| 1. |
- Boström, Eva, et al.
(author)
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Registered nurses' experiences of communication with patients when practising person-centred care over the phone: a qualitative interview study
- 2020
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In: Bmc Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 19:1
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Journal article (peer-reviewed)abstract
- Background To explore registered nurses' (RNs') experiences of practising person-centred care (PCC) by telephone with people diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure. Methods Qualitative interview study. Four RNs were individually interviewed before, during, and after participating in an intervention practising PCC by telephone. The interviews were analysed using qualitative content analysis. Results The results reflect three categories of their experience: realize the complexity of practising PCC by distance, gain insight into what PCC communication meant to RNs and their approach, and develop the professional role by practising PCC theory and ethics. Conclusions PCC over the telephone facilitate healthcare and support patients. Through careful listening, the RNs (1) created space for the individual patients to express their thoughts and feelings and (2) emphasized each patient's capabilities and resources. The RNs also gained an understanding of PCC and what it means to patients and to themselves as practitioners. Potential implications are that it is important for RNs practising PCC by telephone to remould their role, to listen carefully, and to communicate as equals in conversations that respect both parties' knowledge and expertise. Health professionals need supervision and support to fully understand the person-centred approach and provide communications that support it.
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| 2. |
- Boström, Martina, et al.
(author)
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Senior alert : a tool for better care collaboration
- 2022
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Conference paper (peer-reviewed)abstract
- The increasing prevalence of negative events among older frail adults is a challenge for society which calls for pro-active and preventive actions. Senior Alert (SA) is a quality-registry focusing pro-actively on 5 risk areas common among older adults: malnutrition, pressure ulcers, falls, oral health and bladder dysfunction among people = 65 years. It is mandatory to assess risks in all risk areas. SA plays an unique roll among the more than 100 national quality registries in Sweden used for quality improvements, in aspect that it also stimulate staff to perform screening, action taking, and follow-up. However, the overall potential of the register to improve the care of older adults has so far not been recognized. Although the risks are registered to a high degree, the underlying causes are not identified to the same extent. If the need for intervention is not identified, the possibilities for an effective preventive care process and effective collaboration between different actors are missed. We want to study the factors that constitute support or obstacles to the preventive care process to contribute to an effective and robust preventive care process that promotes effective collaboration between different actors for best practice care of older frail adults. The project has an interdisciplinary approach and is based on a mixed method design meaning using both quantitative and qualitative methods
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| 3. |
- Boström, Martina, et al.
(author)
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Senior alert – ett medel för bättre vård i samverkan (SeSam) : Hälsoriksdagen
- 2022
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Conference paper (peer-reviewed)abstract
- Vården och omsorgen av sköra äldre behöver stärkas. Senior alert är ett nationellt kommunalt kvalitetsregister som med evidensbaserade bedömningsinstrument värderar risker bland äldre inom riskområdena fall, trycksår, nutrition, munhälsa och blåsdysfunktion. Cirka 90 000 riskbedömningar görs per år. Registret är unikt då det har ett vårdpreventivt fokus och omfattar såväl riskbedömning som bakomliggande orsaker och åtgärder. Vi har tilldelats närmare 6 miljoner från Forte för att beforska stöd och hinder för den vårdpreventiva processen inom Senior alerts. Syfte: att studera samverkan inom och mellan huvudmän för äldreomsorg, hälso- och sjukvård och tandvård med avseende på vård prevention (VP) i Senior alert, och att identifiera faktorer som utgör stöd respektive hinder inom och mellan huvudmän för att fullfölja VP. Metod: Projektet består av 3 delstudier och bygger på en mixad metod. Delstudie 1 är en kvantitativ studie inom vård och omsorgsboende för att studera om det finns det skillnader mellan kommuner med god respektive bristande registrering i Senior alert med avseende på faktorer som invånarantal, socio-demografi, -ekonomi, organisation av äldreomsorgen, och politisk majoritet? Delstudie 2 är kvalitativ och ska studera uppfattningar om hinder och stöd för en god samverkan inom och mellan huvudmän för VP inom Senior altert. Detta görs genom enskilda intervjuer med personer i ledande ställning samt fokusgruppsintervjuer med tvärprofessionella arbetsgrupper, samt med äldre och deras närstående gällande deras syn på hur Senior alter bidrar till god vård. Delstudie 3 är en pilotstudie för att testa implementering av resultatet från den båda tidigare studierna. Tidsram 2022 - 2025 Elisabet Rothenberg, biträdande professor, fakulteten för hälsovetenskap, Högskolan Kristianstad
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| 4. |
- Dymen, P., et al.
(author)
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Revision Spinal Surgery at a University Hospital : Incidence, Causes, and Microbiological Agents in Infected Patients
- 2022
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In: International Journal of Spine Surgery. - : International Journal of Spine Surgery. - 2211-4599. ; 16:5, s. 928-934
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Journal article (peer-reviewed)abstract
- Background: The number of spinal surgeries performed worldwide have significantly increased over the past decade. However, to the best of our knowledge, there are no national or international studies that report the overall picture of complications following spinal surgery. This article sought to identify the incidence and causes of reoperations in patients undergoing spinal surgery, as well as the average time from index surgery to reoperation. Furthermore, the purpose was to identify the microbiological agents present in cultures from infected patients.Methods: This was a retrospective cohort study that used a university hospital's medical records as the data source. The study population comprised 2110 patients who underwent spinal surgery during a 40 -month period between 2015 and 2018. All suspected reoperations were verified manually. Additional data collected for reoperations included cause, time from index surgery, and laboratory results from cultures. Descriptive analysis was used.Results: The incidence of reoperations during the study period was 11% (n = 232). The most common cause of reoperation was infection (28%, n = 65), followed by implant-related causes (19%, n = 44) and hemorrhage/hematoma (15%, n = 34). The time between index surgery and reoperation varied, but half of all reoperations occurred within 30 days. Coagulase-negative staphylococci were the most common type of bacteria (positive cultures in 39% of infected patients).Conclusion: The number of reoperations in the studied hospital were high during the study period. Infections accounted for a large percentage of reoperations, suggesting that effective preventive measures might significantly reduce the total number of reoperations.Clinical Relevance: Postoperative infection causing reoperations after spinal surgeries is a large problem, and finding effective preventive measures should be a priority for caregivers.Level of Evidence: 3.
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| 5. |
- Egerod, I., et al.
(author)
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Patient and family experience 2 years after necrotizing soft-tissue infection: A longitudinal qualitative investigation
- 2023
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 79:8, s. 2924-2935
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Journal article (peer-reviewed)abstract
- AimsThe study aims were to provide a comprehensive description of the short- and long-term experience of necrotizing soft-tissue infections from the patient and family perspective. Further, to describe how unmet needs related to diagnosis, treatment and rehabilitation are experienced. And finally, to present patient and family recommendations for improvements. DesignThe study had a longitudinal qualitative multi-centre two-country design. MethodsQualitative content analysis was applied to 87 semi-structured interviews involving 50 participants from Denmark and Sweden. In most interviews, patient and family were interviewed separately. Data were collected in 2015-2018. This is the fifth and final paper reporting the study. FindingsAfter initial inductive coding, we constructed a matrix of four timepoints (pre-admission, acute admission, after 6 months and after 2 years) describing physical, psychological and social responses and recommendations for improvement. We analysed deductively according to timepoints and predefined categories describing patient and family responses to life with necrotizing soft-tissue infections. The study suggested that physical recovery was obtained before psychological recovery. The aftermath of job loss and lacking social services amplified the burden. Patients still recovering experienced lack of understanding from family, friends and professionals that failed to recognize the complexity of their suffering. ConclusionsHalf of the patients in our study reported making a full recovery while the remaining described issues still unresolved 2 years after intensive care unit discharge. Predisposing factors and symptoms align with other studies of critical illness. During the acute stage, patients receive state-of-the art treatment and care, but as time passes, rehabilitation becomes less available and less patient-centred. ImpactThe study will increase nurses' understanding of patient and family suffering and complexity of long-term survival of necrotizing soft-tissue infections. Patient or Public ContributionFrom the planning stage of the study, we collaborated with a necrotizing soft-tissue infection survivor.
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| 6. |
- Ejerhed, Lars, 1951, et al.
(author)
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Antimicrobial coating is associated with significantly lower aerobic colony counts in high-touch areas in an orthopedic ward environment
- 2020
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In: Annals of Clinical Microbiology and Antimicrobials. - : Springer Science and Business Media LLC. - 1476-0711. ; 19:1
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Journal article (peer-reviewed)abstract
- Background Hospital acquired infections (HAI) are the most common complication found in the hospital environment. The aim of the study was to examine whether the use of an antimicrobial coating in high-touch areas in an orthopedic ward could reduce bacterial growth and HAI. Methods From December 2017 to February 2018, HAI were registered on two orthopedic wards. A second registration was performed from December 2018 to February 2019. On the second occasion, an antimicrobial organosilane coating was applied just before the study period and thereafter weekly on one ward, while the other ward served as a control. Twenty defined high-touch areas on each ward were cultured before treatment and after 1, 2, 4, 8, 12, 14 and 16 weeks. Samples were cultured for aerobic colony counts, Staphylococcus aureus and E. coli. Results The total aerobic colony counts were 47% lower on the treated ward compared with the non-treated ward over the study period (p = 0.02). The colony counts for Staphylococcus aureus and E. coli were low on both wards. During the first registration period, the incidence of HAI was 22.7% and 20.0% on the non-treated and subsequently treated ward respectively. On the second occasion, after treatment, the incidence was 25.0% and 12.5% (treated ward) respectively (p = 0.0001). Conclusions The use of a long-lasting antimicrobial organosilane coating appears to reduce the bioburden and reduce HAI. Since the incidence of HAI varies substantially over time, longer observation times are needed.
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| 7. |
- Erestam, Sofia, et al.
(author)
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Associations between intraoperative factors and surgeons' self-assessed operative satisfaction.
- 2020
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In: Surgical endoscopy. - : Springer Science and Business Media LLC. - 1432-2218 .- 0930-2794. ; 34:1, s. 61-68
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Journal article (peer-reviewed)abstract
- Little is known concerning what may influence surgeon satisfaction with a surgical procedure and its associations with intraoperative factors. The objective was to explore the relationships between surgeons' self-assessed satisfaction with performed radical prostatectomies and intraoperative factors such as technical difficulties and intraoperative complications as reported by the surgeon subsequent to the operation.We utilized prospectively collected data from the controlled LAPPRO trial where 4003 patients with prostate cancer underwent open (ORP) or robot-assisted laparoscopic (RALP) radical prostatectomy. Patients were included from fourteen centers in Sweden during 2008-2011. Surgeon satisfaction was assessed by questionnaires at the end of each operation. Intraoperative factors included time for the surgical procedure as well as difficulties and complications in various steps of the operation. To model surgeon satisfaction, a mixed effect logistic regression was used. Results were presented as odds ratios (OR) with 95% confidence intervals (CI).The surgeons were satisfied in 2905 (81%) and dissatisfied in 702 (19%) of the surgical procedures. Surgeon satisfaction was not statistically associated with type of surgical technique (ORP vs. RALP) (OR 1.36, CI 0.76; 2.43). Intraoperative factors such as technical difficulties or complications, for example, suturing of the anastomosis was negatively associated with surgeon satisfaction (OR 0.24, CI 0.19; 0.30).Our data indicate that technical difficulties and/or intraoperative complications were associated with a surgeon's level of satisfaction with an operation.
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| 8. |
- Erestam, Sofia, et al.
(author)
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The perceived benefit of intraoperative stress modifiers for surgeons: an experimental simulation study in volunteers
- 2021
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In: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 15:1
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Journal article (peer-reviewed)abstract
- Background: During surgery, surgeons often work under stressful conditions, which could affect patient safety. Reducing intraoperative stress for surgeons could benefit surgeons and subsequently patients. It is difficult to study stress and stress relief in real life situations due to the multitude of confounding factors. The aim of this study was to evaluate simulated intraoperative stressors on surgeons' stress levels and the effect of an intervention (pause including a sugar-containing drink) during standardized experiments (simulated operations). Methods: An experimental interventional study was conducted using a simulator. The healthy surgeon volunteers were randomized to intervention and control in a cross-over design. Primary endpoint was salivary cortisol difference between a pause including a sugar containing drink (intervention) and controls. Secondary endpoints were change in heart rate, change in self-perceived stress measured by the State Trait Anxiety Inventory (STAI), and experience of the intraoperative pause. Endpoints were calculated with a mixed effect analysis of covariance (ANCOVA) model. Results: Seventeen surgeons performed 32 experiments. There was no statistically significant difference in salivary cortisol between simulations with and without a pause including a sugar-containing drink; percent reduction, 8% (0.92 (95%CI:0.72;1.18)), p-value = 0.469. The surgeons' self-estimation of intervention was positive, but there was no statistically significant difference in heart rate or STAI. Conclusions: The surgeons' experience of a pause including a drink was positive but there were no differences in physiological outcomes of the intervention. Lessons learned from this study could contribute to optimizing design of future studies.
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| 9. |
- Erichsen Andersson, Annette, 1966, et al.
(author)
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Reduction of early surgical site and other care related infections in 3553 hip fracture patients : lessons learned from the 5-year Safe Hands project
- 2022
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In: Antimicrobial Resistance and Infection Control. - : Springer Science and Business Media LLC. - 2047-2994. ; 11:1
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Journal article (peer-reviewed)abstract
- Background: Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project. Methods: This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results: The incidence of early SSIs decreased from 2.5% in years 1–2 to 1.1% in years 4–5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly. Conclusions: Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements. Trial registration: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016—Retrospectively registered.
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| 10. |
- Fagerdahl, A. M., et al.
(author)
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Patient experience of necrotising soft-tissue infection from diagnosis to six months after intensive care unit stay: A qualitative content analysis
- 2020
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In: Australian Critical Care. - : Elsevier BV. - 1036-7314. ; 33:2, s. 187-192
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Journal article (peer-reviewed)abstract
- Introduction: Necrotizing soft tissue infection (NSTI) is a severe, life-threatening condition requiring immediate diagnosis and treatment to avoid widespread tissue destruction and death. Current research seeks to explain the complex interaction between patient and disease agent, whereas only few studies have addressed the patient perspective. Objective: The present study aimed to describe the patient experience of NSTI in the first six months after diagnosis. Methods: The study had a qualitative design with patient involvement. We interviewed 27 NSTI survivors at six months after diagnosis and applied content analysis to capture their experiences. Patients were recruited from two referral centers in Sweden and one in Denmark. Findings: We identified three categories representing chronological stages of the illness trajectory depicting pivotal patient experiences: regaining awareness in the intensive care unit, transitioning to the ward, and returning home to normal life. Fear of infection or reinfection permeated all stages of the trajectory. Each stage was characterized by ambivalence: at first the relief of being alive and distress of serious illness, then the relief of independence and distress of abandonment, and finally the relief of being home and distress of still being dependent on others. Conclusion: Fear of infection and reinfection during and after hospitalization characterized lives of NSTI survivors and their family. This fear was potentially debilitating in daily life, working life and social life. Healthcare professionals need to be aware of these modifiable factors to help alleviate the concerns of patient and family throughout the illness trajectory. (C) 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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