| 1. |
- Andreae, Christina, et al.
(författare)
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Patients' Participation as It Appears in the Nursing Documentation, When Care Is Ruled by Standardized Care Plans
- 2011
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Ingår i: ISRN Nursing. - : Hindawi Limited. - 2090-5483 .- 2090-5491. ; 2011:Article ID 707601, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to describe inpatients with myocardial infarction and their participation in care as documented in the nursing records when standardized care plans are used in care. The use of standardized care plans not only has increased the quality of medical treatment but has also overlooked patients' opportunities to participate in their own care. There is a lack of knowledge about how standardized care plans influence patients' participation in nursing care. Data were collected from thirteen patients' records with diagnoses of myocardial infarction. Participation in the decision-making process and participation associated with “sharing with others” were searched for in the analysis. The analytical process was guided by content analysis. The findings were grouped into two categories: patients' intermediary participation and patients' active participation. The main results indicated that patients' intermediary participation depended on healthcare professionals' power to rule the nursing care situation.
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| 2. |
- Asberg, Marie, et al.
(författare)
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Novel biochemical markers of psychosocial stress in women.
- 2009
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prolonged psychosocial stress is a condition assessed through self-reports. Here we aimed to identify biochemical markers for screening and early intervention in women. METHODS: Plasma concentrations of interleukin (IL) 1-alpha, IL1-beta, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-gamma (INF-gamma), tumor necrosis factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), thyroid stimulating hormone (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin, and testosterone were measured in: 195 women on long-term sick-leave for a stress-related affective disorder, 45 women at risk for professional burnout, and 84 healthy women. RESULTS: We found significantly increased levels of MCP-1, VEGF and EGF in women exposed to prolonged psychosocial stress. Statistical analysis indicates that they independently associate with a significant risk for being classified as ill. CONCLUSIONS: MCP-1, EGF, and VEGF are potential markers for screening and early intervention in women under prolonged psychosocial stress.
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| 3. |
- Ekstedt, Mirjam, et al.
(författare)
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Disturbed sleep and fatigue in occupational burnout
- 2006
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 32:2, s. 121-31
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this study was to investigate sleep with polysomnography and self-ratings and the diurnal pattern of sleepiness and fatigue in a group suffering from severe occupational burnout.METHOD: Twelve white-collar workers on long-term sick leave (>3 months) and 12 healthy controls with high and low scores on the Shirom Melamed Burnout Questionnaire (SMBQ) were included. A 1-night polysomnographic recording (after habituation) was carried out at home, and sleepiness and mental fatigue were rated at different times of the day for weekdays and the weekend. Precipitating factors at the time of the illness at work and real life were considered, and different dimensions of occupational fatigue were described. A repeated-measures analysis of variance using two or three within group factors was used to analyze the data.RESULTS: The main polysomnographic findings were more arousals and sleep fragmentation, more wake time and stage-1 sleep, lower sleep efficiency, less slow wave sleep and rapid eye movement sleep, and a lower delta power density in non-rapid eye movement sleep in the burnout group. The burnout patients showed pronounced sleepiness and mental fatigue at most times of the day for weekdays without reduction during weekends. The precipitating factor was occupational stress (psychiatric interview), and work stress indicators were increased.CONCLUSIONS: Occupational burnout is characterized by impaired sleep. It is suggested that impaired sleep may play a role in the development of fatigue or exhaustion in burnout.
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| 4. |
- Ekstedt, Mirjam, et al.
(författare)
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Lived experiences of the time preceding burnout
- 2005
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 49:1, s. 59-67
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper reports a study to illuminate the complex interaction between person and their life world during the burnout development period.BACKGROUND: Burnout is a construct describing the psychological state resulting from ineffective strategies for coping with enduring stress in both client and non-client work. Role conflict and role ambiguity, or long-term stress and frustration caused by strain in daily life, promote or exacerbate burnout, indicating that the person's entire life world is involved. There is still a lack of description of lived experiences of the time preceding manifest burnout.METHOD: Data were collected from interviews with eight people suffering from burnout and analysed using a phenomenological method.FINDINGS: The essential meaning of the phenomenon of burnout is understood as being trapped with stimulating challenges as a self-nourishing drive on one side and with responsibilities and demands on the other. This essence can be illuminated by its eight constituents: inner incentive, feeling responsible, threatened self-image, cutting off, bodily manifestations, psychological manifestations, fatigue and reaching the bottom line.CONCLUSIONS: The lived experiences of the time preceding manifest burnout are an ambiguous struggle. Cutting off is understood as a mean to shelter the threatened self-image in a state of vulnerability and weakened strength. Accordingly, a better understanding of how to reach behind the defence of 'cutting off' and thus help to open up for consolation and self-acceptance is an essential skill for nurses, health care professionals and others encountering the burnout sufferers. Furthermore this study illuminates early signs of burnout and an important issue is how to strengthen the individuals' ability to shelter their need for recovery and restitution.
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| 5. |
- Ekstedt, Mirjam, et al.
(författare)
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Microarousals during sleep are associated with increased levels of lipids, cortisol, and blood pressure
- 2004
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Ingår i: Psychosomatic Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0033-3174 .- 1534-7796. ; 66:6, s. 925-931
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Previous work has demonstrated a link between restricted sleep and risk indicators for cardiovascular and metabolic disease, such as levels of cortisol, lipids, and glucose. The present study sought to identify relations between polysomnographic measures of disturbed sleep (frequency of arousals from sleep, total sleep time, and sleep efficiency) and a number of such indicators. A second purpose was to relate the number of arousals to mood, stress, work characteristics, and other possible predictors in daily life.Methods: Twenty-four people (10 men, 14 women; mean age 30 years), high vs. low on burnout, were recruited from a Swedish IT company. Polysomnographically recorded sleep was measured at home before a workday. Blood pressure, heart rate, morning blood sample, and saliva samples of cortisol were measured the subsequent working day. They were also recorded for diary ratings of sleep and stress, and a questionnaire with ratings of sleep, stress, work conditions, and mood was completed.Results: A stepwise regression analysis using sleep parameters as predictors brought out number of arousals as the best predictor of morning cortisol (serum and saliva), heart rate, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL)-, low-density lipoprotein (LDL)-cholesterol, and LDL/HDL-ratio. Work stress/unclear boundaries between work and leisure time was the best predictor of arousals among the stress variables.Conclusion: Consistent with sleep restriction experiments, sleep fragmentation was associated with elevated levels of metabolic and cardiovascular risk indicators of stress-related disorders. Number of arousals also seems to be related to workload/stress.
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| 6. |
- Ekstedt, Mirjam, Professor, et al.
(författare)
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Nursing students' perception of the clinical learning environment and supervision in relation to two different supervision models : a comparative cross-sectional study
- 2019
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Ingår i: BMC Nursing. - : BioMed Central. - 1472-6955 .- 1472-6955. ; 18:1, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Knowledge concerning nursing students' experiences of the clinical learning environment and how supervision is carried out is largely lacking. This study compares nursing students' perceptions of the clinical learning environment and supervision in two different supervision models: peer learning in student-dedicated units, with students working together in pairs and supervised by a "preceptor of the day" (model A), and traditional supervision, in which each student is assigned to a personal preceptor (model B). Methods: The study was performed within the nursing programme at a university college in Sweden during students' clinical placements (semesters 3 and 4) in medical and surgical departments at three different hospitals. Data was collected using the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, CLES+T, an instrument tested for reliability and validity, and a second instrument developed for this study to obtain deeper information regarding how students experienced the organisation and content of the supervision. Independent t-tests were used for continuous variables, Mann-Whitney U-tests for ordinal variables, and the chi-square or Fischer's exact tests for categorical variables. Results: Overall, the students had positive experiences of the clinical learning environment and supervision in both supervision models. Students supervised in model A had more positive experiences of the cooperation and relationship between student, preceptor, and nurse teacher, and more often than students in model B felt that the ward had an explicit model for supervising students. Students in model A were more positive to having more than one preceptor and felt that this contributed to the assessment of their learning outcomes. Conclusions: A good learning environment for students in clinical placements is dependent on an explicit structure for receiving students, a pedagogical atmosphere where staff take an interest in supervision of students and are easy to approach, and engagement among and collaboration between preceptors and nurse teachers. This study also indicates that supervision based on peer learning in student-dedicated rooms with many preceptors can be more satisfying for students than a model where each student is assigned to a single preceptor.
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| 7. |
- Ekstedt, Mirjam, et al.
(författare)
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Reducing Errors through a Web-Based Self-management Support System
- 2014
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Ingår i: East Meets West eSMART. - Amsterdam : IOS Press. - 9781614994145 - 9781614994152 ; 201, s. 328-334
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Konferensbidrag (refereegranskat)abstract
- Web-based self-management support systems SMSS, can successfully assist a wide range of patients with information and self-management support. O or as a stand-alone service, are e-messages. This study describes how one component of a multi component SMSS, an e-message service, in which patients with breast cancer could direct questions to nurses, physicians or social workers at the hospital where they were being treated, had an influence on safety and continuity of care. Ninety-one dialogues consisting of 284 messages were analysed. The communications between patients and the healthcare team revealed that the e-messages service served as a means for quality assurance of information, for double-checking and for coordination of care. We give examples of how an e-mail service may improve patients' knowledge in a process of taking control over their own care – increasingly important in a time of growing complexity and specialization in healthcare. It remains to be tested whether an e-message service can improve continuity of care and prevent or mitigate medical mishaps.
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| 8. |
- Ekstedt, Mirjam, et al.
(författare)
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Sleep physiology in recovery from burnout
- 2009
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Ingår i: Biological Psychology. - : Elsevier BV. - 0301-0511 .- 1873-6246. ; 82:3, s. 267-73
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to investigate the role of sleep physiology in recovery from burnout, in particular the relation between sleep and changes in fatigue and whether those changes would be related to return to work. 23 white-collar workers on long-term sick leave (>3 months) due to a burnout related diagnosis and 16 healthy controls were subjected to polysomnographic recordings at baseline and after 6-12 months' rehabilitation. Occupational status, subjective sleep quality, fatigue, anxiety and depression were assessed. Recovery from burnout was accompanied by improved sleep continuity. Significant interaction effects were seen for number of arousals, sleep fragmentation, sleep latency, sleep efficiency and time of rising. The burnout group improved significantly on all symptom variables although the post-treatment levels did not reach the levels of the controls. Recovery from fatigue was related to a reduction of the arousal from sleep and was the best predictor of return to work.
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| 9. |
- Flink, M., et al.
(författare)
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The Supporting Patient Activation in Transition to Home (sPATH) intervention : A study protocol of a randomised controlled trial using motivational interviewing to decrease re-hospitalisation for patients with COPD or heart failure
- 2017
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Ingår i: BMJ Open. - : BMJ Publishing Group. - 2044-6055. ; 7:7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Deficient hospital discharging and patients struggling to handle postdischarge self-management have been identified as potential causes of re-hospitalisation rates. Despite an increased interest in interventions aiming to reduce re-hospitalisation rates, there is yet no best evidence on how to support patients in being active participants in their self-management postdischarge. The aim of this paper is to describe the study protocol for an upcoming randomised controlled trial (RCT) of the Supporting Patient in Activation to Home (sPATH) intervention. Methods/analysis The described study is a randomised, controlled, analysis-blinded, two-site trial, with primary outcome re-hospitalisation within 90 days. In total, 290 participants aged 18 years or older with chronic obstructive pulmonary disease or congestive heart failure who are admitted to hospital and who are living in an own home will be eligible for inclusion into an intervention (n=145) or control group (n=145). Patients who need an interpreter to communicate in Swedish, or who have a diagnosis of dementia or cognitive impairment, will be excluded from inclusion. The sPATH intervention, developed with a theoretical base in the self-determination theory, consists of five postdischarge motivational interviewing sessions (face to face or by phone). The intervention covers the self-management areas medication management, follow-up/care plan, symptoms/signs of worsening condition and relations/contacts with healthcare providers. This RCT will add to the literature on evidence to support patient activation in postdischarge self-management. Ethics and dissemination The study is approved by the Regional Research Ethics Committee (No. 2014/1498-31/2) in Stockholm, Sweden. The results of the study will be published in peer-reviewed journals and presented at international and national scientific conferences. Trial registration number NCT02823795; Pre-results.
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| 10. |
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