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1.	Schoeps, Lena N, et al. (författare) Patients' knowledge of and participation in preventing pressure ulcers : an intervention study 2017 Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 14:2, s. 344-348 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to evaluate a patient information pamphlet on pressure ulcer (PU) prevention using a descriptive, comparative pre- and post-test study design. The patient information pamphlet 'How can you help to stop pressure ulcers?' developed by the European PU Advisory Panel in 2012 was implemented in two surgical wards in a university hospital. A total of 61 patients answered pre- and post-test questionnaires. Patients assessed their knowledge of the risks, causes and ways to prevent PUs significantly higher after the intervention than before. Twenty-eight patients (46%) reported that they had participated in PU prevention during the last 24 hours. The patients assessed the content of the PU pamphlet as useful, its language as quite easy to understand and its layout as good. Patients with a PU pamphlet during their hospital stay were more knowledgeable about and more active in their own care. It is important that nurses invite patients to be active partners in preventing PUs but also that they identify patients who need to have a more passive role. The PU pamphlet could be updated to increase its comprehensibility, meaningfulness and manageability for patients.
2.	Athlin, Åsa Muntlin, et al. (författare) Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? : A descriptive and explorative study 2016 Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 24 Tidskriftsartikel (refereegranskat)abstract Background: Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. Methods: Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden. Results: A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47-64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay. Discussion and Conclusions: In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.
3.	Bredesen, Ida Marie, et al. (författare) Effect of e-learning program on risk assessment and pressure ulcer classification : A randomized study 2016 Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 40, s. 191-197 Tidskriftsartikel (refereegranskat)abstract Background: Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian. Objectives: Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. Methods: Design, participants and setting: Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012. Analysis: Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables. Results: An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. Conclusion: An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected.
4.	Bredesen, Ida Marie, et al. (författare) Patient and organisational variables associated with pressure ulcer prevalence in hospital settings : a multilevel analysis 2015 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 5:8 Tidskriftsartikel (refereegranskat)abstract Objectives: To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. Design: Multilevel approach to data from 2 cross-sectional studies. Settings: 4 hospitals in Norway were studied. Participants: 1056 patients at 84 somatic wards. Primary outcome measure: HAPU. Results: Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age > 70 vs < 70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25-29.99 kg/m(2)) (OR 0.32 (95% CI 0.17 to 0.62)). Conclusions: The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.
5.	Bredesen, Ida Marie, et al. (författare) The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals : A cross-sectional study 2015 Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 52:1, s. 149-156 Tidskriftsartikel (refereegranskat)abstract Background: Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals. Objective: To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level. Design: A cross-sectional study. Setting: Six of the 11 invited hospitals in South-Eastern Norway agreed to participate. Participants: Inpatients >= 18 years at 88 somatic hospital wards (N = 1209). Patients in paediatric and maternity wards and day surgery patients were excluded. Methods: The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels. Results: The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level. Conclusions: Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important. (C) 2014 Elsevier Ltd. All rights reserved.
6.	Bååth, Carina, 1959-, et al. (författare) Prevention of heel pressure ulcers among older patients - from ambulance care to hospital discharge : a multi-centre randomized controlled trial 2016 Ingår i: Applied Nursing Research. - : Elsevier BV. - 0897-1897 .- 1532-8201. ; 30, s. 170-175 Tidskriftsartikel (refereegranskat)abstract The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70 +). Background: Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used. Methods: A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards. Results: Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017). Conclusions: Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.
7.	Carlsson, Maria E., et al. (författare) Predictors for Development of Pressure Ulcer in End-of-Life Care : A National Quality Register Study 2017 Ingår i: Journal of Palliative Medicine. - : Mary Ann Liebert Inc. - 1096-6218 .- 1557-7740. ; 20:1, s. 53-58 Tidskriftsartikel (refereegranskat)abstract Background: The scientific knowledge about pressure ulcers (PUs) is growing, but there is a shortage of studies of PUs at end of life. The recommendations regarding PU prevention in palliative care (PC) are based on consensus documents. Aim: To use data from a national register to identify predictors for development of PUs at the end of life. Design: A retrospective, descriptive, and comparative study design was used. Setting/Participants: All deceased patients over 17 years old (n = 60,319) and registered in the Swedish Register of Palliative Care (SRPC) during 2014 were included. Statistical Analysis: Logistic regression. Results: In the full model, all health units except general palliative home care had a significantly higher incidence of PUs than did the nursing homes. The well-known predictors of PUs in general, diabetes, post-fracture state, infections, and multiple sicknesses, are predictors even in dying patients. Dementia was significantly associated with lower likelihood of PUs, while pain was associated with more PUs. Intravenous drip or enteral feeding was associated with a significantly decreased likelihood of developing PUs. Conclusions: The SRPC could be a unique resource for quality improvement and research. The present study cannot prove causation, but it can report correlations between background variables and PU prevalence. More studies, with different designs, are warranted to establish the roles of risk factors for PU in end-of-life care.
8.	Carlsson, Maria E., 1958-, et al. (författare) Unavoidable pressure ulcers at the end of life and nurse understanding 2017 Ingår i: British Journal of Nursing. - 0966-0461 .- 2052-2819. ; 26:20, s. s6-s17 Tidskriftsartikel (refereegranskat)abstract Objectives:prevention of pressure ulcers (PUs) in end-of-life care is often problematic because both PUs and interventions to prevent them can cause suffering. The primary aim of this study was to identify and describe the different ways in which nurses understood unavoidable PUs in late palliative care. A second aim was to explore the expediency of the different levels of understanding.Methods:a qualitative interview study with a phenomenographic approach was carried out. The study participants were nurses and healthcare assistants who worked in nursing homes or in specialist palliative inpatient care units run by private providers, non-profit foundations, municipalities and county councils. A phenomenographic analysis of the interview data was undertaken.Results:all participants shared a fundamental understanding that the prevention of PUs is highly worthwhile in end-of-life care. Within this common view, practitioners' understanding of whether PUs could be prevented differed in four main ways, and were divided into categories: A: unavoidable PUs do not exist. All can be prevented if all interventions are applied, and all patients are at the same risk for developing PUs in end-of-life care; B: unavoidable PUs do not exist, but some patients do not participate in prevention interventions, which makes prevention difficult. The risk of developing pressure ulcers in end-of-life care varies between patients; C: some PUs are unavoidable because some patients do not participate in prevention interventions; the risk of developing pressure ulcers in end-of-life care differs between patients. D: some PUs are unavoidable, depending on the pathophysiological processes in the dying body. The risk of developing pressure ulcers in end-of-life care differs between patients.Conclusion:it is paramount to communicate to nurses that not all PUs can be prevented in dying patients, to lessen the burden of ethical stress for the nurses.
9.	Dahlberg, Karuna, 1979- (författare) e-Assessed follow-up of postoperative recovery : developement, evaluation and patient experiences 2018 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.
10.	Florin, Jan, 1956-, et al. (författare) Attitudes towards pressure ulcer prevention : a psychometric evaluation of the Swedish version of the APuP instrument 2016 Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 13:5, s. 655-662 Tidskriftsartikel (refereegranskat)abstract The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.
11.	Gunnarsson, Anna-Karin, et al. (författare) Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter : a double-blind randomised trial 2017 Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 12, s. 137-143 Tidskriftsartikel (refereegranskat)abstract BackgroundUrinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries (lat. Vaccinium macrocarpon Ait.) are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters.AimTo investigate whether cranberry capsules given pre- and postoperatively are useful in preventing hospital-acquired UTIs in female patients with hip fracture and urinary catheter.DesignRandomised, placebo-controlled double-blind trial.MethodFemale patients, age 60 years and older, with hip fracture were recruited (n=227). The patients were randomised to receive cranberry (n=113) or placebo (n=114) capsules daily, from admission to the ward, until five days postoperatively. Urine cultures were obtained at admission and at five and 14 days postoperatively. In addition, EQ-5D assessments were performed and patients were screened for UTI symptoms.ResultThere was no difference between the groups in the proportion of patients with postoperative positive urine cultures. When excluding patients with positive cultures at admission, patients with antibiotic treatment during follow-up, and patients that did not adhere to the protocol, there was a trend towards a protective effect of cranberry treatment against hospital-acquired UTIs ; e.g. 36% (n=33) in the control group vs. 22% (n=41) in cranberry group (p=0.17) at 5 days postoperatively.ConclusionCranberry concentrate does not seem to have an effect in preventing UTI in female patients with hip fracture and indwelling urinary catheter.
12.	Gunningberg, Lena, 1954-, et al. (författare) Facilitating student nurses' learning by real time feedback of positioning to avoid pressure ulcers--Evaluation of clinical simulation 2016 Ingår i: Journal of Nursing Education and Practice. - : Sciedu Press. - 1925-4040 .- 1925-4059. ; 6:1 Tidskriftsartikel (refereegranskat)abstract Background: Reduction of pressure and shear is recognised as the single most important intervention in order to prevent pressure ulcers (PU). Recently, an objective way to measure and receive feedback about the amount of pressure at the body-mattress interface has become available. Using such feedback in a simulated scenario in which there is a hypothetical risk for pressure ulcer development may prepare students in a safe and controlled environment for clinical placements. The aim of the study was to assess whether student nurses’ learning about optimal repositioning could be facilitated by real-time feedback in a simulated PU prevention scenario.Methods: A quantitative study was performed in the Clinical Training Center using a descriptive, comparative design. Student nurses from the second (n = 24) and last (n = 32) semesters worked in pairs. Their task was to place two volunteers (69 and 70 years) in the best pressure-reducing position (lateral and supine), initially without access to the pressure mapping monitor and then again after feedback. In total 232 positionings were conducted.Results: Despite the controlled environment, there was considerable variation in peak-pressure readings between student pairs Mean peak pressures were consistently higher in the lateral position compared with the supine, both before and after feedback. After feedback from the pressure mapping monitor, most peak pressure readings were significantly reduced and the number of preventive interventions and patients’ comfort had increased.Conclusions: Including simulation of PU prevention in the nursing curriculum provides the possibility for students to train repositioning in a safe environment. The immediate feedback from the pressure monitoring system may strengthen students’ confidence and competence on clinical placements.
13.	Gunningberg, Lena, 1954-, et al. (författare) Pressure mapping to prevent pressure ulcers in a hospital setting : A pragmatic randomised controlled trial 2017 Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 72, s. 53-59 Tidskriftsartikel (refereegranskat)abstract Background: Pressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking. Objective: To evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting. Design: Pragmatic randomised controlled trial. Setting: A geriatric/internal medical ward with 26 beds in a Swedish university hospital. Participants: 190 patients were recruited (intervention: n = 91; control: n = 99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4 pm and Friday 4 pm, and expected to stay in the ward >= 3 days. Intervention: The continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care. Results: No significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34-3.79). Conclusions: This study failed to demonstrate a beneficial effect of a pressure mapping system on pressure ulcer prevalence and incidence. However, the study could have increased staff awareness and focus on pressure ulcer prevention, thus affecting the prevalence and incidence of pressure ulcers in a positive way in both study groups. It is important to further investigate the experience of the multidisciplinary team and the patients regarding their use of the pressure mapping system, as well as strengths and weaknesses of the system.
14.	Gunningberg, Lena, et al. (författare) Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses : a descriptive, comparative multicentre study in Sweden 2015 Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 12:4, s. 462-468 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.
15.	Gunningberg, Lena, 1954-, et al. (författare) Reduced pressure for fewer pressure ulcers : can real-time feedback of interface pressure optimise repositioning in bed? 2016 Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 13:5, s. 774-779 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.
16.	Gunningberg, Lena, 1954-, et al. (författare) Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward : A qualitative study 2018 Ingår i: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 26:2, s. 140-147 Tidskriftsartikel (refereegranskat)abstract Aim: To describe staff's perceptions of a continuous pressure mapping system to prevent pressure injury in a hospital ward. Background: Pressure injury development is still a problem in hospitals. It is important to understand how new information and communication technologies can facilitate pressure injury prevention. Method: A descriptive design with qualitative focus group interviews was used. Results: Five categories were identified: “Need of information, training and coaching over a long period of time,” “Pressure mapping – a useful tool in the prevention of pressure injury in high risk patients,” “Easy to understand and use, but some practical issues were annoying,” “New way of working and thinking,” and “Future possibilities with the pressure mapping system.”. Conclusion: The pressure mapping system was an eye-opener for the importance of pressure injury prevention. Staff appreciated the real-time feedback on pressure points, which alerted them to the time for repositioning, facilitated repositioning and provided feedback on the repositioning performed. Implications for Nursing Management: A continuous pressure mapping system can be used as a catalyst, increasing staff's competence, focus and awareness of prevention. For successful implementation, the nurse managers should have a shared agenda with the clinical nurse leaders, supporting the sustaining and spread of the innovation.
17.	Gunningberg, Lena, 1954-, et al. (författare) Tracking pressure injuries as adverse events : National use of the Global Trigger Tool over a 4-year period 2018 Ingår i: Journal of Evaluation In Clinical Practice. - : Blackwell Publishing. - 1356-1294 .- 1365-2753. ; 25:1, s. 21-27 Tidskriftsartikel (refereegranskat)abstract Aim: To examine the frequency, preventability, and consequences of hospital acquired pressure injuries in acute care hospitals over a 4-year period. Method: A retrospective record review was performed using the Swedish version of the Global Trigger Tool (GTT). A total of 64 917 hospital admissions were reviewed. Data were collected between 2013 and 2016 from all 63 Swedish acute care hospitals. Results: The prevalence of pressure injuries (category 2-4) was 1%. Older patients, "satellite patients", and patients with acute admissions had more pressure injuries. Most pressure injuries (91%) were determined to be preventable. The mean extended length of hospital stay was 15.8 days for patients who developed pressure injuries during hospitalization. Conclusion: The GTT provides a useful and complementary national perspective on hospital acquired pressure injuries across hospitals, informing health care providers on safety priorities to reduce patient harm. Clinical leaders can use information on the preventability and the consequences of pressure injuries, as well as evidence-based arguments for improving the health care organization.
18.	Hommel, A, et al. (författare) Lägg förslaget om förändrad utbildning i papperskorgen 2016 Ingår i: Dagens medicin. - 1104-7488. Tidskriftsartikel (populärvet., debatt m.m.)abstract Skapa specialistutbildningar för sjuksköterskor som motsvarar vårdens behov både i dag och i framtiden, skriver Ami Hommel, ordförande Svensk sjuksköterskeförening, och nio vårdprofessorer.
19.	Hommel, A, et al. (författare) Lägg förslaget om förändrad utbildning i papperskorgen 2016 Ingår i: Dagens medicin. - 1104-7488. Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Skapa specialistutbildningar för sjuksköterskor som motsvarar vårdens behov både i dag och i framtiden, skriver Ami Hommel, ordförande Svensk sjuksköterskeförening, och nio vårdprofessorer.
20.	Hommel, Ami, et al. (författare) Sucessful factors to prevent pressure ulcers - An interview study 2017 Ingår i: Journal of Clinical Nursing. - Oxford : Wiley. - 0962-1067 .- 1365-2702. ; 26:1-2, s. 182-189 Tidskriftsartikel (refereegranskat)abstract AIM AND OBJECTIVES: The aim of present study was to explore successful factors to prevent pressure ulcers (PU) in hospital settings.BACKGROUND: PU prevalence has been recognized as a quality indicator for both patient safety and quality of care in hospital and community settings. Most PU can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions (SALAR) initiated nationwide PU prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of PU in the spring of 2014 was 14% in hospital settings with a range from 2.7% to 36.4%.DESIGN: Qualitative semi-structured interviews were conducted.METHODS: A qualitative content analysis, in addition to PARIHS frameworks was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014.RESULTS: Three main categories were identified as successful factors to prevent PU in hospitals: creating a good organization, maintaining persistent awareness, and realising the benefits for patients.CONCLUSION: The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of PU is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organization in prevention work.RELEVANCE TO CLINICAL PRACTICE: The nurse managers' attitude and crucial to enable the personnel to work actively with PU prevention. Strategies are proposed to advance clinical leadership, knowledge, skills, and abilities for the crucial implementation of PU prevention.
21.	Hommel, Ami, et al. (författare) Öka satsningarna på forskning i omvårdnad 2017 Ingår i: Dagens Medicin. - 1104-7488. ; :19 januari Tidskriftsartikel (populärvet., debatt m.m.)abstract Långsiktiga satsningar för välfärdsforskning är bra, men för att nå ända fram och minimera hälsoklyftorna är det nödvändigt att även forskning inom omvårdnad prioriteras, skriver tio debattörer.
22.	Hommel, Ami, et al. (författare) Öka satsningarna på forskning i omvårdnad 2017 Ingår i: Dagens medicin. - 1104-7488. ; :19 januari Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Långsiktiga satsningar för välfärdsforskning är bra, men för att nå ända fram och minimera hälsoklyftorna är det nödvändigt att även forskning inom omvårdnad prioriteras, skriver tio debattörer.
23.	Hultin, Lisa, et al. (författare) Information and Communication Technology Can Increase Patient Participation in Pressure Injury Prevention A Qualitative Study in Older Orthopedic Patients 2019 Ingår i: Journal of Wound, Ostomy and Continence Nursing (WOCN). - : LIPPINCOTT WILLIAMS & WILKINS. - 1071-5754 .- 1528-3976. ; 46:5, s. 383-389 Tidskriftsartikel (refereegranskat)abstract PURPOSE: The aim of this study was to assess the participatory capabilities of hospitalized older adults in response to the Continuous Bedside Pressure Mapping system placed on the beds to prevent pressure injuries. DESIGN: Descriptive study. SUBJECTS AND SETTING: A convenience sample of 31 orthopedic patients were recruited from an orthopedic rehabilitation unit at a university hospital in Uppsala, Sweden, that served patients aged 65 years and older. METHODS: Semistructured interviews were conducted between November 2016 and February 2017, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULT: The overall theme from 21 interviews was "A new way of understanding helped patients to recognize vulnerable pressure points and to take action in their own care" from which 2 categories, "awareness" and "action," emerged. The study showed that verbally adapted information combined with using information and communication technology increased most participants' knowledge and as they became aware of increased pressure, they started to take preventative action by changing position. CONCLUSIONS: It is possible for older participants in a rehabilitation unit who had recent orthopedic surgery to understand and use new information and communication technology and should be invited to participate in pressure injury prevention.
24.	Hultin, Lisa, et al. (författare) Pressure Mapping in Elderly Care : A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff 2017 Ingår i: Journal of Wound, Ostomy and Continence Nursing (WOCN). - 1071-5754 .- 1528-3976. ; 44:2 Tidskriftsartikel (refereegranskat)abstract PURPOSE: The purpose of this study was to evaluate the use of a pressure mapping system with real-time feedback of pressure points in elderly care, with specific focus on pressure injury (PI) knowledge/attitudes (staff), interface pressure, and PI prevention activities (residents). DESIGN: Descriptive, 1-group pretest/posttest study. SUBJECTS AND SETTING: A convenience sample of 40 assistant nurses and aides participated in the study; staff members were recruited at daytime, and 1 nighttime meeting was held at the facility. A convenience sample of 12 residents with risk for PI were recruited, 4 from each ward. Inclusion criteria were participants older than 65 years, Modified Norton Scale score 20 or less, and in need of help with turning in order to prevent PI. The study setting was a care facility for the elderly in Uppsala, Sweden. METHODS: A descriptive, comparative pretest/posttest study design was used. The intervention consisted of the use of a pressure mapping system, combined with theoretical and practical teaching. Theoretical and practical information related to PI prevention and the pressure mapping system was presented to the staff. The staff (n = 40) completed the Pressure Ulcer Knowledge and Assessment Tool (PUKAT) and Attitudes towards Pressure Ulcer (APuP) before and following study intervention. Residents' beds were equipped with a pressure mapping system during 7 consecutive days. Peak pressures and preventive interventions were registered 3 times a day by trained study nurses, assistant nurses, and aides. RESULTS: Staff members' PUKAT scores increased significantly (P = .002), while their attitude scores, which were high pretest, remained unchanged. Peak interface pressures were significantly reduced (P = .016), and more preventive interventions (n = 0.012) were implemented when the staff repositioned residents after feedback from the pressure mapping system. CONCLUSIONS: A limited educational intervention, combined with the use of a pressure mapping system, was successful as it improved staff members' knowledge about PI prevention, reduced interface pressure, and increased PI prevention activities. As many of the staff members lacked formal education in PI prevention and management, opportunities for teaching sessions and reflection upon PI prevention should be incorporated into the workplace. More research is needed to evaluate the effect of continuous pressure mapping on the incidence of PI.
25.	Jangland, Eva, et al. (författare) Improving patient participation in a challenging context : a 2-year evaluation study of an implementation project 2017 Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 25:4, s. 266-275 Tidskriftsartikel (refereegranskat)abstract AimTo evaluate an implementation project on patient participation.BackgroundPatient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years.MethodPatients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed.ResultsAlthough the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients’ involvement in their own care. Several barriers to change and sustainability were acknowledged.ConclusionsImproving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement.Implications for Nursing ManagementA dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care.
26.	Karlsson, Ann-Christin, et al. (författare) Registered nurses' perspectives of work satisfaction, patient safety and intention to stay : A double-edged sword 2019 Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 27:7, s. 1359-1365 Tidskriftsartikel (refereegranskat)abstract AimTo describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these.BackgroundNurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment.MethodDescriptive design with 25 qualitative interviews.ResultsFive categories were identified: RNs feel satisfied when providing person‐centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal.ConclusionRegistered nurses' job satisfaction could be described as a double‐edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety.Implications for Nursing ManagementOur findings suggest that nursing leadership can increase RNs’ intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.
27.	Karlsson, Anna, et al. (författare) Evidence-based nursing-How is it understood by bedside nurses? : A phenomenographic study in surgical settings 2019 Ingår i: Journal of Nursing Management. - : WILEY. - 0966-0429 .- 1365-2834. ; 27:6, s. 1216-1223 Tidskriftsartikel (refereegranskat)abstract Aim The aim was to identify and describe nurses' understanding of working with evidence-based nursing (EBN) in clinical practice. Background Evidence-based health care is recognized as fundamental to nursing practice, but it is challenging to implement. How nurses understand this part of their work can affect their practice. Methods Using a qualitative explorative design with a phenomenographic approach, we interviewed 21 nurses working in Swedish surgical wards. Results We identified three understandings of EBN among nurses in surgical care: A. a fragmentary and difficult concept that is not integrated or used in clinical practice; B. an important approach guided by knowledgeable colleagues and students; and C. a process that nurses are responsible for developing and leading. Conclusion Nurses' understandings of working with EBN in surgical wards vary widely. Nurse managers have an important task to create a common outlook among nurses about integrating research, patient experience and clinical experience in decision-making. Implication for nursing management These findings could inspire nurse managers to reflect on how to move nurses towards a more comprehensive understanding of EBN and how to identify nurses who could act as facilitators in quality improvement work.
28.	Muntlin Athlin, Åsa, et al. (författare) To Receive or Not to Receive Analgesics in the Emergency Department : The Importance of the Pain Intensity Assessment and Initial Nursing Assessment 2015 Ingår i: Pain Management Nursing. - : Elsevier BV. - 1524-9042 .- 1532-8635. ; 16:5, s. 743-750 Tidskriftsartikel (refereegranskat)abstract Patients seeking emergency care for abdominal pain still experience poor pain management. Pain intensity is not always seen as a mandatory parameter in the initial nurse assessment. Despite the development of nurse-initiated analgesic protocols, many patients do not receive analgesics in the emergency department. The aim of this study was to describe initial nursing assessment related to pain management and to identify predictors for receiving or not receiving analgesics in the emergency department. The sample consists of 100 patients from an intervention group in a previously undertaken Swedish intervention study. The main findings were that the registered nurses assessed 62 patients as being in need of analgesics, and that 52 of these obtained analgesics. The majority of the patients assessed as not being in need of analgesics did not receive analgesics because they did not want medication. Median value for pain intensity at initial assessment was 6 on the numerical rating scale. The results for the logistic regression (n = 80) showed significant differences between receiving analgesics/not receiving analgesics and the predictor pain intensity (measured at initial nurse assessment). Nurses in emergency departments play a crucial role, in that their initial assessment is of specific importance for the patient's further care and whether the patient may or may not receive analgesics. However, more attention has to be paid to patients' experiences and their expectations regarding the pain management in the emergency department. These complex questions have to be studied further in a more systematic way.
29.	Sving, Eva, et al. (författare) Getting evidence-based pressure ulcer prevention into practice : a multi-faceted unit-tailored intervention in a hospital setting 2016 Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 13:5, s. 645-654 Tidskriftsartikel (refereegranskat)abstract The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.
30.	Sving, Eva, 1959-, et al. (författare) Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multi-faceted intervention in a hospital setting 2017 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 26:19-20, s. 3200-3211 Tidskriftsartikel (refereegranskat)abstract AIM:The aim of the present study was to describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multi-faceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention.BACKGROUND:Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes.DESIGN:A descriptive qualitative approach.METHOD:Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used.RESULT:The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements.CONCLUSION:The multi-faceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feed-back discussions among the staff regarding the results of the care provided also appear to be vital.
31.	Åkerfeldt, Torbjörn, et al. (författare) Postsurgical Acute Phase Reaction is Associated with Decreased Levels of Circulating Myostatin 2015 Ingår i: Inflammation. - : Springer Science and Business Media LLC. - 0360-3997 .- 1573-2576. ; 38:4, s. 1727-1730 Tidskriftsartikel (refereegranskat)abstract Muscle strength is of importance for postsurgical rehabilitation. Myostatin is a growth factor that regulates the size of muscles and could thus influence muscle mass and function in the postsurgical period. The aim of the present study was to study the changes in myostatin levels during the postsurgical inflammatory period. Myostatin was analysed in serum samples from two elective surgery groups, orthopaedic surgery (n = 24) and coronary bypass patients (n = 21). The samples were collected prior to surgery and 4 and 30 days after surgery. In the orthopaedic group, the median myostatin levels decreased from 3582 ng/L prior to surgery to 774 ng/L at day 4 (p < 0.001) and to 2016 ng/L at day 30 (p < 0.001). Median CRP increased from 2.35 mg/L preoperatively to 117 mg/L at day 4 and decreased to 5.5 mg/L at day 30 in the same group. The coronary bypass group showed a similar pattern with a decrease in myostatin from 4212 ng/L to 2574 ng/L at day 4 (p < 0.001) and to 2808 ng/L at day 30 (p = 0.002). Median CRP increased from 1.80 mg/L preoperatively to 136 mg/L at day 4 and returned to 6.12 mg/L at day 30 in the coronary bypass group. There was a significant decrease in myostatin concentrations both in the early and late postsurgical period. The lowest myostatin concentration time point coincided with the highest CRP concentration time point.

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