| 1. |
- Jangland, Eva, et al.
(författare)
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A mentoring programme to meet newly graduated nurses' needs and give senior nurses a new career opportunity : A multiple-case study
- 2021
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Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 57
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the implementation of a multifaceted mentoring programme in a large university hospital and describe its value from the perspectives of newly graduated nurses, experienced nurses and the hospital organisation.Background: Healthcare organisations need long-term competence-planning strategies to retain nurses, prevent their premature departure from the profession and use their competencies. This paper reports a mentoring programme focused on supporting newly graduated nurse' transition to practice and senior nurses' professional development as supervisors.Design: A multiple-case study.Methods: We performed 35 interviews with nurses, supervisors and nurse managers in the five units that implemented the programme, mapped the programme at the hospital level and extracted the nurses' working hours. The interviews were analysed thematically using the theoretical lens of the head-heart-hand model to interpret the results.Results: Of 46 units in the hospital, 14 had implemented one or several of the components in the mentoring programme. The programme corresponded to the newly graduated nurses' needs, gave senior nurses a new career opportunity and contributed to an attractive workplace. The main theme, Giving new nurses confidence, experienced nurses a positive challenge and the organisation an opportunity to learn, reflects the value of the programme's supervisory model to new and experienced nurses and to the organisation as a whole.Conclusion: The mentoring programme appeared to be a promising way to smooth the transition for newly graduated nurses. The experienced supervising nurses were key to the success of this complex programme, supporting the new nurses at the bedside and being available to respond to their questions and reflections. Embedding the supervisors in the units' daily practice was necessary to the success of the different parts of the programme. Despite the strategic and well-designed implementation of this mentoring programme aimed to solve the everyday challenge of nurse shortages in the hospital, it was a challenge to implement it fully in all the units studied.
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| 2. |
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| 3. |
- Falk-Brynhildsen, Karin, 1959-, et al.
(författare)
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Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room
- 2023
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Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 20:5, s. 1534-1543
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument.
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| 4. |
- Falk-Brynhildsen, Karin, 1959-, et al.
(författare)
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The Swedish version of the attitude towards pressure ulcer prevention instrument for use in an operating room context (APUP-OR) : A nationwide psychometric evaluation
- 2022
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Ingår i: JOURNAL OF TISSUE VIABILITY. - : Elsevier. - 0965-206X .- 1876-4746. ; 31:1, s. 46-51
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: To assess operating room (OR) nurses' attitudes towards pressure ulcer prevention, the Attitude towards Pressure Ulcer Prevention (APuP) instrument was developed. Aim: The aim of this study was to psychometrically evaluate the Attitude towards Pressure Ulcer Prevention (APuP) instrument in a Swedish OR context. Materials and methods: A psychometric evaluation study was conducted, using a convenience sample, between February and August 2020. Validity (content, construct, discriminatory power) and reliability (stability and internal consistency) were evaluated. Results: The first survey (test) was completed by 284 Swedish OR nurses, of whom n = 50 (17.6%) completed the second survey (retest). A Principal Component Analysis was conducted for the 13-item instrument. The KMO value for this model was 0.62. Bartlett's test for sphericity was statistically significant (p 0.001). Five factors were identified which accounted for 56% of the variance in responses related to attitudes toward pressure ulcer prevention. The Cronbach's a for the instrument "attitude towards Pressure Ulcer Prevention" was 0.66. The intraclass correlation coefficient was 0.49 (95% CI = 0.25-0.67). Conclusion: This Swedish version of the APuP- OR is the first step in the development of an instrument to measure OR nurses' attitudes towards PU prevention in a Swedish OR context. The reliability of the instrument was low and the validity moderate. A larger sample and the revision or addition of items related to the context of the operating room should be considered in order to confirm aspects of the psychometric properties.
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| 5. |
- Hultin, Lisa, et al.
(författare)
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Feasibility of PURPOSE T in clinical practice and patient participation : a mixed-method study
- 2023
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Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 20:3, s. 633-647
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to evaluate the feasibility of implementing an electronic version of PURPOSE T, a risk assessment instrument for pressure ulcers, in a Swedish hospital ward. A mixed-method was used. Nursing staff received training in PURPOSE T and a record review was performed (n=30). PURPOSE T replaced the Modified Norton Scale, and after one month another record review was performed (n=30). Individual interviews with patients (n=15) and focus groups interviews with nursing staff (n=23) were performed after the implementation. The results of the record review and the focus groups interviews showed a good clinical feasibility of PURPOSE T. The record review showed that more patients were at risk of developing pressure ulcers and more nursing interventions were prescribed with PURPOSE T compared to the Modified Norton Scale. The focus group interviews showed that all nursing staff were satisfied with PURPOSE T. The instrument contributed to increased reflection and analysis as well as the opportunity for nursing staff to draw their own conclusions regarding patients´ risk status. The documentation encouraged the prescription of more preventive actions, and the nurses were more involved at bedside. However, almost all the patients experienced that they did not receive any information about pressure ulcers. Key Messages· PURPOSE T demonstrates successful feasibility when implemented in clinical practice.· The study provides evidence that an electronic version of PURPOSE T can replace pressure ulcer risk assessment instruments that are used today.· Routines for sharing information with patients about pressure ulcers need to be prioritized in clinical practice.
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| 6. |
- Hultin, Lisa, et al.
(författare)
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Pressure ulcer risk assessment - registered nurses' experiences of using PURPOSE T : A focus group study
- 2022
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 31:1-2, s. 231-239
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the clinical usability of PURPOSE T among registered nurses in Sweden.BACKGROUND: Pressure ulcers are an adverse event and a problem worldwide. Risk assessment is a cornerstone, and a first step in pressure ulcer prevention is to identify possible risk patients and/or pressure ulcers. There are many pressure ulcer risk assessment instruments; however, they are not updated and/or evidence-based. PURPOSE T has been psychometrically evaluated in the UK and in Sweden with good inter-rater and test-retest reliability, and convergent validity was reported as moderate.DESIGN: A descriptive study design with a qualitative approach.METHODS: A total of six focus group interviews with 29 registered nurses were conducted. They were recruited from May 2018 to November 2018 from a university hospital and two nursing homes in Sweden. Data analysis was performed as described by Krueger. The study adheres to the COREQ guidelines.RESULTS: Four categories were identified: "An efficient risk assessment instrument performed at the bedside," "Deeper understanding and awareness of risk factors," "Benefits compared to the Modified Norton Scale" and "Necessity of integration of PURPOSE T in the electronic health record and team collaboration."CONCLUSION: The registered nurses acknowledged an overall positive perception of PURPOSE T's clinical usability. Future research is needed to evaluate the feasibility of PURPOSE T.RELEVANCE TO CLINICAL PRACTICE: PURPOSE T has the potential to replace outdated pressure ulcers risk assessment instruments that are used today.
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| 7. |
- Hultin, Lisa, 1977-
(författare)
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Preventing pressure ulcers : – risk assessment and patient participation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pressure ulcers are considered as an adverse event. Identifying patients at risk is the first step in pressure ulcer prevention. The patient should receive relevant information about their risk status and be encouraged to participate in their own preventive care. PURPOSE T is a new pressure ulcer risk assessment instrument, and the CBPM system shows the patient’s pressure points visually in real time. Aim: This thesis aimed to evaluate the psychometric values, usability and feasibility of PURPOSE T and to investigate the possibility of improving patient participation through the CBPM system. Method: The study setting was a university hospital and three nursing homes. Nurses (n=28) risk assessed patients (n=235) with PURPOSE T in an observational, descriptive and comparative study (I). Focus group interviews were then conducted with the nurses (II). A mixed-method study evaluated the feasibility of PURPOSE T with patient record review (n=60), individual patient interviews (n=15) and focus group interviews with nurses (n=15) and assistant nurses (n=8) (III). A descriptive study with patients (n=31) evaluated if the CBPM system increased patient participation (IV). Results: Study I demonstrated good inter-rater and test-retest reliability of PURPOSE T. Study II showed that PURPOSE T had good clinical usability. It was an efficient risk assessment instrument performed at bedside; the nurses gained a deeper understanding and awareness of risk factors. Study III showed that PURPOSE T has good clinical feasibility. More patients were identified at risk for pressure ulcers and were prescribed more preventive interventions in comparison with patients assessed with the Modified Norton Scale. These results were mirrored in the focus group interviews with the nurses´ and assistant nurses’ experiences. Risk assessment took the same amount of time despite being more comprehensive; the instrument encouraged more preventive actions, and nurses were more involved at bedside. However, almost all the patients expressed not receiving any information about pressure ulcers. Study IV showed that the CBPM system increased the patients’ knowledge, and as they became aware of increased pressure, they started to take preventative action in their own care. Thus, patient participation increased. Conclusion: The evaluation of PURPOSE T in Sweden demonstrates good results and could be considered as replacing the Modified Norton Scale at a national level. Providing information to the patient needs to be a priority, and new information and communication technologies, such as the CBPM system, need to be taken advantage of, to benefit the patients.
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| 8. |
- Hultin, Lisa, et al.
(författare)
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PURPOSE T in Swedish hospital wards and nursing homes : A psychometric evaluation of a new pressure ulcer riskassessment instrument
- 2020
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 29:21/22, s. 4066-4075
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the psychometric characteristics of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T); reliability (inter-rater and test–retest) and validity (convergent validity) in a Swedish context.Background: Pressure ulcers are considered as an adverse event and are a problem in healthcare worldwide. The first step in pressure ulcer prevention is to identify pa-tients that are at risk. PURPOSE T is a new pressure ulcer risk assessment instrument that was developed in the UK using “golden standard” instrument method.Design: Observational, descriptive and comparative.Methods: A total of 235 patients and 28 registered nurses were recruited (May 2018–November 2018) from six hospital wards at a university hospital and two community nursing homes in Sweden. Blinded (ward/nursing home nurses and expert nurses) PURPOSE T assessments and follow-up retests were undertaken. Cross-tabulation and kappa statistics were used to examine the reliability, and phi correlation was used to test the convergent validity. The study followed the STROBE guideline.Results: The clinical evaluation showed “very good” (kappa) inter-rater and test–re-test reliability for PURPOSE T assessment decision overall. The agreement of “at risk”/“not at risk” for both inter-rater and test–retest was also high, at least 95.5%. The convergent validity between PURPOSE T and other traditional assessment in-struments was moderate.Conclusion: The evaluation of PURPOSE T demonstrated good psychometric char-acteristics. Further research is needed to evaluate PURPOSE T’s usability among reg-istered nurses.Relevance to clinical practice: There is a lack of evidence-based validated pressure ulcer risk assessment instruments for use in health care. According to our findings, the Swedish version of PURPOSE T could be used in hospitals and nursing homes to identify patients in risk or with pressure ulcers.
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| 9. |
- Källman, Ulrika, et al.
(författare)
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Pressure ulcer prevalence and prevention interventions : A ten-year nationwide survey in Sweden
- 2022
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Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 19:7, s. 1736-1747
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe pressure ulcer prevalence and prevention interventions in hospital care in Sweden based on nationwide surveys conducted over a 10-year period. All Swedish hospitals were invited to participate in annual pressure ulcer prevalence surveys during the period 2011-2020. The data collection protocols included gender, age, skin assessment, risk assessment, and preventive interventions. In total, more than 130,000 patients were included in the ten prevalence surveys. The prevalence of pressure ulcers in Swedish hospital patients decreased significantly from 17.0 %to 11.4% between 2011 and 2020 and hospital-acquired pressure ulcers decreased from 8.1% to 6.4% between 2018 and 2020. There was no significant decline in medicaldevice-related pressure ulcers during the same period. The proportion of patients who were risk and skin assessed increased, as did the use of pressure-reducing mattresses, sliding sheets, heel protection, and nrepositioning plans. This study shows that the implementation of a national patient safety program has had an impact on the nationwide prevalence of pressure ulcers in hospital care and the occurrence of prevention strategies. However, one in ten patients in Swedish hospitals still suffers from pressure ulcers. Further improvements can be made.
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| 10. |
- Lantz, Ann‐Christin Hultman, et al.
(författare)
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Evaluation of patient participation in relation to the implementation of a person-centered nursing shift handover
- 2023
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Ingår i: Worldviews on Evidence-Based Nursing. - : WILEY. - 1545-102X .- 1741-6787. ; 20:4, s. 330-338
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIt has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient. AimThe aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH). MethodA pretest-posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient-fair-sufficient). ResultsThere were no differences regarding experience or preference-based participation between patients at pretest-posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing ones symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing ones symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning. Linking evidence to actionMost patients want to be present at PCH. Therefore, nurses should ask for the patients preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.
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| 11. |
- Muntlin Athlin, Åsa, Docent, 1971-, et al.
(författare)
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Bedside nurses' perspective on the fundamentals of care framework and its application in clinical practice. : A multi-site focus group interview study
- 2023
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 145, s. 104526-104526
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Tidskriftsartikel (refereegranskat)abstract
- Background: A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives.Objective: To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice.Design: A descriptive qualitative design informed by the Fundamentals of Care framework.Setting(s): The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019.ParticipantsA total sample of 53 registered nurses working at the bedside participated.Participants: had a wide variety of clinical experience and represented a range of different nursing practice areas.Methods: Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach.Results: Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership.Conclusions: The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework.Tweetable abstract: Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.
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| 12. |
- Sving, Eva, 1959-, et al.
(författare)
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A multifaceted intervention for evidence-based pressure ulcer prevention : a 3 year follow-up.
- 2020
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Ingår i: International Journal of Evidence-Based Healthcare. - : JBI Evidence Implementation. - 1744-1595 .- 1744-1609. ; 18:4, s. 391-400
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess sustainability of an intervention used to implement pressure ulcer prevention.BACKGROUND: The Promoting Action on Research Implementation in Health Service, framework was used to develop an intervention aimed to implement evidence-based pressure ulcer prevention in a hospital setting. A short-term follow-up showed that significantly more patients received pressure ulcer prevention. A qualitative process evaluation gave support that the intervention and the implementation process changed the understanding and approach to working with pressure ulcer prevention from treating to preventing.METHOD: The study had a sequential mixed method approach, combining quantitative and qualitative data. For the quantitative data, baseline and short-term follow-up (6-8 months) data reported in an initial study were compared with long-term follow-up (36-42 months) data (n = 259 patients). For the qualitative data, interviews with registered nurses (n = 20), assistant nurses (n = 7) and first-line managers (n = 5) were performed.RESULTS: The performance of pressure ulcer prevention was sustained 3 years from its conception. The number of patients with pressure ulcers was reduced (P = 0.021). Systematic work with quality measurements, support from first-line managers, internal facilitation, collaboration and pressure ulcer prevention skills could explained the sustainability. Obstacles to achieve high-quality pressure ulcer prevention were inadequate communication, high workloads and high rates of new and substitute nurses.CONCLUSION: Three different components for sustainability on the micro-level are described; benefits for the patients, the need for routinization and development over time. Threats to sustainability are described as factors on the macro-level. There needs to be collaboration in the healthcare organization from the micro-to-macro levels, and committed experienced nurses are needed to obtain high-quality sustainable pressure ulcer prevention.
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| 13. |
- Sving, Eva, 1959-, et al.
(författare)
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Using pressure mapping intraoperatively to prevent pressure ulcers—A quasi-experimental study
- 2023
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Ingår i: Health Science Reports. - : John Wiley & Sons. - 2398-8835. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.
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