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1.	Swenne, C.L., et al. (author) Patients' experiences of mediastinitis after coronary artery bypass graft procedure 2007 In: Scandinavian Cardiovascular Journal. - 1401-7431 .- 1651-2006. - 1401-7431 ; 41:4, s. 255-264 Journal article (peer-reviewed)abstract Few studies have focussed on patients' experiences of and suffering due to mediastinitis following Coronary Artery by-pass Graft ( CABG). Mediastinitis creates a complex and invasive experience for the patient with prolonged hospitalisation, and would be expected to be a significant stressor. The aim of the present study was to capture patients' experiences of the medical and nursing care they received for mediastinitis following CABG. Content analysis revealed three themes with regard to how the patients coped with the stress and threats of mediastinitis and its treatment and how they thought it would influence their future life. A first theme centred on physical and psychological discomfort and impact on autonomy. The staff's medical knowledge and the quality of nursing care as well as the patients' understanding of the situation influenced their experience. A second theme was how patients dealt with perceived danger and stress. Coping strategies such as problem solving, information seeking, dissociation, distraction, minimisation and expression of emotion were used to handle the situations. The third theme comprised the patients' belief that the mediastinitis would not affect the outcome of the CABG procedure, even though their confidence in this was influenced by uncertainty about the rehabilitation process.
2.	Fröjd, Camilla, et al. (author) Patient information and participation still in need of improvement : evaluation of patients' perceptions of quality of care 2011 In: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 19:2, s. 226-236 Journal article (peer-reviewed)abstract Aims:To identify areas in need of quality improvement by investigating inpatients' perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission.Background:Nursing managers play an important role in the development of high-quality care.Methods:Quality of care was assessed using the Quality from the Patients' Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP.Results:Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors' care than did patients with planned admissions.Conclusion:Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role.Implications for nursing management:Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.
3.	Albért, Ulla, et al. (author) Att undervisa om mäns våld mot kvinnor och våld i nära relationer 2021 In: SMT Socialmedicinsk tidskrift. - Stockholm. ; 98:4, s. 624-632 Journal article (peer-reviewed)abstract Tema nummerUtbildning inom högskolor, universitet och kriminalvprden om mäns våld mot kvinnor och våld i nära relationer
4.	Arakelian, Erebouni, 1973-, et al. (author) The meaning of person-centred care in the perioperative nursing context from the patient's perspective : an integrative review 2017 In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 26:17-18, s. 2527-2544 Journal article (peer-reviewed)abstract AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing. BACKGROUND: Person-centred care (PCC) is used but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts. METHODS: A two-part search strategy was employed; firstly, a computerized database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004 to 2014, and secondly, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected and an integrative review was conducted. RESULTS: Four themes were discovered: 'Being recognized as a unique entity and being allowed to be the person you are', 'Being considered important by having one's personal wishes taken into account', 'The presence of a perioperative nurse is calming; prevents feelings of loneliness and promotes wellbeing, which may speed up recovery', and 'Being close to and being touched by the perioperative nurse during surgery'. CONCLUSIONS: PCC means respecting the patient as a unique individual, considering the patient's particularities and wishes, and involving the patient in their own care. PCC also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone. RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of PCC, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient', resulting in personalization of care rather than simply defining the concept. This article is protected by copyright. All rights reserved.
5.	Blomgren, Per-Ola (author) Clean work, the pursuit of increased adherence to hand hygiene routines : a descriptive study 2022 Licentiate thesis (other academic/artistic)abstract Healthcare-associated infections (HAI) are a problem in health care worldwide. In Sweden 7-8% of all patients treated in hospital suffer from an adverse event of varying severity, of which approximately 60,000 from a HAI. Proper hand hygiene is considered the single most important measure to reduce HAI. Despite the importance, adherence to correct hand hygiene routines are lacking among healthcare workers (HCWs). The World Health Organizations (WHO) multimodal promotion strategy promotes areas that need to be addressed in order to change the behaviour of individual HCWs to optimise adherence to hand hygiene and to improve patient safety. These areas include feedback, education, reminders at the workplace and institutional safety climate. The overall aim of this study was to examine the possibility of adherence to hand hygiene routines and to explore factors that might influence the HCWs adherence. The study used a descriptive research design made through qualitative method, with focus group interviews, and quantitative method, using a questionnaire survey. Eight focus group interviews were conducted with assistant nurses (n=18), nurses (n=15) and physicians (n=5) and analysed with abductive qualitative content analysis. The questionnaire survey was answered by nurses (n=84) and nursing students in their first semester (n=71) and last semester (n=46) and the data was statistically analysed.The main findings show that there are barriers to hand hygiene adherence and measures to improve these. HCWs highlighted discrepancies regarding how the organisation was supposed to give feedback and how it actually was at the workplace and expressed needs for more direct feedback to improve adherence. The study also found that hygienic knowledge gaps exists among nurses and nursing students regarding causes of HAI and how the risk of contamination of patients and HCWs can be minimized among others. Students at the beginning of the education had a lower level of knowledge than last semester students and registered nurses. The last semester students tended to have the highest level of hand hygiene knowledge. In conclusion, the key areas presented by WHO’s multimodal promotion strategy to improve adherence all lack the appropriate measures, in some extent. The use of an electronic reminder system could give the means to improve a behaviour as long as the individual integrity is protected and development of curriculums for nursing students and continuing education of nurses is needed to further develop and maintaining knowledge.
6.	Blomgren, Per-Ola, 1986-, et al. (author) Hand hygiene knowledge among nurses and nursing students : a descriptive cross-sectional comparative survey using the WHO's "Hand Hygiene Knowledge Questionnaire" 2024 In: Infection Prevention in Practice. - : Elsevier. - 2590-0889. ; 6:2 Journal article (peer-reviewed)abstract AimTo determine the level of knowledge and explore the difference of hand hygiene between nursing students and nurses.BackgroundAnnually, 3.8 million people in Europe acquire healthcare-associated infections, highlighting the importance of hand hygiene. Despite WHO's emphasis on the fact that greater hand hygiene knowledge correlates with improved hand hygiene compliance, several studies have shown knowledge gaps among nurses and nursing students regarding hand hygiene.DesignDescriptive cross-sectional comparative survey.MethodsA version of the WHO “Hand Hygiene Knowledge Questionnaire”, translated into Swedish, was used for data collection among nursing students in the first and last semester, and registered nurses from a university and associated hospital. Data were analyzed by descriptive statistics, and comparison between groups with Fisher's exact test, one-way ANOVA, and post-hoc tests (Pairwise Z-Tests, Tukey HSD).ResultsThe survey, conducted between December 2020 and January 2021, received responses from 201 participants, including 71 first semester students, 46 last semester students and 84 registered nurses, showing moderate (55.7% [50–74% correct answers]) to good (43.8% [75–100% correct answers]) knowledge levels. First-semester students scored lower (17.0 ± 2.1) than last-semester students (18.8 ± 1.8) and registered nurses (18.3 ± 2.1) out of 25 questions.DiscussionIt is necessary for all groups to receive proper education on hand hygiene knowledge and to have an educational program that does not separate the groups but combines them with continuing education, since the students will someday be influencing future hand hygiene knowledge as a peer, together with the nurse.
7.	Christiansen, Mats, med. lic. 1972-, et al. (author) Hur AI-verktyget ChatGPT klarar en hemtentamen i palliativ vård 2023 In: Högre Utbildning. - Oslo : Cappelen Damm Akademisk. - 2000-7558. ; 13:2, s. 56-62 Journal article (other academic/artistic)abstract Dataprogrammet ChatGPT är en bott som utför automatiska uppgifter. Denna chattbott skapade rubriker under hösten på grund av dess förmåga att med artificiell intelligens (AI) skapa svar på riktade frågor och texter utifrån ett beskrivet syfte. I slutet av december 2022 lades 16 frågor från en hemtentamen i palliativ vård vid sjuksköterskeprogrammet in i AI-botten för att få dem besvarade och testa bottens förmåga att besvara frågorna korrekt. Vi ville även testa om man kunde se någon skillnad på svaren i rättningsmallen och på studenternas svar och på de svar som genererats från AI-botten. En bedömning av bottens svar visade på att den hade klarat examinationen. Somliga svar var mycket bra och resonerande till sin natur, något gav reducerade poäng pga. bristande innehåll och ett par svar felaktiga. Ett svar stack ut då det var på engelska. Svaren hade ibland smärre grammatiska fel, men var främst betydligt längre och bättre strukturerade än studerandes. Möjligheten att upptäcka försök till vilseledande i examination hade varit svårt. Det finns skillnad i svarens diskurs, där svaren från botten har en mer amerikansk stil i sin formulering.
8.	Enö Persson, Johanna, et al. (author) Experiences of nurses and coordinators in a childhood obesity prevention trial based on motivational interviewing within Swedish child health services 2022 In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 17:1 Journal article (peer-reviewed)abstract Purpose: To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity.Methods: Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis.Results: Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses' commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended.Conclusions: Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints.
9.	Falk-Brynhildsen, Karin, 1959-, et al. (author) Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room 2023 In: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 20:5, s. 1534-1543 Journal article (peer-reviewed)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.
10.	Falk-Brynhildsen, Karin, 1959-, et al. (author) 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 In: JOURNAL OF TISSUE VIABILITY. - : Elsevier. - 0965-206X .- 1876-4746. ; 31:1, s. 46-51 Journal article (peer-reviewed)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.
11.	Gunningberg, Lena, et al. (author) Medication administration accuracy : using clinical observation and review of patient records to assess safety and guide performance improvement 2014 In: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 20:4, s. 411-416 Research review (peer-reviewed)abstract Rationale, aims and objectives Medication-related errors are common and can occur at every step of the medication process. The aim was to explore (1) the extent to which nurses perform fundamental safe practices related to medication administration (MA); (2) the frequency and characteristics of MA errors; and (3) the clinical significance of medication types (classes) subject to error. Methods A descriptive, exploratory cross sectional design with point in time sampling was used combining direct observations, conducted by naive observers, and medical record review. A convenience sample of three adult surgical units was drawn from a 1000-bed university hospital. Seventy-two patient-nurse MA encounters were observed including 306 MA doses based on a minimum sample of 100 doses per unit. The Medication Administration Accuracy Assessment developed by the Collaborative Alliance for Nursing Outcomes in the United States was used. Results Observed adherence to MA safe practices varied between units. Identity control (9%), explaining medication to patient (11%) and medication labelled throughout the process (25%) were found to be safe practices with greatest deviation. 18% of doses involved a MA error (n = 54). Wrong time (9%) was the most common MA error, typically involving analgesics. Conclusions Given recent reports suggesting MA safe practices are strongly associated with MA errors, it is timely to strengthen RN awareness of the critical role of safe practices in MA safety. In nursing education, clinical examination using the six safe practices studied herein may enhance medication administration accuracy.
12.	Gunningberg, Lena, et al. (author) Pre- and postoperative nutritional status and predictors for surgical wound infections in elective orthopaedic and thoracic patients 2008 In: European Journal of Clinical Nutrition. - : Elsevier BV. - 0954-3007 .- 1476-5640. ; 3:3, s. e93-e101 Journal article (peer-reviewed)abstract Aim: To describe pre- and postoperative nutritional status for patients undergoing elective orthopaedic or thoracic surgery, compare different methods for screening and assessment of nutritional status and identify predictors for surgical-wound infection. Method: Ninety-four patients were consecutively included and assessed preoperatively using the Patient-Generated Subjective Global Assessment (PG-SGA), nutritional screening indicators (NSI), nutrition risk index (NRI), and the biochemical indicators serum albumin (S-Albumin) and serum insulin-like growth factor 1 (S-IGF-1). Thirty days postoperatively, a structured infection surveillance questionnaire, weight and blood sampling were conducted. Results: The prevalence of malnutrition preoperatively ranged from 3.2% (PG-SGA) to 17.0–17.1% (S-IGF-1 and NSI). Thirty days postoperatively, the body weight, the body mass index and S-Albumin had decreased, while the S-IGF-1 had increased significantly. The only significant correlation between different methods preoperatively was found between S-Albumin and S-IGF-1. The agreement between NRI and S-Albumin was fair. Six patients (6.4%) developed surgical-wound infections. Preoperative S-Albumin was significantly lower for patients who developed surgical-wound infection compared to those who did not. Conclusion: The prevalence of malnutrition and risk for malnutrition in patients undergoing elective surgery varied depending on which evaluation method was used. Low preoperative S-Albumin was identified as the only significant predictor for surgical-wound infection.
13.	Helmersson-Karlqvist, Johanna, et al. (author) Serum MMP-9 and TIMP-1 concentrations and MMP-9 activity during surgery-induced inflammation in humans 2012 In: Clinical Chemistry and Laboratory Medicine. - : Walter de Gruyter GmbH. - 1434-6621 .- 1437-4331. ; 50:6, s. 1115-1119 Journal article (peer-reviewed)abstract Background: Matrix metalloproteinase 9 (MMP-9) and the endogenous inhibitor to MMP-9, tissue inhibitor of metalloproteinase 1 (TIMP-1), have important roles in tissue remodelling and are implicated in a number of diseases related to inflammation. The time course in activation and formation of MMPs and TIMPs during an inflammatory reaction is not fully known. This study investigates MMP-9 and TIMP-1 concentrations and MMP-9 activity at different time points after major surgery when a state of noticeable inflammation is expected. Methods: Serum MMP-9 and TIMP-1 concentrations and MMP-9 activity were analysed preoperatively and 4 and 30 days postoperatively in patients undergoing elective surgery (coronary artery bypass n=21; orthopaedic surgery, n=29). Results: Serum TIMP-1 and MMP-9 activity increased significantly 4 days after surgery (p<0.05 and p<0.01, respectively) and decreased again 30 days after surgery (p<0.01, respectively, compared to 4 days after surgery). Serum MMP-9 increased significantly 4 days after surgery (p<0.05) and was still high 30 days after surgery (p<0.01 compared to before surgery). The calculated MMP-9/TIMP-1 ratio was increased 30 days after surgery compared to before surgery (p<0.01). Conclusions: The inflammatory state induced by elective surgery is associated with increased TIMP-1 response and MMP-9 activity in serum within a few days which may be of importance for the postoperative heeling process. The further increase in MMP-9 concentrations at day 30 postoperative did not result in increased MMP-9 activity. Serum MMP-9 concentrations or the calculated MMP-9/TIMP-1 ratio do not entirely represent MMP-9 activity during surgery-induced inflammation.
14.	Henriksson, Catrin, et al. (author) Faktorer som påverkar beslutet att söka sjukvård vid symtom på akut hjärtinfarkt 2008 In: Vård i Norden. - 0107-4083 .- 1890-4238. ; 28:1, s. 4-7 Journal article (peer-reviewed)abstract It is important to receive medical treatment as soon as possible, to decrease morbidity and mortality, when an acute myocardial infarction (AMI) occurs. The aim of the present study was to investigate factors, which influence the decision-making from symptom onset to hospital admission. One hundred and twenty-six patients with AMI were included. A structured questionnaire was used to register background data, knowledge of symptoms, the importance of fast decision-making, place according to symptoms onset, type of transportation to the hospital, clinical symptoms and ECG-changes. The proportion of elderly, women, patients with diabetes, those who lived alone and patients with symptom onset at home was higher in the group with more than four hours delay. Patients with knowledge of the importance of seeking medical care when experiencing symptoms of an AMI arrived earlier at hospital. Our main conclusion is that knowledge of the importance of fast seeking of medical care is crucial. More information to the public will increase the awareness of actions needed and hopefully it also will shorten the delay time.
15.	Henriksson, Catrin, et al. (author) Faktorer som påverkar beslutet att söka vård vid symtom på akut hjärtinfarkt 2008 In: Vård i Norden. - 0107-4083 .- 1890-4238. ; 87:28, s. 4-7 Journal article (peer-reviewed)abstract It is important to receive medical treatment as soon as possible, to decrease morbidity and mortality, when an acute myocardial infarction (AMI)occurs. The aim of the present study was to investigate factors, which influence the decision-making from symptom onset to hospital admission.One hundred and twenty-six patients with AMI were included. A structured questionnaire was used to register background data, knowledge ofsymptoms, the importance of fast decision-making, place according to symptoms onset, type of transportation to the hospital, clinical symptomsand ECG-changes.The proportion of elderly, women, patients with diabetes, those who lived alone and patients with symptom onset at home was higher in thegroup with more than four hours delay. Patients with knowledge of the importance of seeking medical care when experiencing symptoms of anAMI arrived earlier at hospital.Our main conclusion is that knowledge of the importance of fast seeking of medical care is crucial. More information to the public will increasethe awareness of actions needed and hopefully it also will shorten the delay time.
16.	Leo Swenne, Christine, 1958-, et al. (author) Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay 2018 In: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 38:4, s. 212-219 Journal article (peer-reviewed)abstract The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.
17.	Leo Swenne, Christine, 1958- (author) Riskfaktorer för postoperativa sårinfektioner 2012 In: Omvårdnad vid kirurgiska sjukdomar. - Lund : Studentlitteratur. - 9789144060606 Book chapter (other academic/artistic)
18.	Leo Swenne, Christine, 1958-, et al. (author) Surgical team members’ compliance with and knowledge of basic hand hygiene guidelines and intraoperative hygiene 2012 In: Journal of Infection Prevention. - : SAGE Publications. - 1757-1774 .- 1757-1782. ; 13:4, s. 114-119 Journal article (peer-reviewed)abstract The aim of the present study was to observe surgical team members’ compliance with basic hand hygiene and intraoperative hygiene guidelines during the anaesthetic and surgical procedure. A secondary aim was to investigate the team members’ knowledge and attitudes toward these guidelines. A structured observation schedule was designed to capture observational data on compliance with hygiene guidelines. A questionnaire was also designed to elicit written responses on attitudes, beliefs and knowledge about hygiene routines.The results showed that the clinical procedures for basic hand hygiene and intraoperative hygiene were flawed in three areas. Hand disinfection before and after direct patient contact was incomplete. Secondly, the team members used gloves in an incorrect way. Thirdly, the scrub nurse did not always change sterile gloves after intraoperative skin disinfection before handling sterile instruments. The quantity of 0.5% chlorhexidine with 70% ethanol used varied and the mechanical performance of skin disinfection varied. Knowledge of hand hygiene routines and intraoperative hygiene routines among surgical team members is incomplete and adherence needs to improve. Regular routine observations and continuous feedback to all staff may be necessary to improve compliance and avoid deterioration of practice.
19.	Leo Swenne, Christine, 1958- (author) Vård vid kirurgiska sjukdomar : Pre-, per- och postoperativ vård 2016 In: Omvårdnad & kirurgi. - Lund : Studentlitteratur AB. - 9789144088860 Book chapter (other academic/artistic)
20.	Lindblom, Rickard P F, et al. (author) Outcomes following the implementation of a quality control campaign to decrease sternal wound infections after coronary artery by-pass grafting 2015 In: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261 .- 1471-2261. ; 15 Journal article (peer-reviewed)abstract BACKGROUND: Coronary artery by-pass grafting (CABG) remains the optimal strategy in achieving complete revascularization in patients with complex coronary artery disease. However, sternal wound infections (SWI), especially deep SWI are potentially severe complications to the surgery. At the department of cardiothoracic surgery in Uppsala University Hospital a gradual increase in all types of SWI occurred, which peaked in 2009. This prompted an in-depth revision of the whole surgical process. To monitor the frequency of post-operative infections all patients receive a questionnaire that enquires whether any treatment for wound infection has been carried out.METHODS: All patients operated with isolated CABG between start of 2006 and end of 2012 were included in the study. 1515 of 1642 patients answered and returned the questionnaire (92.3 %). The study period is divided into the time before the intervention program was implemented (2006-early 2010) and the time after the intervention (early 2010- end 2012). To assess whether potential differences in frequency of SWI were a consequence of change in the characteristics of the patient population rather than an effect of the intervention a retrospective assessment of medical records was performed, where multiple of the most known risk factors for developing SWI were studied.RESULTS: We noticed a clear decrease in the frequency of SWI after the intervention. This was not a consequence of a healthier population.CONCLUSIONS: Our results from implementing the intervention program are positive in that they reduce the number of SWI. As several changes in the perioperative care were introduced simultaneously we cannot deduce which is the most effective.
21.	Lindholm, Christina, et al. (author) Sår vid kirurgi och trauma 2016. - 1 In: Omvårdnad & kirurgi. - Lund : Studentlitteratur AB. - 9789144088860 ; , s. 133-146 Book chapter (other academic/artistic)
22.	Lytsy, Birgitta, 1968-, et al. (author) Hygienic interventions to decrease deep sternal wound infections following coronary artery bypass grafting 2015 In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 91:4, s. 326-331 Journal article (peer-reviewed)abstract BACKGROUND: The department of Cardiothoracic Surgery at Uppsala University Hospital has 25 beds in one to four patient rooms and an operating suite consisting of five operating rooms with ultraclean air. Around 700 open heart (250 isolated coronary artery bypass grafting, CABG) operations are performed annually. In 2009, the numbers of deep sternal wound infections (DSWIs) increased to unacceptable rates despite existing hygienic guidelines.AIM: To show how root cause analysis (RCA) followed by quality improvement interventions reduced the rate of DSWI after CABG surgery.METHODS: Only isolated CABG patients requiring surgical revision due to DSWI were included. Swabs and tissue biopsies were taken during surgical revision and analysed with standard methods. DSWIs were registered prospectively according to US Centers for Disease Control and Prevention definitions. RCA for infection was performed between September 2009 and April 2010. Interventions based on results of the RCA and on nationally recommended practices were concluded in April 2010, and thought to have taken full effect by July 1st, 2010. Air was actively sampled at ≤0.5m from the sternal incision.FINDINGS: DSWI incidence rates per CABG operations decreased from 5.1% pre intervention to 0.9% post intervention. Wound cultures pre intervention grew Staphylococcus aureus 27.1% and coagulase negative staphylococcus (CoNS) 47.1%, post intervention S. aureus 23.1% and CoNS 30.8%. Air counts did not exceed 5cfu/m(3).CONCLUSION: When the aetiology of an error is multifactorial, RCA engaging both the medical professions and the infection control team is a potential tool to map causes leading to adverse events such as healthcare-associated infections. A systematic quality improvement intervention based on the RCA may reduce the number of deep sternal wound infections after CABG surgery.
23.	Näslund Andréasson, Sara, 1971-, et al. (author) Exposure to electrocautery smoke: what theatre nurses and surgeons experience influences their behaviour when choosing protective equipment Other publication (other academic/artistic)
24.	Näslund Andréasson, Sara, 1971- (author) Work Environment in the Operating Room during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy : Factors Influencing Choice of Protective Equipment 2011 Doctoral thesis (other academic/artistic)abstract Peritoneal carcinomatosis (PC) is a common metastatic manifestation of both gastrointestinal and gynecological malignancies. Curative modes of treatment are cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Surgeons and operating room (OR) staff attending these procedures are exposed to chemotherapy and electrocautery smoke. Heated chemotherapy (HIPEC) may vaporize and become inhaled by those administering it and, moreover, large quantities of electrocautery smoke may also be inhaled by surgeons and OR staff, with unknown adverse health effects. The general aim of this thesis was to investigate the work environment during major abdominal surgery and HIPEC, and to map the factors influencing the behavior of OR nurses and surgeons when choosing protective equipment against electrocautery smoke. To determine the presence of platinum, a total of 36 blood and 36 urine samples were collected from one surgeon and one perfusionist during six oxaliplatin-based HIPEC treatments (Paper I). Regarding electrocautery smoke, amounts of ultrafine particles (UFPs) in the smoke from 14 CRS procedures and 11 colorectal cancer (CRC) procedures were collected and compared (Paper II). Additionally, polycyclic aromatic hydrocarbons (PAHs) were identified and quantified in electrocautery smoke during 40 CRS procedures (Paper III). Lastly, seven OR nurses and seven surgeons were interviewed individually to explore what factors influenced their behavior when choosing protective equipment against electrocautery smoke. The transcribed texts were analyzed with qualitative content analysis (Paper IV). All blood and urine samples were below the detection limit (Paper I). The amount of UFPs produced during CRS procedures was significantly higher than from CRC procedures (Paper II), and PAHs never exceeded Swedish occupational exposure limits (OELs) (Paper III). OR nurses and surgeons had a knowledge of electrocautery smoke and were aware of risks. However, external factors governed the use of protective equipment against electrocautery smoke (Paper IV). HIPEC with oxaliplatin seems to present no risk for treatment givers. However, the possible risks from exposure of cumulative amounts of UFPs and PAHs are still unknown. OR nurses’ and surgeons’ knowledge about the possible risks of electrocautery smoke, and the use of protective equipment, are therefore important.
25.	Pålsson, Ylva, 1971- (author) A pathway into the profession : The use, feasibility and outcomes of a peer learning intervention for nursing students and newly graduated nurses 2020 Doctoral thesis (other academic/artistic)abstract The overall aim of present thesis was to study the use, feasibility and outcomes of a peer learning intervention for nursing students and new graduates, including studies using a quasi-experimental (Study I and III), descriptive (Study II) and mixed-methods (Study IV) design. Data were collected using questionnaires, observations, checklists for intervention fidelity, individual interviews and group interviews. When studying peer learning outcomes among nursing students, peer learning seems to have a significant interaction effect on self-efficacy, based on a comparison of changes over time between the intervention (n=42) and comparison (n=28) groups. Studying each group separately over time, significant improvements were found in the intervention group on thirteen of the twenty variables, whereas the comparison group improved on four (Study I). Observations of how nursing students (n=16) used peer learning revealed that the student pairs collaborated to different extents and in different ways. All students were observed practicing several competencies together (Study II). Testing the peer learning model in new graduates’ workplace introduction (n=10) revealed that new graduates’ descriptions of peer learning were consistent with the theoretical description (Study III). Feasibility was tested in relation to compliance and acceptability, and lessons were learned. In Study IV, fidelity to the intervention was generally good. When first-line managers (n=8) described their perception of using the peer learning intervention with new graduates, predominantly positive outcomes were expressed. When examining the effect of peer learning in workplace introduction for newly graduated nurses (n=35), it was difficult to draw any conclusions due to recruitment problems (Study IV). The conclusions is that peer learning is a useful model for nursing students’ that seems to improve self-efficacy more than traditional supervision does. The model gives nursing students opportunities to practice several competencies on each other, and these competencies, e.g., leadership and organizational skills are useful in their future profession. The students practice teaching and supervision skills on each other, which seems to be a natural part of the peer relationship. Peer learning in the context of new graduates’ workplace introduction describes in a way consistent with the theoretical description of peer learning outcomes thus, also here it seems as a useful model. When developing and testing new interventions such as peer learning, it is important to do so systematically to minimize problems when conducting an evaluation, where the MRC framework can be useful. First-line managers generally expressed a positive attitude toward the peer learning model.
26.	Pålsson, Ylva, Adjunkt, 1971-, et al. (author) A peer learning intervention in workplace introduction - managers’ and new graduates’ perspectives 2022 In: BMC Nursing. - : BMC. - 1472-6955. ; 21 Journal article (peer-reviewed)abstract BackgroundEvaluation of a complex intervention are often described as being diminished by difficulties regarding acceptability, compliance, delivery of the intervention, recruitment and retention. Research of peer learning for nursing students have found several positive benefits while studies of peer learning for newly graduated nurses are lacking. This study aimed (1) to investigate the study process in terms of (a) first-line managers’ perspectives on the intervention study, the difficulties they face and how they handle these and (b) new graduates’ fidelity to the intervention and (2) to examine the effect of the peer learning intervention in workplace introduction for newly graduated nurses.MethodsA mixed-methods approach using semi-structured interviews with eight managers, repeated checklist for fidelity and questionnaires conducted with 35 new graduates from June 2015 and January 2018, whereof 21 in the intervention group. The peer learning intervention’s central elements included pairs of new graduates starting their workplace introduction at the same time, working the same shift and sharing responsibility for a group of patients for 3 weeks. The intervention also included 3 months of regular peer reflection.ResultsManagers offered mostly positive descriptions of using peer learning during workplace introduction. The intervention fidelity was generally good. Because of recruitment problems and thereby small sample size, it was difficult to draw conclusions about peer learning effects and, thus, the study hypothesis could either be accepted or rejected. Thereby, the study should be regarded as a pilot.ConclusionsThe present study found positive experiences of, from managers, and fidelity to the peer learning intervention; regarding the experimental design, there were lessons learned.Trial registrationBefore starting data collection, a trial registration was registered at (Trial ID ISRCTN14737280).
27.	Pålsson, Ylva, et al. (author) A peer learning intervention targeting newly graduated nurses : A feasibility study with a descriptive design based on the Medical Research Council framework 2018 In: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 74:5, s. 1127-1138 Journal article (peer-reviewed)abstract Aims: The aim of this study was to describe the feasibility of a peer learning intervention targeting newly graduated nurses. Feasibility was tested concerning consistency of the theoretical description of peer learning with empirical findings in a new context, compliance and acceptability, as well as usability of a questionnaire measuring the intended future outcome variables.Background: Newly graduated nurses who meet, socialize and share experiences have described supporting each other's ability to cope with stress. Peer learning involves individuals in a similar situation learning from and with each other through interaction. When implementing new interventions, feasibility studies are used to minimize problems in future evaluation studies.Design: Quasi‐experimental design with an intervention group, followed over time using descriptive methods. The study was based on the Medical Research Council framework.Methods: Repeated semi‐structured interviews, a checklist for fidelity and a questionnaire were conducted with 10 newly graduated nurses from January to March 2015. The intervention's main component included pairs of newly graduated nurses working the same shift and having joint responsibility for a group of patients for a period of 3 weeks. The intervention also included 3 months of regular reflection by the pair.Findings: Using deductive analysis, the peer learning intervention was found to be consistent with the theoretical description. Due to the compliance and acceptability, there were lessons learnt. The tested questionnaire was found to be useful.Conclusions: This peer learning intervention seems to be feasible in this context. This study will serve as the basis for a future full‐scale evaluation study.
28.	Pålsson, Ylva, Adjunkt, 1971-, et al. (author) An intervention study on peer learning 2019 Conference paper (peer-reviewed)
29.	Pålsson, Ylva, et al. (author) A peer learning intervention for nursing students in clinical practice education : a quasi-experimental study 2017 In: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793. ; 51, s. 81-87 Journal article (peer-reviewed)abstract BACKGROUND: Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice.OBJECTIVES: To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance.DESIGN: Quasi-experimental.SETTING: The study was conducted during nursing students' clinical practice.PARTICIPANTS: All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group).METHODS: During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice.RESULTS: Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four.CONCLUSIONS: The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found.
30.	Pålsson, Ylva, Adjunkt, 1971-, et al. (author) First-year nursing students' collaboration using peer learning during clinical practice education : An observational study. 2021 In: Nurse Education in Practice. - : Elsevier Ltd. - 1471-5953 .- 1873-5223. ; 50 Journal article (peer-reviewed)abstract The purpose of this observational study was to describe the collaboration between first-year nursing students using peer learning during their first clinical practice education. In earlier, predominantly interview studies, peer learning has been described as a model with several positive outcomes. However, no studies on how students act in collaboration in a real-life context have been found. The present study observed sixteen arbitrarily paired nursing students (eight pairs) on three to five occasions per pair, in total 164 h from September 2015 to March 2016. Repeated unstructured observations including informal conversations were used. Using qualitative content analysis, one theme 'Involuntary collaboration leads to growth in different competencies' emerged and three categories 'Practising nursing skills and abilities when working together', 'Establishing knowledge by helping each other to understand' and 'Sharing thoughts, feelings, and knowledge and put them into words'. In conclusion, nursing students using peer learning were observed practising several competencies, some of them not so easily elicited according to earlier research as organization, nursing leadership, teaching, and supervision.
31.	Ramdma, Maria, et al. (author) Implementing SBAR in an anaesthetic clinic and subsequent information retention among receivers: a prospective interventional study of postoperative handovers. 2015 In: European journal of anaesthesology. - : Elsevier BV. Journal article (peer-reviewed)
32.	Randmaa, Maria, 1957- (author) Communication and Patient Safety : Transfer of information between healthcare personnel in anaesthetic clinics 2016 Doctoral thesis (other academic/artistic)abstract Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective.The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews.The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV).The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.
33.	Randmaa, Maria, 1957-, et al. (author) Different professionals´descriptions of and reflections on postoperative handover : a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses Other publication (other academic/artistic)
34.	Randmaa, Maria, 1957-, et al. (author) Different professionals´descriptions of and reflections on postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses Other publication (other academic/artistic)
35.	Randmaa, Maria, 1957-, et al. (author) Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics. 2019 In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19:1 Journal article (peer-reviewed)abstract BACKGROUND: The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha.METHODS: A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation.RESULTS: The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82.CONCLUSIONS: The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples.TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).
36.	Randmaa, Maria, 1957-, et al. (author) SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic : a prospective intervention study 2014 In: BMJ Open. - : BMJ. - 2044-6055. ; 4:1 Journal article (peer-reviewed)abstract Objectives: We aimed to examine staff members’ perceptions of communication within and between different professions, safety attitudes and psychological empowerment, prior to and after implementation of the communication tool Situation-Background-Assessment-Recommendation (SBAR) at an anaesthetic clinic. The aim was also to study whether there was any change in the proportion of incident reports caused by communication errors.Design: A prospective intervention study with comparison group using preassessments and postassessments. Questionnaire data were collected from staff in an intervention (n=100) and a comparison group (n=69) at the anaesthetic clinic in two hospitals prior to (2011) and after (2012) implementation of SBAR. The proportion of incident reports due to communication errors was calculated during a 1-year period prior to and after implementation.Setting: Anaesthetic clinics at two hospitals in Sweden.Participants: All licensed practical nurses, registered nurses and physicians working in the operating theatres, intensive care units and post anaesthesia care units at anaesthetic clinics in two hospitals were invited to participate.Intervention: Implementation of SBAR in an anaesthetic clinic.Primary and secondary outcomes: The primary outcomes were staff members’ perception of communication within and between different professions, as well as their perceptions of safety attitudes. Secondary outcomes were psychological empowerment and incident reports due to error of communication.Results: In the intervention group, there were statistically significant improvements in the factors “Between-group communication accuracy” (p=0.039) and “Safety climate” (p=0.011). The proportion of incident reports due to communication errors decreased significantly (p<0.0001) in the intervention group, from 31% to 11%.Conclusions: Implementing the communication tool SBAR in anaesthetic clinics was associated with improvement in staff members’ perception of communication between professionals and their perception of the safety climate as well as with a decreased proportion of incident reports related to communication errors.
37.	Randmaa, Maria, 1957-, et al. (author) The postoperative handover : a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses 2017 In: BMJ Open. - : BMJ. - 2044-6055. ; 7:8 Journal article (peer-reviewed)abstract OBJECTIVES To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.DESIGN A focus group interview study with a descriptive design using qualitative content analysis of transcripts.SETTING One anaesthetic clinic at two hospitals in Sweden.PARTICIPANTS Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).RESULTS Patterns and five categories emerged: 1) Having different temporal foci during handover, 2) Insecurity when information is transferred from one team to another, 3) Striving to ensure quality of the handover, 4) Weighing the advantages and disadvantages of the bedside handover, and 5) Having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information, and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient, but also that it could threaten the patient’s privacy and that frequent interruptions could be disturbing.CONCLUSIONS The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimize the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision-makers need to pay attention to the environment and infrastructure in postanaesthesia care.
38.	Swenne, Christine Leo, 1958-, et al. (author) Compliance to intraoperative basic hygiene in the operating theatre and patient safety culture in Mozambique 2016 In: Journal of Prevention and Infection Control.. ; 2:1, s. 1-13 Journal article (peer-reviewed)abstract Background: Surgical site infections are commonly occurring within healthcare, especially in Africa. Good hygiene is the most effective way in which to reduce and prevent infection. However, compliance is often low or insufficient.Objective: To assess intraoperative compliance to basic hygiene in the operating theatre and the staffs’ views on patient safety and to assess whether adherence to hand hygiene is related to patient safety culture in a developing country. Methods: The design was a structured observation in order to gathered information on compliance to basic intraoperative hygiene routines in operating theatres in Mozambique. Theatre staff was also asked to complete a survey on patient safety culture.Results: The study reveals that none of the work elements were performed in complete compliance to WHO’s guidelines at all times. The theatre staff’s views on patient safety culture showed the highest percentage of positive responses was within “Teamwork Within Hospital Units” and the dimensions with the least positive response was “Nonpunitive Response To Error” and “Staffing”. A medium relation was found between compliance to basic hygiene and the results of the patient safety culture survey.Conclusion: This study shows that compliance to basic hygiene during the intraoperative phase in theatre was insufficient. There was a medium relation between the views of the staff on patient safety and their compliance to basic hand hygiene. This implies that working with the attitudes of the staff concerning patient safety could be one way of improving hygiene compliance which would be expected to reduce the number of surgical site infections.
39.	Swenne, Christine Leo, et al. (author) Patients' experiences of mediastinitis after coronary artery bypass graft procedure 2007 In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 41:4, s. 255-264 Journal article (peer-reviewed)abstract Few studies have focussed on patients' experiences of and suffering due to mediastinitis following Coronary Artery by-pass Graft (CABG). Mediastinitis creates a complex and invasive experience for the patient with prolonged hospitalisation, and would be expected to be a significant stressor. The aim of the present study was to capture patients' experiences of the medical and nursing care they received for mediastinitis following CABG. Content analysis revealed three themes with regard to how the patients coped with the stress and threats of mediastinitis and its treatment and how they thought it would influence their future life. A first theme centred on physical and psychological discomfort and impact on autonomy. The staff's medical knowledge and the quality of nursing care as well as the patients' understanding of the situation influenced their experience. A second theme was how patients dealt with perceived danger and stress. Coping strategies such as problem solving, information seeking, dissociation, distraction, minimisation and expression of emotion were used to handle the situations. The third theme comprised the patients' belief that the mediastinitis would not affect the outcome of the CABG procedure, even though their confidence in this was influenced by uncertainty about the rehabilitation process.
40.	Swenne, Christine Leo, 1958-, et al. (author) Patients' experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy : a qualitative follow-up study 2017 In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:4, s. 904-913 Journal article (peer-reviewed)abstract BACKGROUND: Patients with peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have a long recovery process.AIM: To describe patients' experiences of their everyday lives after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.METHOD: A follow-up study with a qualitative, descriptive design. Data were collected by individual, in-depth telephone interviews with 16 patients who had been treated for peritoneal carcinomatosis 14 months earlier at a university hospital in Sweden. The interviews were performed between May and June 2013 and analysed using systematic text condensation.RESULTS: Five themes were identified: (i) finding one's new self and relating to the new situation; (ii) the disease making its presence felt through bodily complications or mental fatigue; (iii) worrying about the return of the disease and passing it on to one's children; (iv) experiencing difficulties contacting various care facilities, not having a clear plan for ongoing rehabilitation; and (v) the need for online support through the Internet and counselling for both patients and their family members.CONCLUSIONS: Despite bodily complications, mental fatigue and worries about the return of the disease, the patient's everyday life was focused on finding his/her new self and adapting to the new circumstances. Difficulties in contacting care facilities and the lack of an ongoing medical and nursing rehabilitation plan called for a need for network support for patients and their families.CLINICAL RELEVANCE: After advanced surgery, patients require a continuous medical and nursing rehabilitation plan, and a platform of support such as meetings via social media and Internet which would connect former patients and their families with future patients and their family members. A contact nurse with specific expertise should design an individual rehabilitation plan and continuously identify the individual needs for long-term support.
41.	Swenne, Christine Leo, et al. (author) Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft 2005 In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 61:3, s. 201-212 Journal article (peer-reviewed)abstract Elevated blood glucose following coronary artery bypass graft (CABG) is associated with an increased risk of surgical wound infection (SWI). It is unclear whether hyperglycaemia, the diabetic state, the longstanding vascular effects of diabetes, or the systematic inflammatory response confers the increased vulnerability to SWI. This study was designed to examine the significance of postoperative blood glucose control as a risk factor for SWI after vein graft harvesting on the leg and sternotomy. Patients with and without diabetes had a CABG within 60 days to be eligible. The present study was part of a larger protocol investigating SWI following CABG in a total of 374 patients. Potential risk factors, duration of diabetes, pre-operative glycated haemoglobin (HbA1c) and presence of long-term complications were recorded. All patient records were reviewed retrospectively to record 10% glucose infusions during the operation, and blood glucose concentrations and insulin therapy on postoperative days 0, 1 and 2. Patients were contacted by telephone 30 and 60 days after surgery and interviewed in accordance with a questionnaire about symptoms and signs of wound infection. In the present study, it was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia. However, in the subgroup of patients without a pre-operative diagnosis of diabetes, increased blood glucose concentrations during postoperative days 0, 1 and 2 was associated with an increased risk of mediastinitis.
42.	Swenne, Christine: Leo (author) Postoperativasårinfektioner. I: Kirurgiska Sjukdomar : Postoperativasårinfektioner. I: Kirurgiska Sjukdomar 2004 Book (other academic/artistic)
43.	Swenne, Christine Leo, et al. (author) Postoperative health and patients' experiences of efficiency and quality of care after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, two to six months after surgery 2015 In: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 19:2, s. 191-197 Journal article (peer-reviewed)abstract Purpose: To study post-discharge health after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and to. analyse patients' experiences of in-hospital efficiency and quality of care. Methods: In-depth individual telephone interviews using an interview guide with open-ended questions were performed with 19 patients with peritoneal carcinomatosis between April and October, 2012. Data were analysed with systematic text condensation. Results: Four themes were identified: 1) Coming home was an essential step in the recovery process and the focus was on getting well physically despite mental stress, uncertainty about the medical rehabilitation plan and the future. 2) Health was affected negatively by postoperative chemotherapy and its side effects. 3) Stoma - a necessary evil affecting the patient's social life. 4) Quality of care and efficiency were defined in patient-centred terms and inter-personal care from the patient's perspectives on Micro level. Despite all, 32% of the patients described being fully recovered and had started to study or work two months after surgery. Conclusions: The study gives insights into some real-life experiences described by patients. The study results can be used to prepare written information, to design a postoperative rehabilitation plan for future patients with Peritoneal Carcinomatosis (PC) and to create a home-page through which patients can receive support from both health care professionals and other fellow patients.
44.	Swenne, Christine Leo, et al. (author) Prediction of and risk factors for surgical wound infection in the Saphenous vein harvesting leg in patients undergoing coronary artery bypass 2006 In: The thoracic and cardiovascular surgeon. - : Georg Thieme Verlag KG. - 0171-6425 .- 1439-1902. ; 54:5, s. 300-306 Journal article (peer-reviewed)abstract Background: Surgical wound infection (SWI) of the leg after saphenous vein harvesting is an important complication of coronary artery bypass graft (CABG) procedures. SWIs may restrict mobility in the postoperative period and increase costs of postoperative hospitalisation and antibiotic treatment. Methods: A total of 356 patients were followed. Surgical risk factors were evaluated for SWI following saphenous vein harvesting, and the effectiveness of an occlusive glycerinated hydrogel dressing in reducing postoperative SWIs was assessed. In addition, the ability of postoperative clinical wound assessment to predict SWI following CABG 30 and 60 days after operation was investigated. Results: The most important risk factor for SWI after saphenous vein harvesting was the use of a monofilament suture for skin closure (glycomer 4-0 Biosyn® Tyco Healthcare, Stockholm, Sweden) (p > 0.001). The hydrogel dressing did not prevent the development of SWIs. The clinical wound assessment showed that wound gap was associated with leg infection, but other signs were poor predictors of SWI. Conclusion: The choice of suture and suturing technique is important to prevent SWI following saphenous vein harvesting. More precise definitions of wound signs are necessary if they are to be used as predictors of SWI.
45.	Swenne, Christine Leo, et al. (author) Surgical-site infections within 60 days of coronary artery by-pass graft surgery 2004 In: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 57:1, s. 14-24 Journal article (peer-reviewed)abstract Surgical wound infections (SWIs) after coronary artery by-pass graft (CABG) within 30 and 60 days of operation were registered. Already known risk factors and possible risk factors for wound infection were studied. SWIs of sternal and/or leg wounds have been reported to occur in 2–20% of patients after CABG. Deep sternal infection, mediastinitis, occurs after 0.5–5% of CABG procedures. The duration and methods of follow-up, as well as definitions of SWI, vary in different studies. Previously known and possible new risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed in accordance with a questionnaire about symptoms and signs of wound infections. Our definition of SWI was based on the Centers for Disease Control and Prevention (CDC) definition. SWIs were diagnosed in 114 of 374 (30.5%) of the patients. In total SWI were diagnosed in 120 surgical-site incisions. Almost all SWIs of the sternum (93.3%) were diagnosed within 30 days of surgery. Most of the SWIs of the leg (73%) were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days of surgery. Being female was the most important risk factor for SWI of the leg. Low preoperative haemoglobin concentrations were the most important risk factor for superficial SWI on the sternum. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day two or later than those without infections.
46.	Swenne, Christine, Leo, 1958-, et al. (author) The ward round : patient experiences and barriers to participation 2014 In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 28:2, s. 297-304 Journal article (peer-reviewed)abstract BACKGROUND:Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication.AIM AND OBJECTIVE:The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care.METHODOLOGICAL DESIGN AND JUSTIFICATION:The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis.ETHICAL ISSUES AND APPROVAL:The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University.RESULTS:The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process.CONCLUSIONS:Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved.
47.	Swenne, Christine Leo, 1958- (author) Wound Infection Following Coronary Artery Bypass Graft Surgery : Risk Factors and the Experiences of Patients 2006 Doctoral thesis (other academic/artistic)abstract The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.
48.	von Vogelsang, Ann-Christin, et al. (author) Operating theatre nurse specialist competence to ensure patient safety in the operating theatre : A discursive paper 2020 In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 7:2, s. 495-502 Journal article (peer-reviewed)abstract Aim: To discuss specialist operating theatre nurses' competence in relation to the general six core competencies and patient safety.Design: A discursive analysis of legal statutes and scientific articles.Methods: Swedish legal statutes and an overview of scientific articles on operating theatre nursing were deductively analysed and classified into healthcare providers' general six core competencies.Results: All healthcare professionals should possess the general core competencies, regardless of their discipline. The specific content within these competencies differs between disciplines. The specialized operating theatre nurse is the only healthcare professional having the competence to be responsible for asepsis, instrumentation, infection and complication, control and management of biological specimens during the surgical procedure. Besides operating theatre nurses, no other healthcare profession has the formal education, competence or skills to perform operating theatre nursing care in the theatre during the surgical procedure. Operating theatre nurse competence is therefore indispensable to ensure patient safety during surgery.
49.	von Vogelsang, Ann-Christin, et al. (author) Operation 2016 In: Omvårdnad & kirurgi. - Lund : Studentlitteratur AB. - 9789144088860 ; , s. 189-202 Book chapter (other academic/artistic)
50.	Åkerfeldt, Torbjörn, et al. (author) Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels 2014 In: European Journal of Medical Research. - : Springer Science and Business Media LLC. - 0949-2321 .- 2047-783X. ; 19, s. 61- Journal article (peer-reviewed)abstract Background: Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels.Methods: Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA.Results: Serum endostatin was significantly reduced 30 days after surgery in comparison with presurgical values in both the orthopedic (P =0.03) and cardiopulmonary surgery (P =0.04) group.Conclusion: Serum endostatin is reduced 30 days after surgery. This reduction would favor angiogenesis and wound-healing.

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