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| 2. |
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| 3. |
- Kierkegaard, Marie, et al.
(författare)
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Online self-management fall prevention intervention for people with multiple sclerosis : a feasibility study protocol of a parallel group randomised trial
- 2022
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Falls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences (including ambulation status) are needed to meet fall prevention needs for PwMS. Thus, using a codesign process involving key stakeholders a novel online self-management fall prevention intervention was created specifically for ambulatory and non-ambulatory PwMS. The feasibility, acceptability, fidelity and outcome of this complex intervention will be explored. Findings will inform a future full-scale randomised controlled trial.METHODS AND ANALYSIS: A mixed-method design will be used. Forty-eight PwMS, stratified for ambulation level, will be randomised to control (n=24) or intervention (n=24). Both groups will receive a brochure about fall risk factors and fall prevention. The intervention is group-based (eight PwMS in each group); will be delivered online; and involve six, 2-hour weekly sessions and a booster session 8 weeks after the sixth session. Each intervention group will be led by a trained facilitator. Data collection will be performed at baseline, and after seven and 18 weeks. Outcome measures will capture data on fall prevention behaviours, fear of falling, falls self-efficacy, social and everyday activities, perceived impact of MS and number of falls. Feasibility of recruitment process, data collection procedures, outcome measures, and delivery, and intervention acceptability, fidelity and outcomes will be evaluated. Both quantitative and qualitative methods will be used.ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number 2021-04817). Results will be disseminated in peer-review journals, at conferences, research meetings, in social media and through the patient organisation Neuro Sweden.TRIAL REGISTRATION NUMBER: NCT04317716.
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| 4. |
- Tuvemo Johnson, Susanna, et al.
(författare)
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Self-management of falls in people with multiple sclerosis : A scoping review
- 2023
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 37:2, s. 162-176
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Tidskriftsartikel (refereegranskat)abstract
- Objective Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used. Data sources A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022. Review methods Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted. Results Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition. Conclusion The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed.
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| 5. |
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| 6. |
- Anåker, Anna, et al.
(författare)
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A comparative study of patients' activities and interactions in a stroke unit before and after reconstruction-The significance of the built environment
- 2017
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203 .- 1932-6203. ; 12:7, s. Article no e0177477-
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Tidskriftsartikel (refereegranskat)abstract
- Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients' activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients' lounge was located in a far corner of the unit with a smaller entrance than the patients' lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients' activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.
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| 7. |
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| 8. |
- Anåker, Anna, et al.
(författare)
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Enriched Environments in Stroke Units : Defining Characteristics and Limitations
- 2024
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 17:2, s. 344-359
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units.OBJECTIVE: The aim of this systematic review was to compile the concept of an EE in stroke units.METHODS: The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included.RESULTS: This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements.CONCLUSIONS: To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.
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| 9. |
- Anåker, Anna
(författare)
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Fysisk miljö på strokeenheter : betydelse för vården
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Den fysiska miljön har betydelse för människors hälsa och välbefinnande. Rehabilitering som påbörjas på strokeenheter i ett tidigt skede, kan förbättra återhämtning och minska risken för funktionshinder. Hur den fysiska miljön på en strokeenhet ska vara utformad för att utgöra ett stöd för patientens aktiviteter och vård är i begränsad omfattning studerat. Vidare är kunskapen begränsad gällande hur utformningen av den fysiska miljön kan påverka det multidisciplinära teamets arbete på en strokeenhet.Syfte: Det övergripande syftet var att generera kunskap om den fysiska miljön på strokeenheter och den komplexa relationen mellan utformningen av miljön, vården och användarens erfarenhet av den fysiska miljön.Metod: Avhandlingen baserades på fyra delstudier. Delstudierna hade en beskrivande och explorativ design. Tre nybyggda strokeenheter studerades, varav en strokeenhet följdes från den ursprungliga, via den temporära till den nybyggda enheten. I delstudie I, II och IV användes strukturerade observationer för att dokumentera patientens aktivitetsnivå, det fysiska rummet för aktiviteten, samt vilken eller vilka personer som var med patienten i rummet. I delstudie I, II och IV användes även icke-strukturerade observationer. De icke-strukturerade observationerna syftade till att utforska stöd och hinder i den fysiska miljön för patienter och det multidisciplinära teamet. För delstudie III användes en kvalitativ metod som med hjälp av intervjuer syftade till att studera patienternas erfarenheter av den fysiska miljön.Resultat: Delstudie I visade att på den nybyggda strokeenheten tillbringade patienterna mer tid på sina rum, hade lägre aktivitetsnivå och hade färre interaktioner med personal och anhöriga, än på den gamla strokeenheten. Förändringar av den fysiska miljön kan ha påverkat patienternas aktiviteter och interaktioner. Delstudie II visade att strokeenheterna skilde sig åt gällande patienternas aktivitetsnivå och proportion av dagen som patienterna var ensamma på sina rum. Patienterna hade högre aktivitetsnivå på en strokeenhet med en kombination av enkelrum och flerbäddsrum jämfört med en strokeenhet med uteslutande enkelrum. En flexibel, lättorienterad och omväxlande miljö utgjorde ett stöd för vård och aktiviteter. I delstudie III framkom två teman: (i) inkongruens mellan gemenskap och avskildhet och (ii) förbindelse med världen utanför ger distraktion och en känsla av normaltillstånd. I enkelrummen upplevde patienterna ensamhet och en frånvaro av social gemenskap. Patienterna blev positivt distraherade när de tittade på natur eller på aktiviteter som fortgick utanför deras fönster. Delstudie IV visade att det multidisciplinära teamet inte arbetade tillsammans i mötet med patienten. Vidare framkom i resultatet olika stöd och hinder i den fysisk miljö som påverkade teamets aktiviteter, exempelvis hinder i form av en fysiskt uppdelad miljö för teamet.Konklusion: Denna avhandling har bidragit till att öka förståelsen och kunskapen om den fysiska miljön på strokeenheter. Att använda ett evidensbaserat kunskapsunderlag när det gäller planering och design av nya strokeenheter är centralt. Den fysiska miljön kan vara ett stöd både för den person som insjuknat i en stroke och för det multidisciplinära teamet. Den fysiska miljön bör utformas för att minska inaktiviteten och upplevelsen av ensamhet, samt bidra till att det multidisciplinära teamet har lämpliga lokaler där teamet kan arbeta tillsammans.
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| 10. |
- Anåker, Anna, et al.
(författare)
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“It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit
- 2019
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 12:3, s. 141-152
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients (n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
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| 11. |
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| 12. |
- Anåker, Anna, et al.
(författare)
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Nursing students' perception of climate change and sustainability actions - A mismatched discourse : A qualitative, descriptive exploratory study.
- 2021
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 105
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Climate change is described as the biggest global challenge for human health in the upcoming decade. Nurses play a central role in mitigating the effect of climate change on the healthcare sector and adapting to the phenomenon. Therefore, nursing students must be prepared for a new professional role keeping climate change in mind; consequently, it is important to study students' perceptions of climate change and sustainability.OBJECTIVES: To explore nursing students' perceptions of climate change and sustainability and examine how they perceive their role as nursing students in working towards a more sustainable development within the healthcare sector.DESIGN: It is a qualitative, descriptive exploratory study.SETTINGS: A nursing program at a university in central Sweden.PARTICIPANTS: Nursing students.METHODS: Individual in-depth interviews and one group interview were conducted for the study.RESULTS: The main findings revealed that students saw themselves living in a mismatched discourse. They perceived the future of humanity as gloomy but thought that sustainability is the society's joint obligation to achieve the right to a good life for all people equally.CONCLUSIONS: Nursing students perceived themselves as important actors in the work of climate change and sustainability. Thus, nursing education needs to integrate the impact of climate change on healthcare and promote sustainability into the curriculum for preparing students to take responsibility for sustainability in society.
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| 13. |
- Anåker, Anna, et al.
(författare)
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The physical environment and multi-professional teamwork in three newly built stroke units
- 2020
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; , s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. Materials and methods: An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. Results: Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. Conclusion: The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units.IMPLICATIONS FOR REHABILITATION Understanding the link between the physical environment and effective teamwork can lead to more tailored and supportive design solutions. The design of the physical environment should be considered as a vital part of effective teamwork in stroke units. The physical environment should include shared workstations, allowing team members to meet and communicate face to face.
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| 14. |
- Anåker, Anna, et al.
(författare)
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The physical environment and patients' activities and care. A comparative case study at three newly built stroke units
- 2018
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.BACKGROUND: Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce.DESIGN: This work is a comparative descriptive case study.METHOD: Patients (N=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 - December 2015.RESULTS: The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care.CONCLUSIONS: Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.
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| 15. |
- Anåker, Anna, et al.
(författare)
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The physical environment is essential, but what does the design and structure of stroke units look like? : A descriptive survey of inpatient stroke units in Sweden
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 37:2, s. 328-336
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Tidskriftsartikel (refereegranskat)abstract
- Background: The design of the physical environment is a critical factor in patient care and is known to influence health, well-being, clinical efficiency, and health-related outcomes. To date, there has been no general review of the physical environment of modern Swedish stroke units.Aim: To explore the physical environment of inpatient stroke units in Sweden and describe the design and structure of these units. Methods: This was a cross-sectional study. Data were collected in Sweden from April to July 2021 via a survey questionnaire.Results: The layout of the stroke units varied broadly, such as the number of single-bed and multi-bed rooms. More than half the stroke units comprised spaces for rehabilitation and had an enriched environment in the form of communal areas with access to computers, games, books, newspapers, and meeting places. However, they offered sparse access to plants and/or scenery.Conclusions: Healthcare environments are an essential component of a sustainable community. From a sustainability perspective, healthcare facilities must be built with high architectural quality and from a long-term perspective. Research on the physical environment in healthcare should contribute to improved quality of care, which can be achieved through building healthcare facilities that support the performance of care and recovery. Therefore, mapping of areas of interest for further investigation is crucial.
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| 16. |
- Aronsson, Jennie, et al.
(författare)
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Awareness and attitudes towards sustainability and climate change amongst students and educators in nursing : A systematic integrative review protocol.
- 2022
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 9:1, s. 839-844
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This review identifies and synthesizes literature related to the awareness of and attitudes towards sustainability and climate change from the perspective of nursing students and educators.DESIGN: A systematic integrative review.METHODS: The review will follow the five stages outlined by Whittemore and Knafl: problem identification, literature search, data evaluation, data analysis and presentation. The data analysis will be based on inductive content analysis developed by Elo and Kyngäs. Principles of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) will also inform the review process.RESULTS: This review will offer insights about sustainability and climate change in relation to an important target population: the future nursing workforce and those educating its members. Findings might inform curriculum development, potentially contributing to a nursing profession that looks after the health of the planet and the health of the population inhabiting it.
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| 17. |
- Aronsson, Jennie, et al.
(författare)
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Nursing students' and educators' perspectives on sustainability and climate change : An integrative review
- 2023
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648.
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify and synthesize research on the awareness, attitudes and action related to sustainability and climate change from the perspective of nursing students and educators globally.Design: Integrative review.Methods: The review was guided by Whittemore and Knafl. Included studies were appraised using the Mixed Methods Appraisal Tool. A deductive content analysis based on Elo and Kyngäs' methodology was employed.Data Sources: CINAHL, MEDLINE, EMBASE, Web of Science, British Education Index, GreenFILE and Scopus were searched up to the 8th November 2022.Results: Thirty-two studies were included in the review. Two studies included nursing educators in their samples, the rest focused solely on students. Findings suggest that whilst some students were aware of sustainability issues and felt that nurses have a responsibility to mitigate climate change, others showed limited awareness and believed that nurses have more important priorities. A global interest was seen among students for increased curricular content related to sustainability and climate change. Waste management and education of others were suggested actions students can take; however, barriers included lack of confidence and limited power.Conclusion: There is a need for sustainability education within nursing curricula, accompanied by student support.Implications for the Profession: The review acts as a starting point to make sustainable healthcare and climate change mitigation integral aspects of nursing.Impact: Sustainability education within nursing curricula can positively impact on sustainable healthcare and climate change mitigation. More research is needed on the perspectives of nursing educators.Reporting Method: The review is reported according to the PRISMA guidelines.Patient or Public Contribution: No Patient or Public Contribution.
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| 18. |
- Aronsson, Jennie, et al.
(författare)
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Sustainability in Clinical Practice : A Cross-National Comparative Study of Nursing Students in England and Sweden
- 2022
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Ingår i: Journal of Nursing Education. - : SLACK, Inc.. - 0148-4834 .- 1938-2421. ; 61:7, s. 390-393
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Tidskriftsartikel (refereegranskat)abstract
- Background: Delivering health care negatively influ-ences the environment and contributes to climate change. This study examined how nursing students in England and Sweden can make changes in clinical practice to enhance environmental sustainability. Method: Third-year under-graduate nursing students at English and Swedish universities responded to open-ended questions on the Sustainability Attitudes in Nursing Survey. Data were analyzed using inductive content analysis. Results: Students in both countries identified lack of confidence as the main barrier to challenging unsustainable practice, followed by a resistance to change in practice. English students predominantly changed their own behavior or influenced the practice of others. Swedish students either changed their own behavior or their own attitudes to sustainability. Conclusion:There is a need to ensure students have confidence to act as change agents to enhance sustainable practice in the clinical environment.
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| 19. |
- Bernhardt, Julie, et al.
(författare)
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Why hospital design matters : A narrative review of built environments research relevant to stroke care
- 2022
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Ingår i: International Journal of Stroke. - : SAGE Publications. - 1747-4930 .- 1747-4949. ; 17:4
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports health care in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behaviour. Contrary to many new ward design approaches, single bed rooms are neither uniformly favoured, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing and we highlight emerging collaborative multi-stakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.
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| 20. |
- Charise, A, et al.
(författare)
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Questioning Context: A set of interdisciplinary questions for investigating contextual factors affecting health decision-making
- 2011
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Ingår i: Health Expectations. - : Wiley. - 1369-7625 .- 1369-6513. ; 14:2, s. 115-132
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making.Background: Decision-making processes and outcomes may be shaped by a range of non-medical or contextual factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide ranging research for health decision-making purposes.Methods: To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings: We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasseshealth-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided.
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| 21. |
- Charise, Andrea, et al.
(författare)
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Questioning Context: A set of interdisciplinary questions for investigating contextual factors affecting health decision-making".
- 2010
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Ingår i: Health Expectations. - 1369-7625 .- 1369-6513. ; 14:2, s. 115-132
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To combine insights from multiple disciplines into a set ofquestions that can be used to investigate contextual factors affectinghealth decision making.Background. Decision-making processes and outcomes may be shaped by a range of non-medical or contextual factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide ranging research for health decision-making purposes.Methods. To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings. We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasseshealth-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided.Conclusions. These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health-related research.
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| 22. |
- Eldh, Ann Catrine, et al.
(författare)
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Supporting first-line managers in implementing oral care guidelines in nursing homes
- 2018
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Ingår i: Nordic Journal of Nursing Research. - : SAGE Publications. - 2057-1585 .- 2057-1593. ; 38:2, s. 87-95
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.
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| 23. |
- Elf, Lena Marie, 1962, et al.
(författare)
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A dynamic conceptual model of care planning
- 2007
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Ingår i: SCANDINAVIAN JOURNAL OF CARING SCIENCES. - : Wiley. - 0283-9318 .- 1471-6712. ; 21:4, s. 530-538
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Tidskriftsartikel (refereegranskat)abstract
- This article presents a conceptual model of the care planning process developed to identify the hypothetical links between structural, process and outcome factors important to the quality of the process. Based on existing literature, it was hypothesized that a thorough assessment of patients' health needs is an important prerequisite when making a rigorous diagnosis and preparing plans for various care interventions. Other important variables that are assumed to influence the quality of the process are the care culture and professional knowledge. The conceptual model was developed as a system dynamics causal loop diagram as a first essential step towards a computed model. System dynamics offers the potential to describe processes in a nonlinear, dynamic way and is suitable for exploring, comprehending, learning and communicating complex ideas about care processes.
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| 24. |
- Elf, Lena Marie, 1962, et al.
(författare)
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An audit of the content and quality in briefs for Swedish healthcare spaces
- 2009
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Ingår i: Journal of Facilities Management. - : Emerald. - 1741-0983 .- 1472-5967. ; 7:3, s. 198-211
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Initial briefs (programs) were examined in order to obtain an overview of current practice in documenting the briefing process for new health care buildings in Sweden. Methodology: An audit instrument was developed and used to examine briefs for the content and quality of information and to determine whether and to what extent the information was comprehensive and patient oriented. Findings: The results indicate that few strategic briefs make use of evidence to support their statements. Moreover, few briefs had an explicitly patient-focused goal for the project or measurable outcomes. Implication for practice: This new audit approach can be applied in various organisations and over time to improve the briefing process and create clearer goals and guidelines. Originality/value: The present study contributes with an audit of written briefs. The question of whether the use of briefing and a systematic brief make a significant contribution to the high quality of design solutions remains unanswered, as is also the case of whether the brief, in general, reflects the briefing process. Despite the recent focus on improving the quality of the briefing process, there is a lack of knowledge concerning the documentation resulting from the briefing process. Studies are needed that employ different approaches in order to accept or reject the assumption that the briefs are an accurate reflection of the briefing process.
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| 25. |
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| 26. |
- Elf, Lena Marie, 1962, et al.
(författare)
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Developing a model of a Stroke Care Process
- 2009
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Ingår i: Online Journal of Nursing Informatics. - 1089-9758. ; 13:3, s. 1-34
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The paper presents the development and structure of a generic stroke care simulation model, used in designing of a stroke unit in Sweden. Background and rationale. Designing new health care spaces is a multifaceted process; requiring multi-professional (nurses, other healthcare professionals, building planners and architects) involvement. To secure that the patients’ interest are in focus the different stakeholders need to analyze and develop a common understanding of the care processes that are to take place in the new space. Modeling and simulation is one significant method, making it possible to depict the dynamic structure of the system and experiment with the model, asking “what – ifs” questions. Methods. System dynamics, a modeling method was used to develop the model. The iterative and group-modeling process included development of a quantified model (with a multi-professional design team, based on evidence from the literature, and a survey from stroke care experts), and validation of the model. Results. The dynamic care model developed included variables that are essential in modern care, such as patient-participation, care-planning, and teamwork. Conclusion. The presented generic model provides a framework for exploring, comprehending, and communicating complex ideas about stroke care.
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| 27. |
- Elf, Lena Marie, 1962
(författare)
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Modelling and simulation as planning tools for improvement of the quality of health care environments : towards a conceptual model of a care process
- 2003
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Planning for and designing new health care environments that meet the standards of contemporary and future health care are complex tasks. Understanding the nature of the health care environment and the care process is essential for a successful design process. Building and health care administrators, as well as professionals such as nurses and physicians should be engaged in discussions of what takes place within the environment. In this process, simulation and modeling may be a support for building future scenarios. The aim of the present thesis was to explore simulation as a planning tool for the process of designing new health care environments. The literature in the field was scrutinized and a first step towards a conceptual model of a care process was developed. The model is based on important concepts in health care and results from an observational study. Simulation has been used in industry for many years. Health care has adopted industrial models and it has proven to be useful for analyzing and solving problems of limited scope e.g. waiting lists and waiting times. However, health care involves issues beyond those of waiting lists, waiting times and ways of optimising processes with the aim of increasing production. A simulation model for health care should focus on how professionals' work together, how they communicate with each other and with the patient, and how they plan care with and for the patient. The conclusion of present study is that there is need for models with comprehensive scope that can handle questions from a process-oriented view. The care process should be modelled from a patient – centered perspective. Key words: simulation and modeling, health care services, health care process, design process
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| 28. |
- Elf, Lena Marie, 1962
(författare)
-
Modelling of Care Processes. The use of Simulation Models for the Design of Health Care Environments
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The necessity to improve the building design process is stressed in many studies. Communication in the early stages of the process is particularly important and it is suggested that this influences the quality of the whole process. In recent times, the construction sector has become more customer-oriented and is making use of the organisation and its main process as a basis for design decisions and as an important complement to construction issues. Participants in the building design process need tolls to indentify the requirements of the organisation for a building project. The overall aim of this thesis was to explore modelling and simulations (system dynamics) as at tool in facilitating collaboration between participants in the early stages in the design process for new health care environments. Two models were developed: a conceptual model for care planning and a simulation model of a stroke care process with a patient-centred focus. The thesis also investigated whether system dynamics with group modelling facilitates collaboration between participants in the design process. A case study approach was adopted to gain a detailed understanding of the activities during the group modelling project. Data was collected through literature, interviews and observations of the group modelling sessions. The results showed that group modelling with system dynamics facilitated the design work. The method allows the participants to visualise and understand the relationships between important factors in the stroke care process and brings system thinking into the stroke care process. The findings from the thesis have implications for managing the requirements of the buildings in the early stages of the design process.
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| 29. |
- Elf, Lena Marie, 1962, et al.
(författare)
-
Space Planners' Perception of an Assessment Instrument for Briefs in the Pre-Design Phase of New Healthcare Environments
- 2014
-
Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 8:1, s. 67-80
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The main purpose of the study was to investigate the usability of a newly developed instrument designed to assess the content and quality briefs (CQB-I) in programs for new healthcare environments. We studied the perception of using the instrument on a group of space planners.BACKGROUND: The study is part of a larger project designed to ensure the quality of the planning of new healthcare environments with a focus on documents (programs or briefs) created in the early phases of the planning process. In this study, we used an instrument that measures the clarity of the mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. The instrument further evaluates whether there are clear patient-related outcome measures specified and whether the information in the documents is person-oriented and evidence-based.METHODS: The study used a mixed-method design where the relevance and usability of the instrument was estimated and a focus group interview was conducted.RESULTS: The study showed that a CQB-I is perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs.CONCLUSIONS: Instruments like CQB-I can help to bring research results into planning and contribute to dialogue and collaboration in the early phases of a planning process by orienting planning participants to user needs and facilitating the discussion and articulation of clear performance indicators.
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| 30. |
- Elf, Marie, 1962-, et al.
(författare)
-
A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments
- 2019
-
Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 12:3, s. 107-118
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.
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| 31. |
- Elf, Marie, 1962-, et al.
(författare)
-
A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings
- 2024
-
Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112.
-
Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.
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| 32. |
- Elf, Marie, 1962, et al.
(författare)
-
A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare
- 2017
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 73:12, s. 2796-2816
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties. Background. The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment. Data sources. A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016). Review method. Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported. Results. Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated. Conclusions. Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators are user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required.
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| 33. |
- Elf, Marie, 1962, et al.
(författare)
-
Designing Sustainable Health Care Spaces
- 2008
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Ingår i: The Natural Step´s Sustainability Leadership Challenge - conference in Stockholm. - Stockholm.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 34. |
- Elf, Marie, 1962, et al.
(författare)
-
Designing sustainable healthcare environments.
- 2012
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Ingår i: 19th International Conference on Health Promoting Hospitals and Health Services. June 1-3, 2011 Turku, Finland.
-
Konferensbidrag (refereegranskat)
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| 35. |
- Elf, Marie, 1962-, et al.
(författare)
-
Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke : An Explorative Study
- 2023
-
Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 18:3, s. 237-237
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke.BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse.METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis.RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings.CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.
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| 36. |
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| 37. |
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| 38. |
- Elf, Marie, 1962-, et al.
(författare)
-
Tailoring and Evaluating an Intervention to Support Self-management After Stroke : Protocol for a Multi-case, Mixed Methods Comparison Study
- 2022
-
Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 11:5
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.OBJECTIVE: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.METHODS: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.RESULTS: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.CONCLUSIONS: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.
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| 39. |
- Elf, Marie, 1962, et al.
(författare)
-
The built environment and its impact on health outcomes and experiences of patients, significant others and staff—A protocol for a systematic review
- 2020
-
Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 7:3, s. 895-899
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: This review will identify, evaluate and synthesize the literature related to evidence-based design of healthcare environments and to identify impacts of the built environment on the outcomes and experiences of patients, significant others and staff. Design: A mixed-method systematic review of literature 2010–2018. Methods: Database searches for evidence in peer-reviewed journals will be conducted electronically using CINAHL, Medline, SCOPUS and Web of Science. Abstract, full-text screening and data extraction will be completed independently by the reviewers. Quality assessment will follow Swedish Agency for Health Technology Assessment and Social Services Assessment. Results: This review will offer knowledge for informed decisions about the design of the healthcare environment. The review is comprehensive, includes a large volume of literature various research designs and will highlight the knowledge gap in evidence-based design and provide a breadth of knowledge about the built environments and its impact on health and well-being.
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| 40. |
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| 41. |
- Elf, Marie, 1962, et al.
(författare)
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The health Care Environment
- 2003
-
Ingår i: International Postgraduate Research Conferences in Lisbon 2003. - Lisbon.
-
Konferensbidrag (refereegranskat)
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| 42. |
- Elf, Marie, 1962-, et al.
(författare)
-
The Home as a Place for Rehabilitation After Stroke : Emerging Empirical Findings
- 2023
-
Ingår i: (Re)designing the Continuum of Care for Older Adults : The Future of Long-Term Care Settings - The Future of Long-Term Care Settings. - Cham : Springer International Publishing. - 9783031209697 - 9783031209703 ; , s. 37-51
-
Bokkapitel (populärvet., debatt m.m.)abstract
- Health care is moving toward integrated services where care and rehabilitation are provided at home rather than in institutions. This, together with the requirement that care must be person-centered, has proven to be a considerable challenge. Older adults living with complex health conditions such as stroke are vulnerable to change when their responsibility for care and rehabilitation becomes extensive. Health care tends to be governed by quick fixes rather than taking people’s own goals, resources, and life situations. Factors in the environment that can affect a person’s health and social, emotional, and physical aspects of daily life are crucial to consider in person-centered care. Nevertheless, the environment is often neglected in both research and clinical practice. This chapter addresses findings within the REARCH (Rehabilitation and Architecture) project. The project was initiated in response to Swedish law in 2018, making it more common for older adults with stroke to be rehabilitated at home rather than in a hospital. The purpose was to explore environmental factors to fulfill person-centered rehabilitation. The results are based on qualitative and quantitative data collected from patients and interdisciplinary care staff. We describe the challenges for people with stroke during rehabilitation and how their possibilities to engage in everyday life in their homes and immediate surroundings are influenced by environmental factors. Our contribution will improve the understanding of how environmental factors relate to everyday life and recovery at home. The discussion aims to guide evidence-based care models for rehabilitation at home.
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| 43. |
- Elf, Marie, 1962-, et al.
(författare)
-
The home as a place for rehabilitation-What is needed?
- 2020
-
Ingår i: Architecture for Residential Care and Ageing Communities: Spaces for Dwelling and Healthcare. - New York, NY : Routledge, 2021. : Routledge. - 9780367358730 ; , s. 252-266, s. 252-266
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- This chapter aims to contribute to an understanding of the physical environment as an important part of the rehabilitation process for patients recovering from a stroke who rehabilitate at home. To further develop evidence-based care models for rehabilitation at home and incorporate person-environment dynamics, an understanding of how environmental factors relate to everyday life and recovering at home is crucial, especially for persons with long-term conditions, such as stroke survivors. Along with highlighting the challenges for the stroke survivors when rehabilitated at home, we discuss initiatives and intervention needed. We also present important theories that can be used in research in order to increase the knowledge of the person-environment interaction from a societal perspective vital to increase our knowledge of home and health dynamics in this context.
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| 44. |
- Elf, Marie, 1962-, et al.
(författare)
-
The importance of context : a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke
- 2023
-
Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.METHODS: Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.RESULTS: The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.CONCLUSIONS: Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.
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| 45. |
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| 46. |
- Elf, Marie, 1962-, et al.
(författare)
-
The Swedish version of the Normalization Process Theory Measure S-NoMAD : translation, adaptation, and pilot testing
- 2018
-
Ingår i: Implementation Science. - : Springer. - 1748-5908. ; 13:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe original British instrument the Normalization Process Theory Measure (NoMAD) is based on the four core constructs of the Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. They represent ways of thinking about implementation and are focused on how interventions can become part of everyday practice.AimTo translate and adapt the original NoMAD into the Swedish version S-NoMAD and to evaluate its psychometric properties based on a pilot test in a health care context including in-hospital, primary, and community care contexts.MethodsA systematic approach with a four-step process was utilized, including forward and backward translation and expert reviews for the test and improvement of content validity of the S-NoMAD in different stages of development. The final S-NoMAD version was then used for process evaluation in a pilot study aimed at the implementation of a new working method for individualized care planning. The pilot was executed in two hospitals, four health care centres, and two municipalities in a region in northern Sweden. The S-NoMAD pilot results were analysed for validity using confirmatory factor analysis, i.e. a one-factor model fitted for each of the four constructs of the S-NoMAD. Cronbach’s alpha was used to ascertain the internal consistency reliability.ResultsIn the pilot, S-NoMAD data were collected from 144 individuals who were different health care professionals or managers. The initial factor analysis model showed good fit for two of the constructs (Coherence and Cognitive Participation) and unsatisfactory fit for the remaining two (Collective Action and Reflexive Monitoring) based on three items. Deleting those items from the model yielded a good fit and good internal consistency (alphas between 0.78 and 0.83). However, the estimation of correlations between the factors showed that the factor Reflexive Monitoring was highly correlated (around 0.9) with the factors Coherence and Collective Action.ConclusionsThe results show initial satisfactory psychometric properties for the translation and first validation of the S-NoMAD. However, development of a highly valid and reliable instrument is an iterative process, requiring more extensive validation in various settings and populations. Thus, in order to establish the validity and reliability of the S-NoMAD, additional psychometric testing is needed.
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| 47. |
- Elf, Marie, 1962, et al.
(författare)
-
upporting pre-planning design phases of new dementia care environments through group-modeling
- 2012
-
Ingår i: Operations Research Society, OR54.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Problem and rationale The pre-design phase, before architectural design details are presented is important for the success of the entire construction process. In this phase, it is important to identify the needs of the users and the organization. The present project describes a group-modeling project with system dynamics (SD) in the pre-design phase of a new dementia care environment. The aim was to support a dynamic design process that was oriented towards the users needs. SD uses models to create scenarios and experiment with different solutions to understand complex problems. The method is interactive and suited for group- modeling. The tools used are a construction of a diagram depicting the system and a mathematical model for scenario experiments. Methods and procedureThe group- modeling was performed during five workshops with stakeholders from the organization. The data for the model was collected through discussions with the modeling group, a questionnaire, literature reviews and documents. The process was documented by video-recording and field notes. The participants were interviewed at the end of the project. The data was analyzed by content analysis. ResultsResult show that the modeling process supported the group to explicitly express their goal regarding care. The modeling process moved the group discussions from space solutions and square meters to the goals of the care process. The model developed illustrates a modern perspective of dementia care. Conclusions Group-modeling using SD is interesting for the pre-design process. It can be feasible for linking strategic planning of the organization with the plan over the new healthcare environment since it moves the participants in the pre-design phase to focus on important issues about the care and away from a wish list of various needed spaces, commonly achieved in traditional planning processes.
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| 48. |
- Elke Miedema, Elke, et al.
(författare)
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Health-promotive ambitions related to building design : The case of Angered Nearby Hospital
- 2017
-
Ingår i: ARCH17. - 9788793585003 ; , s. 331-344
-
Konferensbidrag (refereegranskat)abstract
- The potential of the built environment to mediate effects on patient and caregiver physical, cognitive and social health continues to be advocated. Evidence indicates that well-designed physical settings play an important role in making healthcare facilities safer and more healing for patients, and better working places for staff. Collaboration between researchers from varied disciplines is now adding to our understanding of the range of impacts on patient health and well-being. For instance, health architecture and interior designers are involving users of healthcare built environments in the design process using inclusive design or patient-centred care frameworks. Neuroscience researchers are exploring relationships between the environment and recovery from brain injury, often using a model of enriched environments. An overview of the range of theoretical frameworks used in empirical research to test built environment attributes is now warranted. In this paper, we present a mapping of the field showing the use of theories in built environment research. This would enable better selection of theoretical frameworks in order to evaluate the effect of specific design solutions on patient and care-giver health. Today, there are no comprehensive summaries of theories and conceptual frameworks applied in studies of healthcare architecture that could serve as a guide to future research. The aim of this scop- 378 ing review was to (i) identify theories and frameworks used in research of the physical environment in health care, (ii) describe their core constructs, assumptions, scientific utility, (iii) assess their applicability and feasibility for use in research. The basic principles of Arksey and O’Malley’s model of scoping review design were used to identify the theories and frameworks. 15 theories/frameworks were included and described in terms of general characteristics (purpose, country and year of development, discipline), core construct and applicability and feasibility.
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| 49. |
- Eriksson, Gunilla, et al.
(författare)
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Study protocol of a non-randomised controlled trial evaluating the effectiveness of the F@ce 2.0 programme : a person-centred, ICT-supported and interdisciplinary rehabilitation intervention after stroke
- 2022
-
Ingår i: BMJ Open. - : NLM (Medline). - 2044-6055. ; 12:8
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Knowledge is missing on use of information and communication technology (ICT), for example, mobile phones/tablets in rehabilitation after stroke. F@ce 2.0 is a person-centred, interdisciplinary intervention supported by ICT. The components of F@ce 2.0 intend to increase performance in daily activities and participation in everyday life for patients with stroke and their significant others. Based on previous feasibility studies, a full-scale evaluation is planned in Sweden. The aim is to implement and evaluate F@ce 2.0, regarding performance of daily activities and participation in everyday life, in comparison with ordinary rehabilitation among persons who have had stroke and significant others. Second, to increase knowledge about how the programme leads to a potential change by studying the implementation process and mechanisms of impact. METHODS AND ANALYSIS: Twelve rehabilitation teams (intervention n=7; control n=5) will recruit patients (n=160) who receive rehabilitation at home after stroke and their significant others. F@ce 2.0 is an 8-week intervention where patients, together with the team, formulate three activity goals regarding what they need and want to do in daily lives. The patients will receive short messages service (SMS) each morning reminding about goals, and in the evening to rate their performance during the day. Primary outcomes for patients: self-efficacy measured by the Self-Efficacy Scale; perceived performance in daily activities measured by the Canadian Occupational Performance Measure. Significant others: perceived caregiver burden measured by Caregiver Burden Scale. Qualitative interviews with team members delivering, patients receiving intervention and significant others will explore experiences of F@ce 2.0. A process evaluation applying a case-study design using mixed methods will be conducted. ETHICS AND DISSEMINATION: Approved by the Swedish Ethical Review Authority, Stockholm. Knowledge will be created for using ICT for rehabilitation of people after stroke in self-selected activities. Dissemination will include peer-reviewed publications, presentations at conferences, and information to stakeholders. TRIAL REGISTRATION NUMBER DETAILS: NCT04351178 . © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 50. |
- Fakhfakh, Maya, et al.
(författare)
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Canadian older adults' intention to use an electronic decision aid for housing decisions : a cross-sectional online survey
- 2023
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Ingår i: JMIR Aging. - : JMIR Publications Inc.. - 2561-7605. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Older adults experiencing disabilities such as loss of autonomy face the decision of whether to stay at home or move to a healthcare facility such as a nursing home. Thus, they may need support for this difficult decision.OBJECTIVE: We assessed Canadian older adults' intention to use an electronic decision aid (eDA) for making housing decisions and identified the factors that influenced their intention.METHODS: We conducted a cross-sectional study using an online survey targeting older adults across the 10 Canadian provinces and 3 territories. We included respondents from an online panel who were aged 65 years or older, understood English or French, had access to an electronic device with an internet connection and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the online survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence and facilitating conditions). We also assessed e-Health literacy using subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify factors influencing the intention to use the eDA.RESULTS: Of the 11,972 eligible panellists, 1,176 met the eligibility criteria and 1,000 (85%) respondents completed the survey. The mean age was 72.5 ± 5.59 years. Most respondents were male (54.8%), white (90.6%), English-speakers (62.9%) and living in Ontario or Quebec (62.8%) in urban areas (85%). Mean scores for subjective e-Health literacy were 27.8 ± 5.88 out of 40 and for objective e-Health literacy, 3.00 ± 0.97 out of 5. In our sample, the intention score was 4.74 ± 1.7 out of 7. Mean scores of intention constructs out of 7 were 5.63 ± 1.28 for facilitating conditions, 4.94 ± 1.48 for performance expectancy, 5.61 ± 1.35 for effort expectancy and 4.76 ± 1.59 for social influence. In the final model, factors associated with intention included mother tongue (β = .30; P <.001), objective e-Health literacy (β = -.06; P =.03), performance expectancy (β = .55; P <.001), social influence (β = .37; P <.001) and facilitating conditions (β = .15; P <.001).CONCLUSIONS: Findings from this pan-Canadian online survey suggest that Canadian older adults' intention to use an eDA to make housing decisions are similar to findings in other studies using UTAUT. Factors identified as influencing intention were mother tongue, objective e-Health literacy, performance expectancy, social influence and facilitating conditions. These will guide future strategies for implementing the eDA.
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