008
  • Ingår i: Open Nursing Journal. - Bussum, Netherlands : Bentham Science Publishers Ltd. - 1874-4346. ; 2, s. 1-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.
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5.
  • Allvin, Renée, 1956-, et al. (författare)
  • Patient Reported Outcome Measures (PROMs) after total hip- and knee replacement surgery evaluated by the Postoperative Recovery Profile questionnaire (PRP) : improving clinical quality and person-centeredness
  • 2012
  • Ingår i: The International Journal of Person Centered Medicine. - Buckingham, United Kingdom : University of Buckingham Press. - 2043-7730 .- 2043-7749. ; 2:3, s. 368-376
  • Tidskriftsartikel (refereegranskat)abstract
    • Rationale and aims: The importance of evaluating postoperative recovery with consideration to the patient’s perspectivehas been emphasized. The aim of this study was to demonstrate how the recovery-specific Postoperative Recovery Profile(PRP) questionnaire can be used to evaluate patient-reported outcome measures (PROMs) after hip- and knee replacementin the enhancement of clinical quality and the person-centeredness of clinical services.Method: Patients undergoing primary total knee- and hip replacement were eligible for this longitudinal follow-up study. The participants completed the PRP questionnaire on repeated occasions. In this paper, data from Day 3 and Month 1 afterdischarge were used. The change in recovery, between the two measurement occasions, on item-, dimensional- and globallevels, both for each patient and for the group, were evaluated.Results: A total number of 75 patients were included. One month after discharge the median PRP score was 13 (partly recovered) out of 19. Recovery changes towards lower levels of problems/difficulties were shown in both item-, dimensional- and global levels of recovery month 1 after discharge, as compared with Day 3. The group of patients washomogenous in change.Conclusions: We demonstrated that the PRP questionnaire can be used to evaluate postoperative recovery after hip- andknee replacement surgery on item-, dimensional- and global levels. Data from each recovery level can be useful for quality development and in informing increases in the person-centeredness of clinical services. The global population scores can beused to evaluate treatment effect on a group of patients. It can also be used to define endpoints in follow-up studies.
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6.
  • Allvin, Renée, 1956- (författare)
  • Postoperative recovery : development of a multi-dimensional questionnaire for assessment of Recovery
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis aims to present a multi-dimensional instrument for self-assessment of progress in postoperative recovery. The author employs different research paradigms and methodologies to achieve this aim. Walker and Avant’s approach to concept analysis was used to examine the basic elements of postoperative recovery (Study I). The analysis identified different recovery dimensions and developed a theoretical definition showing postoperative recovery to be an energy-requiring process of returning to normality and wholeness, defined by comparative standards. Fourteen patients and 28 staff members participated in individual and focus group interviews aimed at describing patient and staff experiences of patient recovery (Study II). The essence of the postoperative recovery process was described as a desire to decrease unpleasant physical symptoms, reach a level of emotional wellbeing, regain functions, and re-establish activities. In Study III, 5 dimensions and 19 items were identified as a part of the operationalization process of the concept postoperative recovery. Fifteen staff members and 16 patients participated in the evaluation of content validity. On average, 85% of the participants considered the items as essential to the recovery process. In a test run of the questionnaire, 14 of 15 patients considered the questionnaire to be easy to understand and easy to complete. Twenty-five patients participated in the evaluation of intra-patient reliability. Percentage agreement (PA), systematic disagreement (RP, RC), and individual variability (RV) between the two assessments were calculated. PA measures ranged from 72% to 100%. The observed disagreement could be explained mainly by systematic disagreement. In total, 158 patients participated in the evaluation of construct validity, the ability to discriminate between groups, and the investigation of important item variables (Study IV). A rank-based statistical method for evaluation of paired, ordered categorical data from rating scales was used to evaluate consistency between the assessments of the Postoperative Recovery Profile (PRP) questionnaire and a global recovery scale. The number of months needed by participants to be regarded as fully recovered was studied by means of recovery profiles displayed by the cumulative proportion of recovered participants over time. A ranking list based on the participant’s appraisal of the five most important item variables in the PRP questionnaire was compiled to illustrate the rank ordering of the items. In comparing the assessments from the PRP questionnaire and the global recovery scale, 7.6% of all possible pairs were disordered. Twelve months after discharge 73% in the orthopaedic group were regarded as fully recovered, compared to 51% of the participants in the abdominal group (95% CI: 6% to 40%). The pain variable appeared among the top five most important items on eight measurement occasions, of eight possible, in both study groups. In conclusion, the PRP questionnaire was developed and support was given for validity and reliability. The questionnaire enables one to evaluate progress in postoperative recovery.
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7.
  • Allvin, Renée, 1956-, et al. (författare)
  • Postoperative recovery : a concept analysis
  • 2007
  • Ingår i: Journal of Advanced Nursing. - Oxford : Blackwell. - 0309-2402 .- 1365-2648. ; 57:5, s. 552-558
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.Method. Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.
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8.
  • Allvin, Renee, et al. (författare)
  • Recovery after surgery : A concept analysis
  • 2007
  • Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 57:5, s. 552-558
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim. This paper presents a concept analysis of the phenomenon of postoperative recovery. Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. Method. Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.
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9.
  • Allvin, Renée, 1956-, et al. (författare)
  • The Postoperative Recovery Profile (PRP) : a multidimensional questionnaire for evaluation of recovery profiles
  • 2011
  • Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell. - 1356-1294 .- 1365-2753. ; 17:2, s. 236-243
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.
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10.
  • Allvin, Renée, et al. (författare)
  • The Postoperative Recovery Profile (PRP) - a multidimensional questionnaire for evaluation of recovery profiles
  • 2011
  • Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 17:2, s. 236-243
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims and objectives  The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated. Methods  Post-operative recovery was assessed during the period from discharge to 12 months after lower abdominal and orthopaedic surgery. Construct validity was evaluated by comparing the assessments from the PRP questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering. Results  A total of 158 patients were included. Support was given for good construct validity. The result showed that 7.6% of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge the PRP assessments discriminated significantly the recovery profiles of the abdominal and orthopaedic groups. The variable pain was one of the top five most important issues at each follow-up occasion in both study groups. The importance of the item variables was thereby emphasized. Conclusions  The PRP questionnaire allows for evaluation of the progress of post-operative recovery, and can be useful to assess patient-reported recovery after surgical treatment both on individual and group levels. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.
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11.
  • Andersson, Ann-Christine, et al. (författare)
  • Adapting a survey to evaluate quality improvements in Swedish healthcare
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Quality improvement initiatives, a concept with origins in the manufacturing sector, have increased within the Swedish healthcare sector in recent decades. These efforts to improve quality can be seen as a response to demands for more cost-effectiveness and better medical results. However, studies have shown that less than 40% of these initiatives are successful (Olsson et al. 2007). The reason why specific improvement initiatives in healthcare fail or succeed is, therefore, a central question in studies of change. To be able to manage, improve and implement quality initiatives and improvements it is necessary to observe, measure and evaluate. Batalden and Davidoff (2007) point out that if there are no mechanisms to measure the changes, there is no way to know whether they actually lead to improvements. A more severe consequence, as stated by Sorian (2006), is that we sometimes accept an organizational system that not only fails to reward or encourage quality improvements but also sometimes punishes those who prioritize quality over cost-effectiveness. The need for more evidence about how to organize and manage new quality initiatives is identified as an important task within studies of healthcare improvement (Walshe 2009, Olsson et al. 2007).
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12.
  • Andersson, Ann-Christine, et al. (författare)
  • Evaluating a Breakthrough Series Collaborative in a Swedish Health Care Context
  • 2014
  • Ingår i: Journal of Nursing Care Quality. - : Lippincott Williams & Wilkins. - 1057-3631 .- 1550-5065. ; 29:2, s. E1-E10
  • Tidskriftsartikel (refereegranskat)abstract
    • This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.
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13.
  • Andersson, Ann-Christine, et al. (författare)
  • Evaluating a Breakthrough Series Collaborative in a Swedish healthcare context
  • 2013
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Since the mid-1990s, increased attention has been placed on quality improvement and patient safety within the healthcare context. This study aims to evaluate the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after six months. A questionnaire was used, and improvement processes and outcomes were analysed. The results showed an overall large engagement in improvements, although the methodology and the facilitators were seen as only moderately supportive. Nursing educators have highlighted the importance of improvement education amongst healthcare professions, and nurses could play an active role in improving healthcare practices and patient safety.
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14.
  • Andersson, Ann-Christine, et al. (författare)
  • Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare
  • 2013
  • Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 13:48
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare. Methods: A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted. Results: The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work. Conclusions: The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.
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15.
  • Andersson, Ann-Christine, et al. (författare)
  • Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology
  • 2011
  • Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 20:2, s. 122-130
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvemen  work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.
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16.
  • Andersson, Ann-Christine, et al. (författare)
  • Improvement Strategies : Forms and Consequences for Participation in Healthcare Improvement Projects
  • 2013
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • From a management point of view there are many different approaches from which to choose in how to engage staff in initiatives to improve performance. The present study investigates how two different types of improvement strategies stimulate and encourage involvement of different professional groups in healthcare organizations. The first type, Designed Improvement Processes, is constituted of a methodologically guided collaborative program. The second type, Intrapreneurship Projects, is characterized by an “intrapreneur” working with an improvement project in a rather free manner. The data analysis was carried out through classifying the participants´ profession, position, gender and the organizational administration of which they were a part. The result showed that nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Managers need to give prerequisites and incentives for staff who do not participate to do so.
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17.
  • Andersson, Ann-Christine, et al. (författare)
  • Practice-based improvement ideas in healthcare services
  • 2010
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Objective. The present study will contribute to knowledge of how practitioners in a healthcare region engage in quality improvement initiatives. The focus is on individual placement needs, problems/issues and the ability to organize work on the development, implementation and institutionalization of ideas for the healthcare sector. Design and settings. This study is based on the Kalmar county council Improvement Program. Healthcare departments and primary healthcare centers in the county council were invited to apply for money to accomplish improvement projects. The aim is to empirically identify and present the different kinds of practice-based improvement ideas developed in healthcare services. The 202 applications received from various healthcare departments and primary healthcare centers are analyzed using qualitative content analysis. Outcome and Results. Five types of improvement projects were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. In addition, a common characteristic among the studied project applications is to increase patient safety, effectiveness and availability of care, and education/training. Those intentions are found in many of the applications and therefore give the impression of being most important to caregivers today. Conclusions. These projects point to the various problems and experiences healthcare professionals encounter in their day-to-day work. This paper provides valuable insights into the current state of improvement work in Swedish healthcare, and will serve as a foundation for further investigations in this quality program.
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18.
  • Andersson, Ann-Christine (författare)
  • Practice-based Improvements in Healthcare
  • 2010
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A central problem for the healthcare sector today is how to manage change and improvements. In recent decades the county councils in Sweden have started various improvement initiatives and programs in order to improve their healthcare services. The improvement program of the Kalmar county council, which constitutes the empirical context for this thesis, is one of those initiatives.The purpose of this thesis is to contribute to a broader understanding of large-scale improvement program in a healthcare setting. This is done by analyzing practitioner’s improvement ideas, describing participants in the improvement projects, revising and testing a survey to measure the development of improvement ideas and describing the improvement program from a theoretical perspective. The theoretical change model used looks at change from two opposing directions in six dimensions; Goals, Leadership, Focus, Process, Reward system and Use of consultants.The aims of the county council improvement program are to become a learning organization, disseminate improvement methodologies and implement continuous quality improvements in the organization. All healthcare administrations and departments in the county council were invited to apply for funds to accomplish improvement projects. Another initiative invited staff teams to work with improvement ideas in a program with support from facilitators, using the breakthrough methodology. Now almost all ongoing developments, improvements, patient safety projects, manager and leader development initiatives are put together under the county council improvement program umbrella.In the appended papers both qualitative and quantitative research approach were used. The first study (paper I) analyzed which types of improvement projects practitioners are engaged in using qualitative content analysis. Five main categories were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. Most common was a focus on organizational changes and process, while least frequent was proactive patient work. Besides these areas of focus, almost all aimed to increase patient safety and increase effectiveness and availability.Paper II described the participants in two of the initiatives, the categorized improvement projects in paper I and the team members in the methodology guided improvement programs. Strong professions like physicians and nurses were well represented, but other staff groups were not as active. Managers were responsible for a majority of the projects. The gender perspective reflected the overall mix of employees in the county council.Paper III described a revision and test of a Minnesota Innovation Survey (MIS) that will be used to follow and measure how quality improvement ideas develop and improve over time. Descriptive statistics were presented. The respondents were satisfied with their work and what they had accomplished. The most common comment was about time, not having enough time to work with the improvement idea and the difficulty of finding time because of regular tasks. This was the first test of the revised survey and the high use of the answer alternative “Do not know” showed that the survey did not fit the context very well in its present version.Trying to connect the county council improvement program and the initiatives studied in papers I and II with the change model gave rise to some considerations. The county council improvement program has an effort to combine organizational changes and a culture that encourages continuous improvements. Top-down and bottom-up management approaches are used, through setting out strategies from above and at the same time encouraging practitioners to improve their day-to-day work. Whether this will be a successful way to implement and achieve a continuous improvement culture in the whole organization is one of the main issues remaining to find out in further studies.
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19.
  • Andersson, Ann-Christine (författare)
  • Quality Improvement in Healthcare : Experiences from a Swedish County Council Initiative
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study.The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work.
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20.
  • Andersson, Ann-Christine, et al. (författare)
  • Sustainable outcomes of an improvement programme: do financial incentives matter?
  • 2013
  • Ingår i: Total Quality Management and Business Excellence. - : Taylor and Francis (Routledge): SSH Titles. - 1478-3363 .- 1478-3371. ; 24:7-8, s. 959-969
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorisation of the projects intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.
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21.
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22.
  • Andersson, Ann-Christine, et al. (författare)
  • Two Different Strategies to Facilitate Involvement in Healthcare Improvements : A Swedish County Council Initiative
  • 2014
  • Ingår i: Global Advances in Health and Medicine. - : SAGE Publications. - 2164-957X .- 2164-9561. ; 3:5, s. 22-28
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance.Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations.Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation.Setting: An improvement project in a County Council in Sweden.Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects.Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects.Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations.Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside.Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.  
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23.
  • Andersson, Ann-Christine, et al. (författare)
  • Who conducts quality improvement initiatives in healthcare services? An evaluation of an improvement program in acounty council in Sweden
  • 2010
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables. Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council. Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP. Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments. Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings. Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.
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24.
  • Andersson, Pia (författare)
  • Kvalitatsindikatorer för munhälsa
  • 2013
  • Ingår i: Kvalitatsindikatorer inom omvårdnad. - Stockholm : Gothia Förlag AB. ; :6, s. 30-37
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)
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25.
  • Athlin, Elsy, 1945-, et al. (författare)
  • Factors of importance to the development of pressure ulcers in the care trajectory : perceptions of hospital and community care nurses
  • 2010
  • Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 19:15-16, s. 2252-2258
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim. The study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they were understood by nurses working in hospitals or community care. Background. The development of pressure ulcers is considered to be connected with early prevention and awareness among nurses and some studies have indicated that the care trajectory may be a weak point. Design. The study was carried out with a qualitative design. Method. Fifteen nurses from two Swedish hospitals and 15 nurses from community care were interviewed during 2005. Qualitative content analysis was used to make an understanding of patterns possible. Findings. Three main categories arose, showing that pressure ulcers were considered to be affected in the care trajectory by factors related to the individual patient, to the healthcare personnel and to the healthcare structure. Hospital and community care nurses mostly had corresponding perceptions of these factors. Conclusion. The study both confirmed previous findings and added new knowledge about factors that may affect pressure ulcer in the trajectory of care. The informants' views of nurses' responsibilities and their attitudes towards the care of pressure ulcers could, along with their views on the organisation of care, increase the understanding of the occurrence of pressure ulcers. The need for development and clarification of the organisation and responsibility of pressure ulcer care in the care trajectory was stressed. Relevance to clinical practice. The study highlighted attitudes and values among registered nurses, as well as to how to preserve their commitment and increase their knowledge concerning prevention of pressure ulcers.
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26.
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27.
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28.
  • Bahtsevani, Christel, et al. (författare)
  • To Assess Prerequisites Before an Implementation Strategy in an Orthopaedic Department in Sweden
  • 2016
  • Ingår i: Orthopedic Nursing. - : Ingenta. - 0744-6020 .- 1542-538X. ; 35:2, s. 100-107
  • Tidskriftsartikel (refereegranskat)abstract
    • Promoting Action on Research Implementation in Health Services (PARiHS) asserts that the success of knowledge implementation relates to multiple factors in a complex and dynamic way, and therefore the effects of implementation strategies vary by method and context. An instrument based on the PARiHS framework was developed to help assess critical factors influencing implementation strategies so that strategies can be tailored to promote implementation. The purpose of this study was to use the Evaluation Before Implementation Questionnaire (EBIQ), to describe staff perceptions in one orthopaedic department, and to investigate differences between wards. Staff members in four different wards at one orthopaedic department at a university hospital in Sweden were invited to complete a questionnaire related to planning for the implementation of a clinical practice guideline. The 23 items in the EBIQ were expected to capture staff perceptions about the evidence, context, and facilitation factors that influence the implementation process. Descriptive statistics and differences between wards were analyzed. Although the overall response rate was low (n = 49), two of the four wards accounted for most of the completed questionnaires (n = 25 and n = 12, respectively), enabling a comparison of these wards. We found significant differences between respondents' perceptions at the two wards in six items regarding context and facilitation in terms of receptiveness to change, forms of leadership, and evaluation and presence of feedback and facilitators. The EBIQ instrument requires further testing, but there appears to be initial support for pre-implementation use of the EBIQ as a means to enhance planning for implementation.
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29.
  • Berg, Agneta, 1950-, et al. (författare)
  • A comparison between orthopaedic nurses’ and patients’ perception of individualised care
  • 2012
  • Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier. - 1878-1241 .- 1878-1292. ; 16:3, s. 136-146
  • Tidskriftsartikel (refereegranskat)abstract
    • This exploratory study compares orthopaedic nurses’ perceptions of individualised nursing care with previously published orthopaedic patients’ perceptions. Orthopaedic nurses (N = 243) from one university, two central and two county hospitals working within in-patient care were surveyed using the Individualised Care Scale-Nurse (ICS-Nurse) in 2009 (response rate 74%, n = 180). The data were analysed using both descriptive and inferential statistics. About 60% of the nurses stated that it was very important that the care provided is individualised in comparison with 86% of the patients as previously reported (p-value <0.001). The highest rated assessment of individualised care was the clinical situation and the lowest the personal life situation which is in line with the patients’ experiences. This result demonstrates the need of managers in healthcare organisations to redouble their efforts in the implementation of individualised care by investigating nurses’ contemporary beliefs about, and forces that hinder the provision of individualised nursing care.
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30.
  • Berg, Agneta, et al. (författare)
  • A comparison between orthopaedic nurses' and patients' perception of individualised care
  • 2012
  • Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier. - 1878-1241 .- 1878-1292. ; 16:3, s. 136-146
  • Tidskriftsartikel (refereegranskat)abstract
    • This exploratory study compares orthopaedic nurses’ perceptions of individualised nursing care with previously published orthopaedic patients’ perceptions. Orthopaedic nurses (N = 243) from one university, two central and two county hospitals working within in-patient care were surveyed using the Individualised Care Scale-Nurse (ICS-Nurse) in 2009 (response rate 74%, n = 180). The data were analysed using both descriptive and inferential statistics. About 60% of the nurses stated that it was very important that the care provided is individualised in comparison with 86% of the patients as previously reported (p-value <0.001). The highest rated assessment of individualised care was the clinical situation and the lowest the personal life situation which is in line with the patients’ experiences. This result demonstrates the need of managers in healthcare organisations to redouble their efforts in the implementation of individualised care by investigating nurses’ contemporary beliefs about, and forces that hinder the provision of individualised nursing care.
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31.
  • Berg, Agneta, 1950-, et al. (författare)
  • A survey of orthopaedic patients' assessment of care using the Individualised Care Scale
  • 2007
  • Ingår i: Journal of Orthopaedic Nursing. - 1361-3111 .- 1873-4839. ; 11:3-4, s. 185-193
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to describe orthopaedic patients’ assessments of howindividuality in patient carewas supported during specific nursing interventions and how that individuality was perceived during hospitalisation. Orthopaedic inpatients (370) fromtwo central county and two county hospitals in Sweden were surveyed using the Individualised Care Scale (ICS) during 2004/2005, (response rate 74% n = 274). The data were analysed using both descriptive and inferential statistics. Eighty-six percent of the respondents stated that it was very important to be treated as an individual or unique person and 59% experienced this type of care. The lowest rated assessments concerned the personal life situation and the highest were concerned with the clinical situation and the decisional control over care. This analysis of patient assessments of individualised nursing care can be used to implement changes to individualise care processes in orthopaedic wards. This will be useful in the evaluation of health care quality improvement, planning and personnel management.
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32.
  • Berg, Agneta, et al. (författare)
  • A survey of orthopaedic patients' assessment of care using the Individualised Care Scale
  • 2007
  • Ingår i: Journal of Orthopaedic Nursing. - : Elsevier BV. - 1361-3111 .- 1873-4839 .- 1878-1292. ; 11:3-4, s. 185-193
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to describe orthopaedic patients' assessments of how individuality in patient care was supported during specific nursing interventions and how that individuality was perceived during hospitalisation. Orthopaedic inpatients (370) from two central county and two county hospitals in Sweden were surveyed using the Individualised Care Scale (ICS) during 2004/2005, (response rate 74% n = 274). The data were analysed using both descriptive and inferential statistics. Eighty-six percent of the respondents stated that it was very important to be treated as an individual or unique person and 59% experienced this type of care. The lowest rated assessments concerned the personal life situation and the highest were concerned with the clinical situation and the decisional control over care. This analysis of patient assessments of individualised nursing care can be used to implement changes to individualise care processes in orthopaedic wards. This will be useful in the evaluation of health care quality improvement, planning and personnel management. © 2007 Elsevier Ltd. All rights reserved.
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33.
  • Berg, Katarina, et al. (författare)
  • Postoperative recovery after different orthopedic day surgical procedures
  • 2011
  • Ingår i: International Journal of Orthopaedic and Trauma Nursing. - Amsterdam : Elsevier. - 1878-1241 .- 1878-1292. ; 15:4, s. 165-175
  • Tidskriftsartikel (refereegranskat)abstract
    • Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2 weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2 weeks after surgery compared to the other patient groups (p < 0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.
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34.
  • Berg, Katarina, 1959-, et al. (författare)
  • Postoperative recovery for day surgery patients
  • 2004
  • Ingår i: 12th Biennal Conference of the Workgroup of European Nurse Researchers,2004. ; , s. 77-77
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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35.
  • Berg, Katarina, 1959- (författare)
  • Postoperative recovery in daysurgery : Evaluation of psychometric properties and clinical usefulness of a questionnaire in day surgery
  • 2010
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.Aims: The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.Results: In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.Conclusions: The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.
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36.
  • Berg, Katarina, et al. (författare)
  • Postoperativerecovery after different orthopaedic day surgical procedures
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Orthopaedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to two weeks after different orthopaedic day surgical procedures, and tried to identify possible predictors associated with recovery. Three-hundred and fifty-eight patients who had undergone knee arthroscopy or surgery on the hand/arm, foot/leg or shoulder were included. Data were collected preoperatively and on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23, and a general health question. A multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day, and type of surgery. Postoperative recovery after common orthopaedic day surgical procedures differs, and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.
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37.
  • Berg, Katarina, et al. (författare)
  • Psychometric evaluation of the post-discharge surgical recovery scale
  • 2010
  • Ingår i: Journal of Evaluation In Clinical Practice. - : Blackwell Publishing Ltd. - 1356-1294 .- 1365-2753. ; 16:4, s. 794-801
  • Tidskriftsartikel (refereegranskat)abstract
    • Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.
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38.
  • Bramhagen, Ann-Cathrine, et al. (författare)
  • Self-reported post-operative recovery in children : development of an instrument
  • 2016
  • Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell. - 1356-1294 .- 1365-2753. ; 22:2, s. 180-188
  • Tidskriftsartikel (refereegranskat)abstract
    • Rationale, aims and objectives: According to the United Nations (1989) , hildren have the right to be heard and to have their opinions respected. Since post-operative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures.Methods: Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by the Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo question- naire was developed to determine whether the children’s participation would increase compared with the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4–12 years, who underwent tonsil surgery at four hospitals in Sweden.Results: A total o f238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbach’s alpha for the total instrument was 0.83 and the item-total correlations for 22 of the items were ≥0.20.Conclusion: Our results support use of the PRiC instrument to assess and follow-up on children’s self-reported post-operative recovery after tonsil operation, both in clinical praxis as well in research. 
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39.
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40.
  • Bååth, Carina, 1959-, et al. (författare)
  • Assessments of patients’ pain, nutrition and skin in clinical practice : Registered and enrolled nurses’ perceptions
  • 2012
  • Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier. - 1878-1241 .- 1878-1292. ; 16:1, s. 3-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of the study was to describe registered and enrolled nurses’ perceptions of how they assess patients’ pain, nutrition and skin.Introduction: Planning for pain, nutrition and skin care management is an essential part of nursing. In Sweden, it is common that registered and enrolled nurses work together in the care of patients.Method: Interviews with nine registered and nine enrolled nurses were analyzed using qualitative content analysis.Results: One theme; blurring boundaries between registered and enrolled nurses regarding pain, nutrition and skin suit assessments was identified. The manifest content of interviews is described in four categories: nurse–patient interaction, using oneself as a tool, collaborating with colleagues and listening to patients’ next of kin.Conclusion: The analysis showed a blurring of boundaries between RNs and ENs regarding pain, nutrition and skin suit assessments. How they perform their assessments conforms to a large extent. However, even if the activities are the same, the education levels of RNs and ENs are different and therefore the assessment of the patients might be different in clinical practice. Taking the results into account it is important that RNs and ENs collaborate regarding assessment of the patients’ pain, nutrition and skin suit.
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41.
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42.
  • Bååth, Carina, 1959-, et al. (författare)
  • Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form- Mini Nutritional Assessment by registered and enrolled nurses in clinical practice
  • 2008
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:5, s. 618-626
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Aim.  Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form-Mini Nutritional Assessment. Background.  In Sweden, registered nurses and enrolled nurses usually co-operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied. Design cross-sectional.  Registered nurses and enrolled nurses made 228 assessments of patients’ skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke. Results.  The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini-Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card. Conclusion.  The Modified Norton Scale and Short Form Mini-Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients’ skin with the Pressure Ulcer Card. Relevance to clinical practice.  The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop.
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43.
  • Bååth, Carina, 1959-, et al. (författare)
  • Pressure reducing intervention among persons with pressure ulcers : results from the first three national pressure ulcer prevalence surveys in Sweden
  • 2014
  • Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 20:1, s. 58-65
  • Tidskriftsartikel (refereegranskat)abstract
    • Rationale, aims and objectivesThe overall aim of this study was to describe preventive interventions among persons with pressure ulcer (PU) in three nationwide PU prevalence surveys in Sweden.MethodsA cross-sectional research design was used; more than 70 000 persons from different hospitals and nursing homes participated in the three prevalence surveys conducted in March 2011, October 2011 and March 2012.The methodology used was that recommended by the European Pressure Ulcers Advisory Panel.ResultsThe overall prevalence of PU categories I–IV in hospitals was 16.6%, 14.4% and 16.1%, respectively. Corresponding figures for nursing homes were 14.5%, 14.2% and 11.8%, respectively. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PU category I.ConclusionsDespite the three prevalence studies that have showed high prevalence of PU the use of preventing interventions is still not on an acceptable level. Heel protection/floating heels and sliding sheets were more frequently planned for persons with PUs, and individual-planned repositioning also increased. However, when persons already have a PU they should all have pressure-reducing preventive interventions to prevent the development of more PUs. Preventing PUs presents a challenge even when facilities have prevention programmes. A PU prevention programme requires an enthusiastic leader who will maintain the team's focus and direction for all staff involved in patient care.
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44.
  • Bååth, Carina, 1959-, et al. (författare)
  • Registered nurses and enrolled nurses assessment of postoperative pain and risk for malnutrition and pressure ulcers in patients with hip fracture
  • 2010
  • Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292. ; 14:1, s. 30-39
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to describe and compare registered (RNs’) and enrolled nurses’ (ENs’) assessments of postoperative pain, risk for malnutrition and pressure ulcers in patients with hip fracture. Furthermore, the aim was to describe and compare their perceptions of using assessment tools. Thirty-four (34) RNs and forty-three (43) ENs, working on orthopaedic wards in Sweden, took part in the study. The assessments were carried out on 82 patients with hip fracture. The assessment tools included the numerical rating scale (NRS), short-form nutritional assessment tool (MNA-SF), modified Norton scale (MNS) and pressure ulcer card. Many patients were assessed to be in postoperative pain and at possible risk for malnutrition. Around 50% were assessed as being at risk for pressure ulcer formation (PU). There is a difference between RNs and ENs assessments of patients’ postoperative pain, risk for malnutrition and PU. ENs assessed to a greater degree that patients were in intense pain currently. RNs assessed to a greater degree that patients had been in intense pain in the past 24 h. Single items on the tools showed differences. However, there was no statistically difference for MNA-SF screening score and MNS total score. ENs found it easier to assess postoperative pain with the NRS compared to RNs.
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45.
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46.
  • Bölenius, Karin, 1973- (författare)
  • Improving venous blood specimen collection practices : method development and evaluation of an educational intervention program
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: About 60%–80% of decisions regarding diagnosis and treatment are based on laboratory test results. Low adherence to venous blood specimen collection (VBSC) guidelines may lead to erroneous or delayed test results, causing patient harm and high healthcare costs. Educational intervention programs (EIPs) to update, improve and sustain VBSC practices are seldom evaluated. After testing a self-reported venous blood sampling questionnaire, the overall aim of this thesis was to evaluate the impact of a large-scale EIP on healthcare personnel’s VBSC practices.Methods: The study settings were primary healthcare centres (PHCs) in northern Sweden. Participants were VBSC personnel. Data consisted of a VBSC questionnaire of self-reported practices, records of low-level haemolysis index in serum samples (specimen quality indicator), and interviews reflecting VBSC practices. First, experts on questionnaires and VBSC were consulted, and test-retest statistics were used when testing the VBSC questionnaire for validity and reliability. Thereafter, we evaluated the impact of a short, large-scale EIP with a before-after approach comparing self-reported VBSC questionnaire of two county councils. The personnel of the county councils (n = 61 PHCs) were divided into an intervention group (n = 84) and a corresponding control group (n = 79). In order to test changes in blood specimen quality we monitored haemolysis in serum samples (2008, n = 6652 samples and 2010, n = 6121 samples) from 11 PHCs. Finally, 30 VBSC personnel from 10 PHCs reported their experiences. The interview questions were open-ended with reflective elements and the interviews were analysed by qualitative content analysis.Results: The VBSC questionnaire was found to be valid and could be used to identify risk of errors (near misses) and evaluate the impact of an EIP emphasising VBSC guideline adherence. The intervention group demonstrated several significant improvements in self-reported practices after the EIP, such as information search, patient rest, test request management, patient identification, release of venous stasis, and test tube labelling. The control group showed no significant improvements. In total, PHCs showed minor differences in blood specimen quality. Interviews summarized VBSC personnel experiences in the overall theme: education opened up opportunities for reflection about safety.  Conclusion: This thesis is, to our knowledge, the first to evaluate the impacts of a large-scale EIP on VBSC practices. The VBSC questionnaire and monitoring for low-level haemolysis reflected VBSC practices. The frequently occurring near-miss markers made it possible to compare and benchmark VBSC practices down to the healthcare unit and hospital ward. The short, general EIP opened up opportunities for reflection about safety and improved VBSC practices in PHCs with larger deviations from guidelines. EIPs that provide time for reflection and discussion could improve VBSC further. Directed EIPs focused on specific VBSC flaws might be more effective for some near misses in VBSC practices, while some near misses must be changed at a different level in the system.Clinical relevance: Our results indicate that monitoring and counteracting the near misses in VBSC practices is a well-functioning preventive action. We propose that the VBSC monitoring instruments (VBSC questionnaire & haemolysis index) we used and the EIP strategy proposed should be tested in additional countries with different healthcare settings. It is suggested that a national program intended to identify near misses and prevent VBSC errors be developed in the healthcare system. General e-learning programs may be cheaper than, and as effective as, the EIP program and may be performed everywhere and any time. Systematic planning, useful for reflection and with focus on the specific elements in a skill, together with VBSC guidelines, could probably increase improvements. Our studies have led to deeper and extended knowledge of the impact of an EIP on VBSC practices. Our results can be used when considering future VBSC practice interventions. Using a model for practical skills in nursing to describe VBSC in a more holistic and less technical way might highlight VBSC as a practical nursing skill.
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47.
  • Carlson, Elisabeth, et al. (författare)
  • Nursing students' experiences of the clinical learning environment in nursing homes : A questionnaire study using the CLES+T evaluation scale
  • 2014
  • Ingår i: Nurse Education Today. - : Elsevier. - 0260-6917 .- 1532-2793. ; 34:7, s. 1130-1134
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: One major challenge facing the health care systems worldwide is the growing demand for registered nurses able to provide qualified nursing care for a vulnerable population. Positive learning experiences during clinical practice influence not only learning outcomes, but also how students reason in relation to future career choices. Objectives: To investigate student nurses' experiences of the clinical learning environment during clinical practice in nursing homes, and to compare perceptions among student nurses with or without priorwork experience as health care assistants in elderly care. Design: A cross-sectional study was designed, utilising the Swedish version of the CLES + T evaluation scale. Methods: 260 student nurses (response rate 76%)who had completed a five week long clinical placement in nursing homes returned the questionnaire during the data collection period in 2011–2012. Data were analysed using descriptive statistics. Mann–Whitney U-test was used to examine differences in relation to students with or without prior experience of elderly care. Results: Overall, the clinical learning environment was evaluated in a predominantly positive way. The subdimension Supervisory relationship displayed the highest mean value, and the lowest score was calculated for the sub-dimension Leadership style of the ward manager. Statistical significant differences between sub-groups were displayed for four out of 34 items. Conclusion: The supervisory relationship had the greatest impact on how student nurses experienced the clinical learning environment in nursing homes. It is therefore, of utmost importance that collaborative activities, between educational and nursing home settings, supporting the work of preceptors are established and maintained.
  •  
48.
  • Carlson, Elisabeth, et al. (författare)
  • Who wants to work with older people? Swedish student nurses’ willingness to work in elderly care : a questionnaire study
  • 2015
  • Ingår i: Nurse Education Today. - : Elsevier. - 0260-6917 .- 1532-2793. ; 35:7, s. 849-853
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The ageing population is a globally recognised challenge for the health care service. The growing number of older people will probably lead to increased demands for registered and specialised nurses working in nursing homes and home-based care. Clinical practice is of great importance not only to clinical learning processes, but also how student nurses perceive a particular field of nursing. Objectives: To compare perceptions of the clinical learning environment in nursing homes among students considering a career in aged care or not, and to examine the difference in age, gender and previous working experience as health care assistants in elderly care between the two groups. Design: This was a cross-sectional study. Data were obtained by means of the Swedish version of the Clinical Learning Environment and Nurse Teacher evaluation scale. Methods: Consecutive sampling was performed over three semesters commencing in September 2011 through to December 2012. The survey was conducted with 183 student nurses after completion of a compulsory five week long clinical practice in a nursing home. Mann-Whitney U-test was used to examine differences in relation to two groups namely student nurses who did or did not consider to work in elderly care. A chi-square test of independence was performed to examine the difference in age, gender and previous working experience between the two groups. Results: The analysis leaned towards an overall positive evaluation of the clinical learning environment with more positive values for students considering a career. There were no significant differences between younger students (18-23) and older students (24-50) regarding willingness to work in elderly care or not. Neither was any significant difference displayed between students, based on gender nor for previous work experience. Conclusion: Age, gender and previous work experiences as health care assistants did not impact on students willingness to work in elderly care or not. Therefore, future studies need to acknowledge the complexity of why student nurses choose a particular pathway in nursing by longitudinal studies following cohorts of students during the course of the nursing programme.
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49.
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50.
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