| 11. |
- Berg, Linda, 1961, et al.
(författare)
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Tensions during a process of change - implementation of the Bologna educational reform in Swedish specialist nursing programmes
- 2014
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Ingår i: Journal of Nursing Education and Practice. - : Sciedu Press. - 1925-4040 .- 1925-4059. ; 4:5, s. 64-72
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Tidskriftsartikel (refereegranskat)abstract
- Background/Objective: This study is an enquiry into the process of change during the implementation of the European educational reform, the Bologna process. The aim was to critically elaborate tensio ns during the process, focusing on the implementation of the degree project into Swedish specialist nursing programmes. Methods: Data were collected in a multi-centre participatory research project during the period August 2007 to January 2011, and consisted of memorandums kept by the project members and written vignettes from questionnaires answered by students. Eighteen faculty members from five universities, 69 male and 268 female students participated. The data were analysed according to a theoretical framework of thesis: the prevailing perspective, antithesis; a challenging perspective, and synthesis: an amalgamated perspective opening for constructive development. Main findings: The findings revealed conflicting views on research-based versus clinical development-based degree projects, and deductive versus inductive didactic development. The tensions consisted of lack of trust and confidence and were expressed as excluding and supercilious behaviour from the defenders of the traditional model. Conclusions: The implementation process, addressing conflicting views, resulted in a synthesized perspective between research and clinical development, paving the way for shared involvement between students, faculty members and clinicians in regard to the students’ degree projects.
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| 12. |
- Björk Brämberg, Elisabeth, et al.
(författare)
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Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care
- 2018
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. Methods: Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. Results: The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). Conclusions: Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.
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| 13. |
- Björk Brämberg, Elisabeth
(författare)
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Att vara invandrare och patient i Sverige
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on immigrants in Sweden. What experiences from the meeting with Swedish society do immigrants have and what meaning does the immigrant background have when they have been patients within the Swedish health and medical service? Former research about patients with an immigrant background can be divided into two perspectives. One which illuminates ethnically demarcated immigrant groups and specific needs. The other perspective has an individually adopted approach independently of the patients’ ethnical background. Here it is mainly the communication problems that are stressed, since these make it hard to understand the individual’s needs. The two empirical studies of the thesis start from an individualised perspective, a life world perspective. Research data have been collected through open interviews. The overall purpose was to develop a deepened understanding of what it means to live as an immigrant in Sweden and receive care. The aim of the pre-study was to examine immigrants’ experiences of participation in municipal home care. In the main study the overall purpose was used and two research questions were asked: What do persons with an immigrant background have to tell us about their situation in Swedish society? How does the situation as an immigrant in Sweden influence the experience of being a patient in Swedish health and medical care? The pre-study shows that participation means making demands and meeting caregivers who view the patient as an actor with the right to make his or her own decisions. One important postulate seems to be access to a good interpreter. To refrain from participation seems to be about adopting a passive attitude as a patient. It seems as if it is the caregivers who are the active ones and the ones setting the standards for the contents of the care. To experience not being invited to participation mainly seems to originate from the fact that the interviewees could neither understand nor make themselves understood. One consequence is that patients are just looked upon as carriers of a symptom. The main study shows that the interviewees’ existential existence as patients involves the whole life situation. Different forms of unsurmountable difficulties might reinforce each other. The ambition to establish oneself in a new home country might therefore be passivised. For patients with immigrant background earlier experiences from exposed situations seem to influence how the patients feel about their treatment. The additional knowledge is that problems seem to reinforce each other. Patients with an immigrant background must be treated as individuals. Every individual’s story has to be made visible. The thesis shows that caregivers ought to endeavour to understand the individual. To encourage dialogue, despite language problems, is of importance for the patient to be able to express his or her needs. The use of an interpreter may have a positive influence on these patients’ possibilities to exert an influence. This means that caregivers who consult an interpreter should build up their competence to communicate through an interpreter.
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| 14. |
- Björk Brämberg, Elisabeth, 1971-
(författare)
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Att vara invandrare och patient i Sverige : Ett individorienterat perspektiv
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on immigrants in Sweden. What experiences from the meeting with Swedish society do immigrants have and what meaning does the immigrant background have when they have been patients within the Swedish health and medical service? Former research about patients with an immigrant background can be divided into two perspectives. One which illuminates ethnically demarcated immigrant groups and specific needs. The other perspective has an individually adopted approach independently of the patients’ ethnical background. Here it is mainly the communication problems that are stressed, since these make it hard to understand the individual’s needs.The two empirical studies of the thesis start from an individualised perspective, a life world perspective. Research data have been collected through open interviews.The overall purpose was to develop a deepened understanding of what it means to live as an immigrant in Sweden and receive care. The aim of the pre-study was to examine immigrants’ experiences of participation in municipal home care. In the main study the overall purpose was used and two research questions were asked: What do persons with an immigrant background have to tell us about their situation in Swedish society? How does the situation as an immigrant in Sweden influence the experience of being a patient in Swedish health and medical care?The pre-study shows that participation means making demands and meeting caregivers who view the patient as an actor with the right to make his or her own decisions. One important postulate seems to be access to a good interpreter. To refrain from participation seems to be about adopting a passive attitude as a patient. It seems as if it is the caregivers who are the active ones and the ones setting the standards for the contents of the care. To experience not being invited to participation mainly seems to originate from the fact that the interviewees could neither understand nor make themselves understood. One consequence is that patients are just looked upon as carriers of a symptom.The main study shows that the interviewees’ existential existence as patients involves the whole life situation. Different forms of unsurmountable difficulties might reinforce each other. The ambition to establish oneself in a new home country might therefore be passivised. For patients with immigrant background earlier experiences from exposed situations seem to influence how the patients feel about their treatment. The additional knowledge is that problems seem to reinforce each other. Patients with an immigrant background must be treated as individuals. Every individual’s story has to be made visible.The thesis shows that caregivers ought to endeavour to understand the individual. To encourage dialogue, despite language problems, is of importance for the patient to be able to express his or her needs. The use of an interpreter may have a positive influence on these patients’ possibilities to exert an influence. This means that caregivers who consult an interpreter should build up their competence to communicate through an interpreter.
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| 15. |
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| 16. |
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| 17. |
- Björk Brämberg, Elisabeth, et al.
(författare)
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Communication through in-person interpreters : a qualitative study of home care providers' and social workers' views
- 2013
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Ltd.. - 0962-1067 .- 1365-2702. ; 22:1-2, s. 159-167
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe the experiences of home care providers and social workers in communication, via in-person interpreters, with patients who do not share a common language, and to offer suggestions for practice based on this description. BACKGROUND: The use of interpreters is essential for successful communication to provide equal access to health care for patients not sharing a common language with care providers. Successful bilingual communication is probably even more complex within the home care services with its focus on medical treatment, care and daily support in relation to the more exclusive focus on medical treatment within hospital care. DESIGN: An explorative, qualitative, descriptive study. METHODS: Data were collected in seven focus group interviews. A total of 27 persons, working as registered nurses, assistant nurses and social workers in municipal home care, participated. The analysis was inspired by inductive content analysis. RESULTS: The results express a traditional view on interpretation where the in-person interpreter is supposed to act to a greater or lesser extent as an objective and neutral conduit or communicator of what is said. The interpreter is also expected to observe when medical terms and other concepts need to be explained, which thus exceeds the basic role as a communicator of what was said. CONCLUSIONS: This study emphasises the need to view the interpreter as an active and explicit party in a three-way communication. RELEVANCE TO CLINICAL PRACTICE: Viewing the interpreter as an active and explicit party in a three-way communication and as an essential part of the care team might reduce the possible threat to patient confidentiality, and could contribute to solve the problem of interpreting the patient's non-verbal signs.
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| 18. |
- Björk Brämberg, Elisabeth, et al.
(författare)
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Increasing return-to-work among people on sick leave due to common mental disorders: design of a cluster-randomized controlled trial of a problem-solving intervention versus care-as-usual conducted in the Swedish primary health care system (PROSA)
- 2018
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Common mental disorders affect about one-third of the European working-age population and are one of the leading causes of sick leave in Sweden and other OECD countries. Besides the individual suffering, the costs for society are high. This paper describes the design of a study to evaluate a work-related, problem-solving intervention provided at primary health care centers for employees on sick leave due to common mental disorders. Methods: The study has a two-armed cluster randomized design in which the participating rehabilitation coordinators are randomized into delivering the intervention or providing care-as-usual. Employees on sick leave due to common mental disorders will be recruited by an independent research assistant. The intervention aims to improve the employee's return-to-work process by identifying problems perceived as hindering return-to-work and finding solutions. The rehabilitation coordinator facilitates a participatory approach, in which the employee and the employer together identify obstacles and solutions in relation to the work situation. The primary outcome is total number of sick leave days during the 18-month follow-up after inclusion. A long-term follow-up at 36 months is planned. Secondary outcomes are short-term sick leave (min. 2 weeks and max. 12 weeks), psychological symptoms, work ability, presenteeism and health related quality of life assessed at baseline, 6 and 12-month follow-up. Intervention fidelity, reach, dose delivered and dose received will be examined in a process evaluation. An economic evaluation will put health-related quality of life and sick leave in relation to costs from the perspectives of society and health care services. A parallel ethical evaluation will focus on the interventions consequences for patient autonomy, privacy, equality, fairness and professional ethos and integrity. Discussion: The study is a pragmatic trial which will include analyses of the intervention's effectiveness, and a process evaluation in primary health care settings. Methodological strengths and challenges are discussed, such as the risk of selection bias, contamination and detection bias. If the intervention shows promising results for return-to-work, the prospects are good for implementing the intervention in routine primary health care.
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| 19. |
- Björk Brämberg, Elisabeth, et al.
(författare)
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Insatser via företagshälsan för att minska eller förebygga psykisk ohälsa : En kartläggning av forskningen - uppdatering 2018
- 2018
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Ingår i: FALF KONFERENS 2018 Arbetet - problem eller potential för en hållbar livsmiljö? Gävle 10-12 juni 2018. - Gävle : Gävle University Press. - 9789188145284 ; , s. 71-72
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Konferensbidrag (refereegranskat)abstract
- BakgrundPsykisk ohälsa är en vanlig orsak till lidande och försämrad arbetsförmåga både i Sverige och internationellt. Effektiva insatser för att förebygga eller minska psykisk ohälsa är därför av stor betydelse för både folkhälsa och arbetshälsa. Företagshälsovården (FHV) är en viktig aktör på svenska arbetsplatser då majoriteten av alla anställda har tillgång till denna tjänst. Kunskapen är dock begränsad vad gäller effekter av de förebyggande eller rehabiliterande insatser som ges av FHV kring psykisk ohälsa. Denna litteratur-genomgång publicerades först 2015 och har nu uppdaterats med studier publicerade fram t.o.m. maj 2017.SyfteAtt genomföra en systematisk kartläggning av nationell och internationell forskning där insatserna getts av företagshälsovården för att förebygga eller minska psykisk ohälsa i arbetslivet.MetodLitteratursökningar gjordes i fyra databaser och det vetenskapliga underlaget kom att utgöras av 33 studier varav 12 är nytillkomna i denna uppdatering. Prospektiva studier med eller utan jämförelsegrupp inkluderades. Urval av studier och kvalitetsgranskning gjordes av två oberoende forskare.ResultatI 18 av studierna utvärderades rehabiliterande insatser som riktade sig till an-ställda sjuk-skrivna p.g.a. psykisk ohälsa, i elva studier insatser till anställda i risk för psykisk ohälsa och i 4 studier utvärderades förebyggande insatser. Drygt hälften av de inkluderade stud-ierna (17 studier) var från Nederländerna. Tjugoen av 33 studier bedömdes ha medelhög eller hög kvalitet. För rehabiliterande insatser som ges till anställda sjukskrivna för psykisk ohälsa indikerar det vetenskapliga underlaget att problemlösningsbaserad metod och KBT med arbetsplatsinriktning minskar sjukskrivning och/eller påskyndar arbetsåtergång jämfört med sedvanlig insats. Effekten är oklar för övriga rehabiliterande insatser. Kunskapsläget är oklart gällande effekter av förebyggande insatser och effekter av insatser som ges till anställda i risk för psykisk ohälsa. Några av studierna tyder på positiva effekter men insatserna som utvärderats är olika och det är viktigt att försök till replikering görs av dessa utvärderingar. Det finns ett behov av att förebyggande insatser utvärderas med ett forskningsupplägg som ökar möjligheterna att dra slutsatser om effekter. Flera studier indikerar också att det inte finns en tydlig relation mellan omfattning av symtom och arbetsåtergång. Detta understryker vikten av att vid insatser aktualisera arbetsåtergång tidigt i processen och att erbjuda metoder för samtidig symtomhantering och arbetsåtergång.Sammantaget indikerar resultaten att arbetsplatsinriktade insatser med KBT eller problemlösningsbaserad metod som ges via FHV kan förkorta tid till arbetsåtergång bland anställda sjukskrivna för psykisk ohälsa och att särskilt förebyggande insatser behöver utvecklas och utvärderas ytterligare.
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| 20. |
- Björk Brämberg, Elisabeth, et al.
(författare)
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Interpreters in Cross-Cultural Interviews: A Three-Way Coconstruction of Data
- 2013
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 23:2, s. 241-247
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Tidskriftsartikel (refereegranskat)abstract
- Our focus in this article is research interviews that involve two languages. We present an epistemological and methodological analysis of the meaning of qualitative interviewing with an interpreter. The results of the analysis show that such interviewing is not simply exchanging words between two languages, but means understanding, grasping the essential meanings of the spoken words, which requires an interpreter to bridge the different horizons of understanding. Consequently, a research interview including an interpreter means a three-way coconstruction of data. We suggest that interpreters be thoroughly introduced into the research process and research interview technique, that they take part in the preparations for the interview event, and evaluate the translation process with the researcher and informant after the interview.
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